The dimensions of the posterior arch of C2 for instrumented screw fixation. A radiological study in the Spanish population.

BACKGROUND: To describe the feasibility of the posterior arch of C2 accepting two crossing screws in the Spanish population. METHODS: One hundred and fifty patients who underwent a routine neck CT scan for non-cervical pathology were enrolled. Submillimeter slices (thickness 0.7 mm) every 0.4 mm were performed with a 64 multi-detector CT scan, which allows isometric measurements. We measured the length and height of the cortical and cancellous (endomedullar) region of the lamina and the spinous process, inclination, maximal screw length and spinolaminar angle. RESULTS: The average (standard deviation) measurements of the lamina were: width of the left cortical 7.2 (1.5) mm, right cortical 6.9 (1.3) mm, width of the cancellous part of the left lamina 4.8 (1.5) mm, right side 4.6 (1.4) mm. The mean left cortical height was 13.0 (1.5) mm and 13.1 (1.6) mm for the right. The mean height of the cancellous part was 9.0 mm for both sides. The average measurements of the spinous process were: cortical length 15.7 (3.5) mm, endomedullar length 12.5 (3.9) mm; cortical height 11.9 (2.2) mm, endomedullar height 8.4 (2.1) mm; spinolaminar angle 49º (4); the maximum screw length 3.18 cm, and the inclination angle 143º. CONCLUSION: A CT scan with submillimeter slices is necessary in order to avoid malpositioning of the screws. The outer cortical measurements are 2 to 4 mm bigger than the endomedullar ones. Taking into account the dimensions of the spinous process, 24% of the population would not be candidates for this crossing screw technique.

Giant cell tumour of the proximal femur: Is joint-sparing management ever successful?

The purpose of this study was to assess whether the use of a joint-sparing technique such as curettage and grafting was successful in eradicating giant cell tumours of the proximal femur, or whether an alternative strategy was more appropriate. Between 1974 and 2012, 24 patients with a giant cell tumour of the proximal femur were treated primarily at our hospital. Treatment was either joint sparing or joint replacing. Joint-sparing treatment was undertaken in ten patients by curettage with or without adjunctive bone graft. Joint replacement was by total hip replacement in nine patients and endoprosthetic replacement in five. All 11 patients who presented with a pathological fracture were treated by replacement. Local recurrence occurred in five patients (21%): two were treated by hip replacement, three by curettage and none with an endoprosthesis. Of the ten patients treated initially by curettage, six had a successful outcome without local recurrence and required no further surgery. Three eventually needed a hip replacement for local recurrence and one an endoprosthetic replacement for mechanical failure. Thus 18 patients had the affected joint replaced and only six (25%) retained their native joint. Overall, 60% of patients without a pathological fracture who were treated with curettage had a successful outcome.

Enfermedad de Ollier: tumores benignos con riesgo de malignización. Revisión de 17 casos / Ollier disease: benign tumours with risk of malignant transformation. A review of 17 cases

Objetivo: Analizar una larga serie de esta rara entidad para entenderla mejor y valorar el riesgo de malignización y comprender esta enfermedad infrecuente para el correcto diagnóstico y tratamiento. Material y métodos: Diecisiete casos de encondromatosis múltiple tratados desde el año 1976 hasta el año 2006. Las variables estudiadas son: edad al diagnóstico y malignización, localización de la lesión, asociación familiar con otros tumores, hallazgos radiológicos, tratamientos aplicados, evolución en el tiempo, metástasis y supervivencia. Resultados: Se incluyen 16 casos de Ollier y un caso de síndrome de Maffucci. La gammagrafía fue el método de imagen que nos llevó al diagnóstico. La mediana de edad al diagnóstico de las malignizaciones es de 45 años, mientras que la mediana de edad al diagnóstico de los que no sufrieron malignización fue de 11 años. Fracturas patológicas, dismetrías y deformidades conducen al diagnóstico en la gente joven. Las lesiones benignas fueron tratadas mediante cirugía menor. Hubo 5 malignizaciones en 4 pacientes (23,5%). El fémur distal y la pelvis son los lugares de mayor frecuencia de malignización, todos ellos hacia condrosarcoma de grado I. La cirugía es el único tratamiento en todos ellos. Conclusiones: La enfermedad de Ollier es una enfermedad benigna con alto riesgo de malignización a partir de los 40 años. La gammagrafía ósea es la mejor prueba diagnostica para detectar el crecimiento del tumor y la posible malinización de las múltiples lesiones. La cirugía amplia es la única herramienta para lograr la supervivencia en estos pacientes; por eso el diagnóstico precoz es esencial (AU)

Aim: To review Ollier disease, an uncommon disease, in order to understand the clinical symptoms, diagnosis, correct treatment, and risk factors in order to prevent malignant transformation. Materials and methods: Seventeen cases of Ollier disease were treated between 1976 and 2006. The variables studied included: age at diagnosis and onset of malignant transformation, location of the lesion, family association with other tumours, radiological findings, treatment for the different lesions, metastatic lesions and survival. We excluded patients with Chondrosarcoma without previous diagnosis of Ollier disease. All malignant transformations were assessed by histopathology studies and radiological images. Results: We include 16 cases of Ollier's and 1 of Maffucci's syndrome. The median age at diagnosis for patients having malignant transformation was 45 years, whereas the average age at diagnosis for patient without progression to malignancy was 11 years. Pathological fractures, dysmetria and deformities led to the diagnosis in young people. Benign lesions were treated with minor surgery. There were five malignancy transformations in four patients (23.5%), with the distal femur being the most frequent location for transformation to grade I chondrosarcoma. Surgery was the treatment in all of them. We found no family association with other tumours. Conclusions: Multiple enchondromatosis is a benign disease with a high risk of malignant transformation above 40 years old. Bone scintigraphy is the best tool for detecting multiple lesions and malignant transformation. Radical surgery is the only way to improve survival, and this is the reason why early diagnosis is essential (AU)

[Ollier disease: benign tumours with risk of malignant transformation. A review of 17 cases]. / Enfermedad de Ollier: tumores benignos con riesgo de malignización. Revisión de 17 casos.

AIM: To review Ollier disease, an uncommon disease, in order to understand the clinical symptoms, diagnosis, correct treatment, and risk factors in order to prevent malignant transformation. MATERIALS AND METHODS: Seventeen cases of Ollier disease were treated between 1976 and 2006. The variables studied included: age at diagnosis and onset of malignant transformation, location of the lesion, family association with other tumours, radiological findings, treatment for the different lesions, metastatic lesions and survival. We excluded patients with Chondrosarcoma without previous diagnosis of Ollier disease. All malignant transformations were assessed by histopathology studies and radiological images. RESULTS: We include 16 cases of Ollier's and 1 of Maffucci's syndrome. The median age at diagnosis for patients having malignant transformation was 45 years, whereas the average age at diagnosis for patient without progression to malignancy was 11 years. Pathological fractures, dysmetria and deformities led to the diagnosis in young people. Benign lesions were treated with minor surgery. There were five malignancy transformations in four patients (23.5%), with the distal femur being the most frequent location for transformation to grade I chondrosarcoma. Surgery was the treatment in all of them. We found no family association with other tumours. CONCLUSIONS: Multiple enchondromatosis is a benign disease with a high risk of malignant transformation above 40 years old. Bone scintigraphy is the best tool for detecting multiple lesions and malignant transformation. Radical surgery is the only way to improve survival, and this is the reason why early diagnosis is essential.

Utilidad de las tiras reactivas de orina en el diagnóstico de infección de tracto urinario inferior no complicada / Utility of dipstick tests for the diagnostic of non complicated urinary tract infections

Las infecciones urinarias ocupan el segundo lugar entre las infecciones atendidas en Atención Primaria. El diagnóstico de certeza es el urocultivo. Como técnicas rápidas se utilizan los tests de esterasa leucocitaria y nitritos en orina, pero en la bibliografía su sensibilidad y especificidad son muy variables. Objetivos: evaluar la validez de las tiras reactivas de orina en el diagnóstico de infección del tracto urinario inferior no complicada en nuestro medio, en términos de sensibilidad y especificidad empleando como método de referencia el urocultivo. Comparar el resultado de la tira en consulta y en el laboratorio. Estudiar síntomas predictores de enfermedad y test positivo. Sujetos y métodos: estudio descriptivo transversal. Se incluyeron 77 pacientes por muestreo consecutivo, que consultaban por síndrome uretral agudo, realizándoseles tira, urocultivo y registro de la sintomatología. Resultados: sensibilidad = 94,3 porciento (79,5-99,0), especificidad = 78,6 porciento (62,8-89,2), valor predictivo positivo = 78,6 porciento (62,8-89,2), valor predictivo negativo = 94,3 porciento (79,5-99,0), con un nivel de confianza del 95 porciento. No se encontraron diferencias significativas con los resultados para la tira en laboratorio. Los únicos síntomas que resultaron predictores de urocultivos positivos mediante regresión logística fueron la duración del cuadro y la hematuria, y los síntomas predictores de tira positiva (esterasa leucocitaria y/o nitritos) fueron la sensibilidad hipogástrica y la duración del cuadro. Conclusiones: las tiras reactivas de orina son un buen método diagnóstico de infección urinaria en pacientes sin factores de riesgo. Su aplicación rutinaria en la consulta de Atención Primaria permitirá eliminar urocultivos innecesarios (AU)