Tratamiento de la fractura conminuta de patela: ¿existen diferencias entre realizar o no una eversión? / Treatment of comminuted patellar fracture: are there differences between performing or not performing an eversion?

OBJETIVO Comparar los resultados clínicos, funcionales e imagenológicos de dos técnicas quirúrgicas para el manejo de fracturas conminutas de patela: con y sin eversión patelar. MÉTODOS En una serie de casos retrospectivos de fracturas conminutas de patela tratadas en el mismo centro entre 2014 y 2017, con un seguimiento ≥ 3 meses, se hizo una comparación entre el grupo con eversión y el grupo sin eversión. Los criterios de exclusión fueron patelectomía parcial o total, reinserción tendínea, o rehabilitación incompleta. Las variables analizadas fueron edad, sexo, tabaquismo, diabetes mellitus, energía del accidente, tipo de fractura, variables quirúrgicas (banda de tensión, tornillos, alambres, nudos, cerclaje circular), rango de movimiento (RDM) articular postoperatorio, presencia de osteosíntesis sintomática, puntaje de escalas funcionales (de Tegner-Lysholm y de Kujala) al alta definitiva, complicaciones (rigidez articular, infección, trombosis venosa profunda), y variables imagenológicos con tomografías computarizadas pre- y postoperatorias (brecha, desnivel articular > 2 mm, elementos de fijación intraarticular). RESULTADOS En total, 20 de 22 pacientes, 13 con eversión y 7 sin eversión, cumplieron con los criterios de selección. El seguimiento fue de 3 a 12 meses, y no hubo diferencias estadísticamente significativas respecto a las variables demográficas entre ambos grupos, lo cual los hace comparables. Destacaron el tiempo desde el ingreso al alta, con 7 meses para los pacientes con eversión y 5 meses para los sin eversión (p = 0.032), la proporción de pacientes con desnivel articular > 2 mm, con 7.7% para los con eversión y 14.3% para los sin eversión (p = 0.016), y una tendencia a resultados superiores en escalas funcionales para el grupo con eversión. CONCLUSIÓN El tratamiento de fracturas conminutas de patela con eversión parece ser una alternativa viable dados sus resultados imagenológicos y funcionales superiores a los de la técnica habitual.

PURPOSE To compare the clinical, functional and imaging outcomes of two surgical techniques for the treatment of comminuted patellar fractures: with and without eversion. METHODS In a retrospective series of cases of comminuted patellar fractures treated at a single center between 2014 and 2017, with a follow-up 3 months , we performed a comparison between the eversion group and the non-eversion group. The exclusion criteria were partial or total patellectomy, tendon reinsertion, or incomplete rehabilitation. The variables analyzed were age, gender, smoking, diabetes mellitus, the energy of the accident, the fracture type, surgical variables (tension band, screws, wires, knots, circular cerclage), postoperative joint range of motion (ROM), presence of symptomatic osteosynthesis, the scores on the functional scales (of Tegner-Lysholm and of Kujala) at the final discharge, complications (joint stiffness, infection, deep vein thrombosis), and pre- and postoperative computed tomography imaging variables (gap, step-off > 2mm, intra-articular fixation elements). RESULTS In total, 20 out of 22 patients, 13 undegoing eversion and 7 not undergoing eversion, met the selection criteria.. The follow-up ranged from 3 to 12 months, and there were no statistically significant differences regarding the demographic variables between both groups, which makes them comparable. The most remarkable results were the time from admission to final discharge, of 7 months for the patients in the eversion group, and of 5 months for those in the non-eversion group (p » 0.032), the proportion of patients with a step-off > 2 mm, with 7.7% for the eversion group and 14.3% for the non-eversion group (p » 0.016), and a tendency towards higher scores in the functional scales for the eversion group. CONCLUSION The treatment of comminuted patellar fractures with eversion seems to be a viable alternative, given its superior imaging and functional results compared to those of the usual technique.

Síndrome de párpado laxo / The lax eyelid syndrome

RESUMEN El síndrome de párpado laxo es un cuadro que con frecuencia pasa inadvertido. Los síntomas que lo caracterizan son generalmente muy inespecíficos, por lo que a menudo los pacientes son diagnosticados erróneamente con conjuntivitis infecciosa crónica, blefaritis o síndrome del ojo seco, lo que puede llevar a un retraso o falta de tratamiento durante meses o incluso años. Se presenta el caso de una paciente de 54 años, atendida en el Servicio de Cirugía Plástica Ocular del Instituto Cubano de Oftalmología "Ramón Pando Ferrer", quien refirió sensación de arenilla, ardor y secreciones. Durante el interrogatorio se constató la presencia de trastornos del sueño y eversión del párpado superior al dormir. Se le diagnosticó un síndrome de párpado laxo y se decidió realizar tratamiento quirúrgico, con el uso de la técnica de acortamiento horizontal del párpado. Al mes de la cirugía se observó la desaparición de toda la sintomatología y un resultado estético muy favorable. Aunque el síndrome del párpado laxo no es potencialmente mortal, puede conducir a condiciones serias que amenazan la visión y ser un indicador de condiciones sistémicas fatales(AU)

ABSTRACT The lax eyelid syndrome is a condition that often goes unnoticed. The symptoms that characterize it are generally very nonspecific, so patients are often misdiagnosed with chronic infectious conjunctivitis, blepharitis, or dry eye syndrome, which can lead to a delay or lack of treatment for months or even years. The case of a 54-year-old patient is presented. The patient was treated at the Ocular Plastic Surgery Service of Ramón Pando Ferrer Cuban Institute of Ophthalmology and reported gritty sensation, burning and secretions. During the interrogation, the presence of sleep disorders and dislocation of the upper eyelid during sleep was found. The patient was diagnosed with lax eyelid syndrome and it was decided to perform surgical treatment, using the horizontal lid shortening technique. One month after the surgery, the disappearance of all the symptoms and a very favorable aesthetic result were observed. Although lax eyelid syndrome is not life-threatening, it can lead to serious conditions that threaten vision and can be an indicator of fatal systemic conditions(AU)

Morphological evolution of the vertebrate forebrain: From mechanical to cellular processes.

Although the cerebral hemispheres are among the defining characters of vertebrates, each vertebrate class is characterized by a different anatomical organization of this structure, which has become highly problematic for comparative neurobiology. In this article, we discuss some mechanisms involved in the generation of this morphological divergence, based on simple spatial constraints for neurogenesis and mechanical forces generated by increasing neuronal numbers during development, and the different cellular strategies used by each group to overcome these limitations. We expect this view to contribute to unify the diverging vertebrate brain morphologies into general, simple mechanisms that help to establish homologies across groups.

Kinematic analysis of subtalar eversion during gait in women with fibromyalgia.

OBJECTIVE: To analyse the subtalar eversion range of motion during walking in women with fibromyalgia. METHOD: Twenty women diagnosed with fibromyalgia were directed to walk barefoot at comfortable and self-paced speed on a 7m walkway. Subtalar eversion range of motion was measured using the difference between the maximum and minimum values of subtalar eversion in stance phase. A range of motion between 4°-6° was considered as reference values for subtalar eversion during gait. Descriptive statistics were performed. RESULTS: In both right and left lower limb analysis of subtalar eversion range of motion, five women showed joint hypomobility, and twelve showed hypermobility. Only one patient performed unaltered subtalar eversion range of motion in both lower limbs. Both joints expressed high variability, and there were no significant differences between the right and left sides. CONCLUSIONS: The findings suggest that biomechanical function of the subtalar joint eversion during the loading response phase of gait in women with fibromyalgia, by excessive rigidity or complacency joint, tends to be impaired. This finding suggests that the indication of walking as an auxiliary strategy in the treatment of women with fibromyalgia should be preceded by thorough examination of the mechanical conditions of the subtalar joint of the patient.

Prolapso uterino em gata - Relato de caso / Uterine prolapse in a cat - A case report / Prolapso uterino en gata ­ Relato de caso

O prolapso uterino em cadelas e gatas é uma emergência reprodutiva na qual ocorre eversão de um ou ambos os cornos uterinos através da vagina, durante ou após o parto. Tal patologia não é frequente em gatas, por isso o presente relato tem o objetivo de descrever um caso de prolapso uterino em uma gata atendida no Hospital Veterinário da Universidade Federal do Piauí. Na anamnese o proprietário se queixou de massa avermelhada na vulva após a expulsão de dois filhotes. Ao exame clínico, observou-se que a massa era o útero prolapsado. O animal foi encaminhado imediatamente ao centro cirúrgico para redução do útero prolapsado e realização de ovariosalpingohisterectomia (OSH). Após a OSH, o animal permaneceu internado durante 24 horas. Findo este período o animal teve alta e apresentou boa recuperação.

Uterine prolapse in dogs and cats is a reproductive emergency in which there is the protrusion of one or both uterine horns through the vagina during or after delivery. This condition is not common in cats, so this report aims to describe a case of uterine prolapse in a cat treated at the Veterinary Hospital of the Federal University of Piaui. Upon anamnesis, the owner complained of a reddish mass in the vulva after the expelling of two kittens. Clinical examination revealed that the mass was the prolapsed uterus. The animal was immediately sent to the operating room for reduction of the prolapsed uterus and an ovariosalpingohisterectomy (OSH) was performed. After OSH, the animal remained hospitalized for 24 hours. After this period, the animal was discharged and recovered well.

El prolapso uterino en perras y gatas es una emergencia reproductiva en la cual ocurre eversión de uno o ambos los cuernos uterinos a través de la vagina, durante o después del parto. Tal patología no es común en gatas, este informe tiene como objetivo describir un caso de prolapso uterino en una gata tratada en el Hospital Veterinario de la Universidad Federal de Piauí. En la anamnesis el propietario se quejó de una masa rojiza en la vulva después de la expulsión de dos gatitos. El examen clínico reveló que la masa era el prolapso de útero. El animal fue enviado de inmediato al centro quirúrgico para reducción del prolapso de útero y realización de ovariosalpinghisterectomía (OSH). Después de realizada la OSH, el animal permaneció hospitalizado durante 24 horas. Después de este período, el animal fue dado de alta y se recuperó bien.

Prolapso uterino em gata - Relato de caso / Uterine prolapse in a cat - A case report / Prolapso uterino en gata ­ Relato de caso

O prolapso uterino em cadelas e gatas é uma emergência reprodutiva na qual ocorre eversão de um ou ambos os cornos uterinos através da vagina, durante ou após o parto. Tal patologia não é frequente em gatas, por isso o presente relato tem o objetivo de descrever um caso de prolapso uterino em uma gata atendida no Hospital Veterinário da Universidade Federal do Piauí. Na anamnese o proprietário se queixou de massa avermelhada na vulva após a expulsão de dois filhotes. Ao exame clínico, observou-se que a massa era o útero prolapsado. O animal foi encaminhado imediatamente ao centro cirúrgico para redução do útero prolapsado e realização de ovariosalpingohisterectomia (OSH). Após a OSH, o animal permaneceu internado durante 24 horas. Findo este período o animal teve alta e apresentou boa recuperação.(AU)

Uterine prolapse in dogs and cats is a reproductive emergency in which there is the protrusion of one or both uterine horns through the vagina during or after delivery. This condition is not common in cats, so this report aims to describe a case of uterine prolapse in a cat treated at the Veterinary Hospital of the Federal University of Piaui. Upon anamnesis, the owner complained of a reddish mass in the vulva after the expelling of two kittens. Clinical examination revealed that the mass was the prolapsed uterus. The animal was immediately sent to the operating room for reduction of the prolapsed uterus and an ovariosalpingohisterectomy (OSH) was performed. After OSH, the animal remained hospitalized for 24 hours. After this period, the animal was discharged and recovered well.(AU)

El prolapso uterino en perras y gatas es una emergencia reproductiva en la cual ocurre eversión de uno o ambos los cuernos uterinos a través de la vagina, durante o después del parto. Tal patología no es común en gatas, este informe tiene como objetivo describir un caso de prolapso uterino en una gata tratada en el Hospital Veterinario de la Universidad Federal de Piauí. En la anamnesis el propietario se quejó de una masa rojiza en la vulva después de la expulsión de dos gatitos. El examen clínico reveló que la masa era el prolapso de útero. El animal fue enviado de inmediato al centro quirúrgico para reducción del prolapso de útero y realización de ovariosalpinghisterectomía (OSH). Después de realizada la OSH, el animal permaneció hospitalizado durante 24 horas. Después de este período, el animal fue dado de alta y se recuperó bien.(AU)