Targeted Electromyographic Biofeedback With Endoanal Electrostimulation for Anal Incontinence.

Purpose. Anal incontinence (AI) is a disabling condition with a variable response to conservative physical therapies. We assess the utility of combining electromyographic biofeedback with endoanal electrostimulation targeted to the weakest areas of the pelvic floor using the MAPLe® probe (Multiple Array Probe Leiden Novuqare). Methods. Patients with AI unresponsive to conservative measures were assessed before and after treatment with anorectal manometry (ARM), electromyography (EMG), Wexner Continence Scoring, Visual Analog Scoring (VAS), FIQL and SF-12 quality of life determination. Results. Of 29 patients in the final analysis, there was an improvement in the mean Wexner continence score from 13.59 to 8.03 and a concomitant improvement in the reported VAS from 3.45 to 6.72. Both Wexner continence and VAS scores were maintained during follow-up. Maximum voluntary manometric contraction significantly improved from 91.76 mmHg to 110.33 mmHg with no changes in resting pressure. The EMG values ​​(µV) that significantly improved included the average and peak resistance, the average general voluntary contraction, and the average and peak voluntary contraction for both the external anal sphincter and the puborectalis. In the FIQL, behavior, depression and shame domains improved after treatment and during follow-up with lifestyle improvements detected at 6 and 12 months. Physical and mental components of the SF-12 improved at 6 and 12 months. Conclusions. Targeted electromyographic biofeedback and endoanal electrostimulation using MAPLe® probe in AI patients sustainably improves objective ARM and EMG parameters along with subjective reporting of continence severity, VAS, and quality of life.

Resultados a corto plazo de los pacientes con tiempo de estancia prolongada en un servicio de Medicina Interna / Short-term outcomes of patients with a long stay in an internal medicine service

Objetivo Describir las características y los factores pronósticos a corto plazo de los pacientes con estancia prolongada en Medicina Interna. Material y métodos Estudio retrospectivo de una serie de casos que incluyó pacientes ingresados en un servicio de Medicina Interna de un hospital universitario con tiempos de estancia mayor de 30 días durante cinco años. La información se obtuvo del Conjunto Mínimo Básico de Datos. Las variables de resultado fueron tiempo de estancia muy prolongada, mortalidad intrahospitalaria y resultados adversos en los primeros 30 días tras el alta. Resultados De un total de 11.948 pacientes, 335 (2,8%) tuvieron una estancia prolongada. El tiempo total de estancia fue de 15.271 días (15% del total de tiempo de estancia del servicio). La edad media fue de 74,5 (±13,9) años, siendo 180 (53,7%) varones. La mediana de tiempo de estancia fue de 39 (RIC 34-49) días. El ingreso en la Unidad de Cuidados Intensivos (UCI) (OR = 2,5; IC 95% 1,4-4,7; p = 0,003) y recibir una valoración geriátrica (OR = 0,3; IC 95% 0,8-0,9; p = 0,042) fueron factores independientes con efecto en el tiempo de estancia muy prolongado. Un ingreso hospitalario en año previo fue un factor independiente de un resultado adverso a los 30 días tras el alta (OR = 2,2; IC 95% 1,0-4,8). Conclusiones El porcentaje de pacientes con estancias prolongadas es menor de un 3%, pero tienen un alto impacto en la actividad de un servicio de Medicina Interna. Existen factores asociados con el tiempo de estancia muy prolongada y con la presencia de un resultado adverso precoz tras el alta (AU)

Objective To describe the characteristics and short-term prognostic factors of patients with prolonged stay in internal medicine. Material and methods Retrospective case series study including patients admitted to an Internal Medicine service of a university hospital with lengths of stay greater than 30 days during 5 years. Information was obtained from the Minimum Basic Data Set. Outcome variables were a very long length of stay, in-hospital mortality, and adverse outcomes in the first 30 days after discharge. Results Out of 11,948 patients, 335 (2.8%) cases had a prolonged stay. The total length of stay was 15,271 days (15% of the total length of stay of the service). The mean age was 74.5 (±13.9) years, 180 (53.7%) were male. The median length of stay was 39 (RIC 34-49) days. Intensive Care Unit admission (OR = 2.5; 95%CI 1.4-4.7; p = 0.003) and receiving a geriatric assessment (OR = 0.3; 95%CI 0.8-0.9; p = 0.042) were independent factors with an effect on very long length of stay. Having an admission in the previous year was an independent factor for an adverse outcome 30 days after discharge (OR = 2.2; 95%CI 1.0-4.8). Conclusions The percentage of patients with prolonged length of stay is less than 3%, but they have a high impact on the activity of an internal medicine service. There are factors associated with a very long length of stay and with the presence of an early adverse outcome after discharge (AU)

Short-term outcomes of patients with a long stay in an internal medicine service.

OBJECTIVE: To describe the characteristics and short-term prognostic factors of patients with prolonged stay in internal medicine. MATERIAL AND METHODS: Retrospective case series study including patients admitted to an Internal Medicine service of a university hospital with lengths of stay greater than 30 days during 5 years. Information was obtained from the Minimum Basic Data Set. Outcome variables were a very long length of stay, in-hospital mortality, and adverse outcomes in the first 30 days after discharge. RESULTS: Out of 11,948 patients, 335 (2.8%) cases had a prolonged stay. The total length of stay was 15,271 days (15% of the total length of stay of the service). The mean age was 74.5 (±13.9) years, 180 (53.7%) were male. The median length of stay was 39 (RIC 34-49) days. Intensive Care Unit admission (OR = 2.5; 95%CI 1.4-4.7; p = 0.003) and receiving a geriatric assessment (OR = 0.3; 95%CI 0.8-0.9; p = 0.042) were independent factors with an effect on very long length of stay. Having an admission in the previous year was an independent factor for an adverse outcome 30 days after discharge (OR = 2.2; 95%CI 1.0-4.8). CONCLUSIONS: The percentage of patients with prolonged length of stay is less than 3%, but they have a high impact on the activity of an internal medicine service. There are factors associated with a very long length of stay and with the presence of an early adverse outcome after discharge.

Análisis del valor predictivo de los criterios de aislamiento preventivo en una unidad de cuidados intensivos / Analysis of the predictive value of preventive isolation criteria in the intensive care unit

Objetivo Evaluar la precisión diagnóstica de los criterios empleados para detectar al paciente realmente portador de microrganismos multirresistentes (MMR). Diseño Estudio prospectivo, observacional de mayo de 2014 a mayo de 2015. Ámbito Unidad de cuidados intensivos polivalente. Pacientes Cohorte de pacientes ingresados de forma consecutiva que cumplían los siguientes criterios de aislamiento preventivo basados en el proyecto «Resistencia Zero»: hospitalización de más de 4 días en los últimos 3 meses («hospital»); antibioterapia durante una semana en el último mes («antibiótico»), pacientes institucionalizados o en contacto con cuidados sanitarios («institución o cuidado»); portador de MMR los últimos 6 meses («MMR previo»). Variables Variables demográficas, resultados de los cultivos obtenidos con presencia o no de MMR y tiempo de aislamiento. Se realizó un análisis multivariable con regresión logística múltiple entre cada uno de los factores de riesgo y el que el paciente fuera portador de MMR. Resultados Durante el periodo de estudio ingresaron 575 pacientes y cumplieron los criterios de aislamiento un 28%. De los 162 pacientes con criterios 51 (31%) eran portadores de MMR y de los que no cumplían criterios 29 (7%) sí que eran portadores. En el análisis multivariable la única variable asociada de forma independiente con el ser portador fue «MMR previo», con una OR 12,14 (IC 95%: 4,24–34,77). Conclusiones El único criterio que se asoció de forma independiente con la capacidad de detectar los pacientes con MMR al ingreso en la UCI fue haber presentado un «MMR previo». (AU)

Objective To assess the diagnostic accuracy of the criteria used to detect patients carrying multiresistant microorganisms (MRMs). Design A prospective observational study was carried out from May 2014 to May 2015. Setting Polyvalent Intensive Care Unit. Patients A cohort of consecutively admitted patients meeting the following criteria for preventive isolation according to the “Zero Resistance” project: hospital length of stay>4 days in the last three months (“hospital”); antibiotherapy during one week in the last month (“antibiotic”); institutionalized patients or recurrent contact with healthcare (“institution or care”); MRM carrier in the last 6 months (“previous MRM”). Variables Demographic data, culture results and isolation time. A multivariate analysis was performed using multiple logistic regression between each of the risk factors and patient MRM carrier status. Results During the study period, 575 patients were admitted, of which 28% met the isolation criteria (162). Fifty-one (31%) were MRM carriers. Of the patients who did not meet the criteria, 29 (7%) were carriers. In the multivariate analysis, the only variable independently associated to carrier status was “previous MRM”, with OR=12.14 (95%CI 4.24-34.77). Conclusions The only criterion independently associated with the ability to detect patients with MRMs upon admission to the ICU was the existence of “previous MRM”. (AU)

[Analysis of the predictive value of preventive isolation criteria in the intensive care unit]. / Análisis del valor predictivo de los criterios de aislamiento preventivo en una unidad de cuidados intensivos.

OBJECTIVE: To assess the diagnostic accuracy of the criteria used to detect patients carrying multiresistant microorganisms (MRMs). DESIGN: A prospective observational study was carried out from May 2014 to May 2015. SETTING: Polyvalent Intensive Care Unit. PATIENTS: A cohort of consecutively admitted patients meeting the following criteria for preventive isolation according to the "Zero Resistance" project: hospital length of stay>4 days in the last three months ("hospital"); antibiotherapy during one week in the last month ("antibiotic"); institutionalized patients or recurrent contact with healthcare ("institution or care"); MRM carrier in the last 6 months ("previous MRM"). VARIABLES: Demographic data, culture results and isolation time. A multivariate analysis was performed using multiple logistic regression between each of the risk factors and patient MRM carrier status. RESULTS: During the study period, 575 patients were admitted, of which 28% met the isolation criteria (162). Fifty-one (31%) were MRM carriers. Of the patients who did not meet the criteria, 29 (7%) were carriers. In the multivariate analysis, the only variable independently associated to carrier status was "previous MRM", with OR=12.14 (95%CI 4.24-34.77). CONCLUSIONS: The only criterion independently associated with the ability to detect patients with MRMs upon admission to the ICU was the existence of "previous MRM".

Health Care Professionals as Relatives in Organ Donation Interviews: Analysis of the Important Role of Health Care Professionals as Family Members.

INTRODUCTION: The organ and tissue donation interview is a vital step in obtaining the donation. Therefore, it is important to obtain as much information as possible regarding the relatives of the potential donor prior to this interview and know if there is a health care professional among the relatives who may act as an interlocutor. OBJECTIVE: The objective of this study is to assess the influence that relatives who are health care professionals may have if present at the interview for the organ and tissue donation request. METHODS: This is a descriptive study of all the organ donations from 1996 to 2019. Variables of the interview record form were completed by the Regional Transplant Coordination Office. Quantitative variables are expressed as mean (standard deviation) or median (interquartile range), and qualitative variables are expressed in percentage. The χ2 test was used for inferential statistics. RESULTS: Health care professionals were present as interlocutors in 8.4% of the total interviews conducted (9279). Organ donation was accepted in 86% of these interviews, while the relative who was a health care professional gave a 93.8% (729) positive response to the donation. Having a health care professional as an interlocutor favors the acceptance of the donation (odds ratio 9.325, 95% confidence interval: 5.054-17.205; P < .001). CONCLUSION: Health care professionals have a very positive attitude toward donation. This attitude positively impacts other relatives' acceptance of the donation.

Analysis of adherence to HIV-positive quality of care indicators and their impact on service quality perceptions in patients: a Spanish cross-sectional study.

BACKGROUND: Since the identification of human immunodeficiency virus (HIV) infection, there have been significant advances in its diagnosis and treatment, but there have been few contributions to the area of care quality. In 2010, the Spanish AIDS Study Group (GeSIDA) published the document "Health quality indicators of GeSIDA for the care of people infected with HIV/AIDS" in which standards are proposed for the purpose of improving and standardizing the assistance provided to people infected with HIV. The purpose of this study was to evaluate the degree of compliance with these indicators and to analyse whether adherence to the standards improves patient perception of care quality in terms of their satisfaction with the health care they have received. METHODS: Compliance with GeSIDA indicators was analysed within a cohort of people living with HIV (PLHIV) in a hospital in the Madrid region. To evaluate patient perception, the External Consultation User Satisfaction Questionnaire (SUCE) was used, which is a tool that was previously validated in the Spanish population. RESULTS: A total of 334 patients were included. The level of adherence to the indicators was 74.46%. The score on the SUCE questionnaire was 9.04 out of 10 (CI 95%: 8.90-9.19). Of the 47 indicators assessed, only 4 were related to satisfaction with health care. CONCLUSIONS: The levels of compliance with the indicators and patient satisfaction with health care were high. Adherence to quality indicators showed little relation to patient-reported satisfaction.

Niveles de capnometría como indicador de evolución de injerto renal de donantes en asistolia no controlada / Capnometry levels as an indicator of renal graft evolution in uncontrolled non-heart beating donors

OBJETIVO: Los valores de capnometría durante la resucitación son un factor predictor de la evolución de los riñones obtenidos a partir de donantes en asistolia no controlada. DISEÑO: Cohorte de comienzo retrospectivo de 37 donantes en asistolia y cohorte de validación de 55 trasplantados de riñón, entre 2013-2017. Ámbito: Población atendida por el servicio de urgencias y derivada al Hospital Universitario 12 de Octubre, Madrid, como potenciales donantes en asistolia no controlada. PACIENTES: Cincuenta y cinco trasplantados renales con hemodiálisis, procedentes de donantes en asistolia no controlada. INTERVENCIONES: Determinaciones de capnometría y capnografía en pacientes candidatos a donación en asistolia no controlada. Variables: Calores de capnometría inicial y en el momento de la transferencia en el hospital para su comparación con la viabilidad de los riñones extraídos; fallo renal y retraso en función renal. RESULTADOS: Treinta y siete potenciales donantes de los que se consiguen 30 utilizados, de los cuales se trasplantan 55 riñones. El resto de ellos fueron descartados por mala perfusión o signos de isquemia. Se encontró una asociación (p = 0,016) entre valores de capnometría durante la resucitación en los donantes utilizados (μ, = 22,8 mmHg) frente a los donantes no utilizados para el trasplante (μ, = 17,35 mmHg). CONCLUSIONES: Se ha demostrado que los valores de capnometría durante las maniobras de resucitación ofrecen un marcador a tener en cuenta en relación con la viabilidad de los órganos a trasplantar en la donación en asistolia no controlada

OBJECTIVE: The capnometry values during resuscitation are an evolutive predictor of kidneys obtained from uncontrolled non-heart beating donors. DESIGN: The study comprised a retrospective onset cohort of 37 non-heart beating donors and a validation cohort of 55 trasplanted kidneys in the period 2013-2017. Scope: The population served by the emergency service and referred to Hospital Universitario Doce de Octubre (Madrid, Spain) as potential uncontrolled non-heart beating donors. PATIENTS: A total of 55 renal transplant patients subjected to hemodialysis and with grafts from uncontrolled non-heart beating donors. INTERVENTIONS: Capnometry and capnography measurements in potential uncontrolled non-heart beating donors. Variables: Capnometry values recorded initially and at transfer in hospital for comparison with the viability of the extracted kidneys; renal failure and delayed renal function. RESULTS: A total of 55 out of 74 extracted kidneys were trasplanted (74.3%). The rest were ruled out due to poor perfusion or signs of ischemia. An association was observed (P = .016) between the capnometry values during resuscitation in the grafted kidneys (μ = 22.8 mmHg) and in the kidneys discarded for transplantation (μ = 17.35 mmHg). CONCLUSIONS: Capnometry during resuscitation serves as a marker to be taken into account in relation to the viability of the trasplanted organs in uncontrolled non-heart beating donors

Capnometry levels as an indicator of renal graft evolution in uncontrolled non-heart beating donors. / Niveles de capnometría como indicador de evolución de injerto renal de donantes en asistolia no controlada.

OBJECTIVE: The capnometry values during resuscitation are an evolutive predictor of kidneys obtained from uncontrolled non-heart beating donors. DESIGN: The study comprised a retrospective onset cohort of 37 non-heart beating donors and a validation cohort of 55 trasplanted kidneys in the period 2013-2017. SCOPE: The population served by the emergency service and referred to Hospital Universitario Doce de Octubre (Madrid, Spain) as potential uncontrolled non-heart beating donors. PATIENTS: A total of 55 renal transplant patients subjected to hemodialysis and with grafts from uncontrolled non-heart beating donors. INTERVENTIONS: Capnometry and capnography measurements in potential uncontrolled non-heart beating donors. VARIABLES: Capnometry values recorded initially and at transfer in hospital for comparison with the viability of the extracted kidneys; renal failure and delayed renal function. RESULTS: A total of 55 out of 74 extracted kidneys were trasplanted (74.3%). The rest were ruled out due to poor perfusion or signs of ischemia. An association was observed (P=.016) between the capnometry values during resuscitation in the grafted kidneys (µ=22.8 mmHg) and in the kidneys discarded for transplantation (µ=17.35 mmHg). CONCLUSIONS: Capnometry during resuscitation serves as a marker to be taken into account in relation to the viability of the trasplanted organs in uncontrolled non-heart beating donors.

[Reliability and concurrent validity of the app Goniometer Pro vs Universal Goniometer in the determination of passive knee flexion]. / Fiabilidad y validez concurrente de la app Goniometer Pro vs goniómetro universal en la determinación de la flexión pasiva de rodilla.

BACKGROUND: Smartphones have become a fundamental part of our society, not only everyday, but also professional, since many applications have emerged for the health field. The objective of the study was to analyze the reliability and concurrent validity of an app for iPhone in relation to traditional measurement. MATERIAL AND METHODS: A non-experimental, double-blind validation and descriptive study. On a sample of 21 subjects, four measurements of knee mobility were performed. Two using universal goniometer (GU) and two through the application Goniometer-Pro (G-Pro) for IPhone. The X-ray was used as a reference measure of the knee flexion angle and was analyzed by a single evaluator who compared this result with that of the other evaluators. RESULTS: The difference between the average intra-group values was 3.148o (± 2.669o) for GU and 2.476o (± 2.638o) for G-Pro. The inter-group mean difference reached 5.45o. The Inter-observer reliability was 0.990 for GU and 0.993 for G-Pro; as for validity, the values obtained were 0.976 for GU and 0.992 for G-Pro. CONCLUSIONS: The G-Pro app is a reliable tool with a high accuracy to measure the knee flexion angle. Its results are slightly superior and more accurate to those of traditional instruments.

ANTECEDENTES: Los teléfonos inteligentes se han convertido en una parte fundamental de nuestra sociedad, no sólo cotidiana, sino también profesional, pues han surgido numerosas aplicaciones para el ámbito sanitario. El objetivo del estudio fue analizar la fiabilidad y validez concurrente de una app para iPhone en relación con la goniometría tradicional. MATERIAL Y MÉTODOS: Estudio comparativo y descriptivo de validación no experimental a doble ciego. En una muestra de 21 sujetos se realizaron cuatro mediciones de movilidad de rodilla: dos mediante goniometría universal (GU) y dos mediante la aplicación Goniometer-Pro (G-Pro) para iPhone. La radiografía se empleó como medida de referencia del ángulo de flexión de rodilla y fue analizada por un único evaluador que comparó este resultado con el de los otros evaluadores. RESULTADOS: La diferencia entre los valores medios intragrupos fue de 3.148o (± 2.669o) para GU y 2.476o (± 2.638o) para G-Pro. La diferencia de medias intergrupos alcanzó 5.45o. La fiabilidad interobservador fue de 0.990 para GU y 0.993 para G-Pro; en cuanto a la validez, los valores obtenidos fueron 0.976 para GU y 0.992 para G-Pro. CONCLUSIONES: La app G-Pro es una herramienta fiable y con una elevada exactitud para medir el ángulo de flexión de la rodilla. Sus resultados son ligeramente superiores y más precisos a los de la goniometría tradicional.

Fiabilidad y validez concurrente de la app Goniometer Pro vs goniómetro universal en la determinación de la flexión pasiva de rodilla / Reliability and concurrent validity of the app Goniometer Pro vs Universal Goniometer in the determination of passive knee flexion

Resumen: Antecedentes: Los teléfonos inteligentes se han convertido en una parte fundamental de nuestra sociedad, no sólo cotidiana, sino también profesional, pues han surgido numerosas aplicaciones para el ámbito sanitario. El objetivo del estudio fue analizar la fiabilidad y validez concurrente de una app para iPhone en relación con la goniometría tradicional. Material y métodos: Estudio comparativo y descriptivo de validación no experimental a doble ciego. En una muestra de 21 sujetos se realizaron cuatro mediciones de movilidad de rodilla: dos mediante goniometría universal (GU) y dos mediante la aplicación Goniometer-Pro (G-Pro) para iPhone. La radiografía se empleó como medida de referencia del ángulo de flexión de rodilla y fue analizada por un único evaluador que comparó este resultado con el de los otros evaluadores. Resultados: La diferencia entre los valores medios intragrupos fue de 3.148o (± 2.669o) para GU y 2.476o (± 2.638o) para G-Pro. La diferencia de medias intergrupos alcanzó 5.45o. La fiabilidad interobservador fue de 0.990 para GU y 0.993 para G-Pro; en cuanto a la validez, los valores obtenidos fueron 0.976 para GU y 0.992 para G-Pro. Conclusiones: La app G-Pro es una herramienta fiable y con una elevada exactitud para medir el ángulo de flexión de la rodilla. Sus resultados son ligeramente superiores y más precisos a los de la goniometría tradicional.

Abstract: Background: Smartphones have become a fundamental part of our society, not only everyday, but also professional, since many applications have emerged for the health field. The objective of the study was to analyze the reliability and concurrent validity of an app for iPhone in relation to traditional measurement. Material and methods: A non-experimental, double-blind validation and descriptive study. On a sample of 21 subjects, four measurements of knee mobility were performed. Two using universal goniometer (GU) and two through the application Goniometer-Pro (G-Pro) for IPhone. The X-ray was used as a reference measure of the knee flexion angle and was analyzed by a single evaluator who compared this result with that of the other evaluators. Results: The difference between the average intra-group values was 3.148o (± 2.669o) for GU and 2.476o (± 2.638o) for G-Pro. The inter-group mean difference reached 5.45o. The Inter-observer reliability was 0.990 for GU and 0.993 for G-Pro; as for validity, the values obtained were 0.976 for GU and 0.992 for G-Pro. Conclusions: The G-Pro app is a reliable tool with a high accuracy to measure the knee flexion angle. Its results are slightly superior and more accurate to those of traditional instruments.

Resultados del tratamiento quirúrgico de las luxaciones acromioclaviculares tipo iii mediante técnica de Weaver-Dunn modificada / Results of surgical treatment of acromioclavicular dislocations type III using modified Weaver Dunn technique

Objetivo. Valorar los resultados clínicos y radiológicos del tratamiento quirúrgico de las luxaciones acromioclaviculares tipo iii mediante la técnica de Weaver-Dunn en fase diferida. Material y método. Estudio observacional retrospectivo controlado no aleatorizado de 38 pacientes intervenidos entre enero de 2006 y diciembre de 2014. Se excluyeron 10 pacientes por fallecimiento o no localización. Se recogieron datos demográficos, tiempo hasta la intervención y complicaciones, analizando la Escala visual analógica, DASH y Oxford Shoulder Score y el resultado radiológico actualizado. Resultados. Edad media de los pacientes de 35 años con hombro derecho-dominante afectado en un 71% de los casos predominantemente por caídas no a nivel. El 70% de los casos tenían percepción subjetiva tanto de recuperación de fuerza como de desaparición de deformidad. Se objetivó reducción completa radiológica en un 95% de los casos, con aparición de artrosis leve en un 44% y moderada en un 5,6%. Los resultados del DASH presentaron valores de 12,939 (±16,851) y el OSS de 42,736 (±7,794), indicando una función articular satisfactoria. Discusión. Los datos de este estudio muestran similitud en cuanto a resultados de estudios anteriores en lo que respecta a la recuperación subjetiva de la fuerza, mantenimiento de la reducción anatómica, resultados de test funcionales y eficacia de la técnica de Weaver-Dunn. Conclusiones. La técnica de Weaver-Dunn modificada aportó buenos resultados clínicos y radiológicos con reincorporación del paciente a sus actividades habituales y su mantenimiento a lo largo del tiempo (AU)

Objective. To evaluate the clinical and radiological results of the surgical treatment of type III acromioclavicular dislocations using the Weaver-Dunn technique in the delayed phase. Material and method. A non-randomised controlled retrospective observational study of 38 patients operated between January 2006 and December 2014. We excluded 10 patients due to death or non-localisation. We collected demographic data, time to intervention, complications, analysing the Visual Analog Scale, DASH and Oxford Shoulder Score and the updated radiological result. Results. mean age of patients with right-dominant shoulder affected in 71% of cases predominantly by non-level falls was 35. 70% of the cases had subjective perception of both recovery of strength and disappearance of deformity. Full radiological reduction was observed in 95% of the cases with the appearance of mild osteoarthritis in 44% and moderate osteoarthritis in 5.6%. The results of the DASH presented values of 12,939 (±16,851) and the OSS of 42,736 (±7,794), indicating satisfactory articular function. Discussion. The data from this study shows similar results to previous studies regarding subjective recovery of strength, maintenance of anatomical reduction, functional test results and efficacy of the Weaver-Dunn technique. Conclusions. The modified Weaver-Dunn technique provided good clinical and radiological results with patient reincorporation to their usual activities and maintenance over time (AU)

Influencia del espesor del ligamento transverso del carpo en el síndrome del túnel carpiano / Influence of the thickness of the transverse carpal ligament in carpal tunnel syndrome

Objetivo. Determinar si el espesor del ligamento transverso del carpo medido en el corte axial T2 en resonancia magnética influye realmente en la aparición del síndrome del túnel carpiano. Material y método. Se realizó resonancia magnética de la región de la muñeca a 94 pacientes entre enero del 2015 y junio del 2016, de los cuales 28 presentaban síndrome del túnel carpiano, 37 con molestias en diferentes regiones del carpo, sin síntomas de túnel carpiano y 29 sujetos sanos. Dos observadores realizaron 3 medidas en 3 niveles diferentes y en los 3 grupos de pacientes. Resultados. No se evidenciaron diferencias estadísticamente significativas en las medidas del espesor del ligamento transverso del carpo entre el grupo de síndrome del túnel carpiano y el grupo sin afectación del túnel, pero sí hubo diferencias estadísticas entre el grupo control y el grupo afecto de síndrome del túnel carpiano y entre grupo control y grupo sin afectación del túnel carpiano. En estos dos grupos, el espesor del ligamento transverso fue mayor al grupo control. Discusión. En este estudio se evidencia un aumento del ligamento transverso en sujetos con afectación de síndrome del túnel carpiano como demuestran numerosos estudios de la literatura, pero no existe un factor causal determinado sino un conjunto de hechos que hacen posible la aparición de dicho síndrome en un determinado grupo de pacientes. Conclusión. El síndrome del túnel carpiano es multifactorial, sin intervenir directamente el espesor del ligamento trasverso en la aparición de los síntomas (AU)

Objective. To determine if the thickness of the transverse carpal ligament measured by T2 axial magnetic resonance imaging actually influences the onset of carpal tunnel syndrome. Material and method. 94 patients between January 2015 and June 2016, of whom 28 had carpal tunnel syndrome, underwent magnetic resonance imaging, 37 with discomfort in different carpus regions without symptoms of carpal tunnel and 29 healthy subjects. Two observers performed 3 measurements in 3 different levels, and in the 3 groups of patients. Results. No statistically significant differences in transverse carpal ligament thickness measurements between the carpal tunnel syndrome group and the group without carpal tunnel involvement became apparent, but statistical differences between the control group and the carpal tunnel syndrome group, and between the control group and the group without involvement of the carpal tunnel were observed. In both these groups, the thickness of the transverse ligament was higher than in the control group. Discussion. An increase in the thickness of the transverse ligament in was found in this study in subjects with involvement of carpal tunnel syndrome as evidenced by numerous studies in the literature. There is no certain causative factor, but rather a set of facts that make onset of the syndrome possible in a specific group of patients. Conclusion. Carpal tunnel syndrome is multifactorial. The thickness of the transverse ligament does not directly affect the onset of symptoms (AU)

Results of surgical treatment of acromioclavicular dislocations type III using modified Weaver Dunn technique. / Resultados del tratamiento quirúrgico de las luxaciones acromioclaviculares tipo iii mediante técnica de Weaver-Dunn modificada.

OBJECTIVE: To evaluate the clinical and radiological results of the surgical treatment of type III acromioclavicular dislocations using the Weaver-Dunn technique in the delayed phase. MATERIAL AND METHOD: A non-randomised controlled retrospective observational study of 38 patients operated between January 2006 and December 2014. We excluded 10 patients due to death or non-localisation. We collected demographic data, time to intervention, complications, analysing the Visual Analog Scale, DASH and Oxford Shoulder Score and the updated radiological result. RESULTS: mean age of patients with right-dominant shoulder affected in 71% of cases predominantly by non-level falls was 35. 70% of the cases had subjective perception of both recovery of strength and disappearance of deformity. Full radiological reduction was observed in 95% of the cases with the appearance of mild osteoarthritis in 44% and moderate osteoarthritis in 5.6%. The results of the DASH presented values of 12,939 (±16,851) and the OSS of 42,736 (±7,794), indicating satisfactory articular function. DISCUSSION: The data from this study shows similar results to previous studies regarding subjective recovery of strength, maintenance of anatomical reduction, functional test results and efficacy of the Weaver-Dunn technique. CONCLUSIONS: The modified Weaver-Dunn technique provided good clinical and radiological results with patient reincorporation to their usual activities and maintenance over time.

Influence of the thickness of the transverse carpal ligament in carpal tunnel syndrome. / Influencia del espesor del ligamento transverso del carpo en el síndrome del túnel carpiano.

OBJECTIVE: To determine if the thickness of the transverse carpal ligament measured by T2 axial magnetic resonance imaging actually influences the onset of carpal tunnel syndrome. MATERIAL AND METHOD: 94 patients between January 2015 and June 2016, of whom 28 had carpal tunnel syndrome, underwent magnetic resonance imaging, 37 with discomfort in different carpus regions without symptoms of carpal tunnel and 29 healthy subjects. Two observers performed 3 measurements in 3 different levels, and in the 3 groups of patients. RESULTS: No statistically significant differences in transverse carpal ligament thickness measurements between the carpal tunnel syndrome group and the group without carpal tunnel involvement became apparent, but statistical differences between the control group and the carpal tunnel syndrome group, and between the control group and the group without involvement of the carpal tunnel were observed. In both these groups, the thickness of the transverse ligament was higher than in the control group. DISCUSSION: An increase in the thickness of the transverse ligament in was found in this study in subjects with involvement of carpal tunnel syndrome as evidenced by numerous studies in the literature. There is no certain causative factor, but rather a set of facts that make onset of the syndrome possible in a specific group of patients. CONCLUSION: Carpal tunnel syndrome is multifactorial. The thickness of the transverse ligament does not directly affect the onset of symptoms.

Influencia de los estados emocionales en el proceso de recuperación de mujeres con capsulitis adhesiva en el ámbito laboral / Influence of emotional states in the recovery process of women with adhesive capsulitis in the workplace

Objetivo: Documentar si la evolución postquirúrgica y rehabilitadora de mujeres diagnosticadas de capsulitis adhesiva de hombro puede estar influenciada por estados emocionales negativos derivados del estrés y la depresión. Material y método: Estudio de metodología cualitativa, observacional, deductivo y descriptivo, a través de la técnica de entrevista individual semiestructurada, y con un muestreo intencionado. Se seleccionaron 15 pacientes diagnosticadas de capsulitis adhesiva de hombro. Como complemento, se emplearon dos cuestionarios validados que aportaron información acerca del nivel de estrés y sintomatología depresiva: PSS y GHQ28. Resultados: Del análisis y posterior codificación abierta de las entrevistas emergieron cuatro grandes categorías: «el accidente», «la situación laboral», «la situación anímica» y «las relaciones con el entorno». Cuatro pacientes presentaron en el último mes estrés leve (26,7%) y 11 pacientes estrés moderado-severo (73,4%). Por último, se realizó una comparativa con tablas de contingencia para ver si existía una relación causa-efecto entre padecer capsulitis adhesiva y sufrir estrés emocional (p=0,323). Conclusión: La relación causa-efecto entre padecer depresión y sufrir capsulitis adhesiva no es significativa (AU)

Objective: To document whether postoperative evolution and rehabilitation care of women diagnosed with adhesive capsulitis of shoulder can be influenced by negative emotional states arising from stress and depression. Material and method: A qualitative, observational, descriptive and deductive research was completed. Data were collected through semi-structured individual interviews and with a purposive sampling. Fifteen patients diagnosed with adhesive capsulitis of the shoulder were selected. In addition, two validated questionnaires, PSS and GHQ28, were used. These questionnaires provided information about the level of stress and depressive symptoms. Results: The interviews were analyzed and subsequently coded. After the analysis, four major categories emerged: «the accident», «employment status», «the state of mind» and «relations with the environment». Four patients experienced mild stress in the last month (26.7%) and 11 patients moderate-severe stress (73.4%). Finally, a comparison was performed with contingency tables to see if there was a cause-effect relationship between having adhesive capsulitis and suffering from emotional stress (p=0,323). Conclusion: The cause-effect relationship between having depression and suffering from adhesive capsulitis is not significant (AU)