Caracterización del dolor torácico agudo en pacientes del Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández. Matanzas / Characterization of acute chest pain in patients of the Teaching Clinic- Surgical Hospital Comandante Faustino Perez Hernandez. Matanzas

RESUMEN Introducción: el dolor torácico agudo es una sensación dolorosa que se manifiesta entre el diafragma y la base del cuello. En Cuba, constituye una de las causas más frecuentes de consulta médica. La provincia de Matanzas muestra un comportamiento similar. Objetivo: caracterizar el perfil clínico de los pacientes con dolor torácico agudo en la Unidad de Cuidados Intensivos Emergentes, del Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, de Matanzas. Materiales y métodos: se realizó un estudio transversal descriptivo con las historias clínicas de 418 pacientes que acudieron a la Unidad de Cuidados Intensivos Emergentes, refiriendo dolor torácico agudo, de enero a diciembre de 2019. Resultados: el rango de edad más afectado fue el de 50 a 59 años, para un 30,38 %. Predominó el sexo masculino con el 30,08 %. El ejercicio físico intenso elevó el riesgo de aparición de dolor torácico. Las primeras causas de dolor torácico agudo fueron, en orden de frecuencia, la osteocondritis esternocostal, la bursitis del hombro y el síndrome coronario agudo. Conclusiones: se evidenció que en la mayoría de los casos el origen del dolor fueron causas no cardiovasculares, afectando más al sexo masculino. Existió asociación estadística significativa entre la actividad física intensa y el inicio del dolor torácico agudo. Egresaron vivos de la unidad el 71,53 % de los pacientes. Se recomienda priorizar la atención de los pacientes que refieren dolor torácico agudo, para una correcta clasificación y atención en el menor tiempo posible (AU).

ABSTRACT Introduction: acute chest pain is a painful sensation perceptible between the diaphragm and the base of the neck. It is one of the most frequent causes of medical consultation in Cuba. It shows a similar behavior in the province of Matanzas. Objective: to characterize the clinical profile of the patients with acute thoracic pain in the Emergency Intensive Care Unit of the Teaching Clinic-Surgical Hospital Comandante Faustino Perez Hernandez, of Matanzas. Materials and methods: a descriptive, cross-sectional study was carried out with the clinical records of 418 patients who attended the Emergency Intensive Care Unit referring acute thoracic pain, from January to December 2019. Results: the most affected age range was the one from 50 to 59 years, for 30.38 %. Male sex predominated, with 30.08 %. Intense physical exercise raised the risk of thoracic pain. The first causes of acute thoracic pain were, in order of frequency, sternocostal osteochondritis, shoulder bursitis, and acute coronary syndrome. Conclusions: It was evidenced that in most of the cases the source of the pain was non-cardiovascular causes, more affecting the male sex. There was significant statistic association between intense physical activity and acute thoracic pain. 71.53 % of the patients was discharged from the unit alive. It is recommended to prioritize the attention of patients referring acute thoracic pain, for their correct classification and care in the shortest possible time (AU).

Unestable knee osteochondritis dissecans: arthroscopic fixation with bio-absorbable device. / Osteocondritis disecante inestable de rodilla: fijación artroscópica con implante bioabsorbible.

INTRODUCTION: Knee ostheochondritis dissecans is an osteochondral disease, whose treatment is still debated. The purpose this study was to analyze the patients attached with bioabsorbable nail, assisted by arthroscopy. MATERIAL AND METHOD: Analysis was performed using median and interquartile range (P25-P75), with a follow-up of 9 patients (10 knees) operated for stage III osteochondral lesions. After a minimum of 12 months, the KOOS, IKDC, satisfaction questionnaires were evaluated and a MR control was perfomed. RESULTS: Bone healing was observed in 80% of patients in the first year, with a delay in union in 20%. The median for age was 15 years. The average follow-up was 5.93 years. All cases were located in the internal condyle. The OCD lesions did not show comminution or necrosis. The 40% of stable lesions, according to preoperative MR, were unestable in arthroscopy and it were attached with internal nail. Two groups of osteochondral lesions were differentiated: juvenile OCD (60%) and adult OCD (40%); all of them were stage III lesions. IKDC questionnaire results were an improvement of 29.5 (22.25, 37.52). In the KOOS questionnaire, an improvement was obtained in symptoms of 18.07, in pain of 29.12, in daily living 25.53, in function (sports, recreational activities) of 35 and in quality of life of 34.42. CONCLUSIONS: The bioabsorbable nail is a valid, reproducible option for unestable lesions with lesion integrity, with great improvement in function, quality of life and with few complications.

Osteochondritis Dissecans of the Lateral Process of Talus Involving the Subtalar Joint: An Unusual Case.

Osteochondritis dissecans is a fairly recognized entity affecting the talus dome but subtalar joint involvement is not that common. We report a case of a 34-year-old male with osteochondritis dissecans of lateral process talus which was missed on imaging studies and identified intraoperatively. The patient was treated with curettage of the subchondral cyst at talus, followed by bone grafting and fixation of the osteochondral lesion with a 4-mm partially threaded cancellous screw. At the 1-year follow-up evaluation, there were no signs of recurrence and the patient resumed his complete activities including sports. We believe that the threshold for diagnosing these lesions should be low in cases with nonspecific chronic ankle pain, and surgeons are encouraged to consider this diagnosis.

Prevalence of hypovitaminosis D in patients with juvenile osteochondritis dissecans. / Prevalencia de hipovitaminosis D en pacientes con osteocondritis disecante juvenil.

BACKGROUND: Juvenile osteochondritis dissecans (JOCD) is an acquired joint disease of unknown etiology that affects skeletally immature patients and has the potential to progress to osteoarthritis. Recent studies have reported a high prevalence of vitaminD deficiency in patients with osteochondral lesions. The aim of our study was to determine serum vitaminD levels in patients diagnosed with JOCD. METHODS: Serum 25(OH)D levels of 31 patients (22 males) presenting 40 lesions (29 JOCD of the knee, and 11 of the ankle) were evaluated. The average age was 11.9±2.9years. HypovitaminosisD was defined as a value less than 30ng/mL and was divided into vitaminD insufficiency (20 to 30ng/mL) and vitaminD deficiency (<20ng/mL). RESULTS: HypovitaminosisD was present in 45.2% of the evaluated patients (32.2% insufficiency and 13% deficiency). No significant differences were found in the mean values and incidence of hypovitaminosis between those patients in which the sample was taken in warm or cold season (P=.267 and P=.875, respectively). Patients who required surgery had a higher incidence of hypovitaminosis than those treated conservatively (60% versus 31%, P=.054). There was no correlation in the incidence of hypovitaminosis with sex, location, stability of the lesion, or if the lesion was uni- or bilateral. CONCLUSION: In our series, almost half of the patients diagnosed with JOCD presented abnormal serum levels of vitaminD. A two-fold incidence of hypovitaminosis was observed in patients requiring surgical treatment compared to patients managed conservatively. The association found in this study does not imply causation, but it should be considered within the set of actions for the treatment of these injuries.

Lesión osteocondral extensa de cóndilo femoral; tratamiento en un tiempo con matriz colágena y concentrado de médula ósea: reporte de un caso / Big osteochondral lesion; treatment with collagen scaffold and bone marrow concentrate: case report

El tratamiento de las lesiones osteocondrales de gran tamaño y profundidad resultan un desafío debido a que las técnicas habituales (microfractura o transplante osteocondral autólogo), son insuficientes para cubrir el defecto; eso es particularmente importante en pacientes jóvenes, pues se debe intentar técnicas que generen la menor comorbilidad posible. Presentamos un caso de un paciente de 18 años con una lesión osteocondral de 6 cm2 por 14 mm de profundidad, tratado mediante autoinjerto óseo, concentrado de médula ósea y matriz colágena, con resultados satisfactorios tanto en lo funcional como en lo imagenológico. Esa técnica presenta la ventaja de realizarse en un tiempo y con una fuente de células troncales mesenquimáticas (Médula ósea), validada en la literatura y altamente reproducible.

The treatment of large osteochondral defects represent a challenge, because the common techniques used (micro fracture or osteochondral autologous transplantation) are insufficient to cover the defect; this is particularly important in young patients where we expect the least comorbidity. We report a case of an 18-year-old patient with an ostechondral injury of 6 cm2 and 14 mm deep, treated with bone autograft, bone marrow concentrate and a matrix of collagen with satisfactory functional and images results. This technique has the advantage to be performed in one single time and with a source of mesenchymal stem cells (bone marrow) validated in the literature.

Mosaicoplastia / Mosaicplasty

movimiento articular. El tratamiento de esta afección es variado, de estas modalidades la mosaicoplastia es muy empleada por sus diferentes ventajas. Objetivo: actualizar los conocimientos sobre el injerto osteocondral autólogo en la modalidad de mosaicoplastia. Métodos: la búsqueda de la información se realizó en el mes de octubre de 2016, a partir de la información obtenida se realizó una revisión bibliográfica de un total de 654 artículos publicados en las bases de datos PubMed, Hinari, SciELO y Medline mediante el gestor de búsqueda y administrador de referencias EndNote, de ellos se utilizaron 52 citas seleccionadas para realizar la revisión, 47 de ellas de los últimos cinco años, donde se incluyeron cuatro libros. Desarrollo: se describen los elementos necesarios para el diagnóstico clínico e imaginológico, en relación a estos últimos se hace énfasis en la imagen de resonancia magnética y la artroscopia. Se hace referencia a la clasificación de la sociedad internacional para la reparación de los cartílagos. Se describen las indicaciones quirúrgicas generales de las lesiones de cartílago y las específicas de la mosaicoplastia con sus principales ventajas y desventajas. Se plasman las principales complicaciones relacionadas con el procedimiento y los resultados de un grupo de investigaciones. Conclusiones: la mosaicoplastia es una variedad de injerto autólogo osteocondral empleada con buenos resultados en la actualidad, tiene ventajas, desventajas e indicaciones específicas.

Background: cartilage lesions are common nowadays. Their main symptoms and signs are pain and limited joint range of motion. There are many ways to treat them. Mosaicplasty is very used because of its several advantages. Objective: to update knowledge of autogenous osteochondral transplantation in mosaicplasty modality. Methods: a search in the databases PubMed, Hinari, SciELO and Medline was conducted through the information locator EndNote in October 2016. From the information obtained, a bibliographic review was carried out with 654 articles. Among them, 52 citations were used and 47 of them from the last five years, including four books. Development: fundamental elements for clinical and imaging diagnosis were described. With regard to the latter, it is emphasized on magnetic resonance imaging and arthroscopy. The international cartilage repair society classification system was pointed out. General surgical indications for cartilage lesions were described as well as specific ones for mosaicplasty and its main advantages and disadvantages. Complications were highlighted as well as the results of a group of researchers. Conclusions: mosaicplasty is a modality of autogenous osteochondral transplantation with good results because of its many advantages and disadvantages and specific indications to do it.

From loose body to osteochondritis dissecans: a historical account of disease definition.

Osteochondritis dissecans (OCD) is a rare yet fascinating disease affecting young, active patients. It remains a 'mysterious disease' whose etiopathology, still unclear, is the subject of ongoing studies aiming improving the knowledge of this condition and, therefore, treatment options, too. Even though the first descriptions of intra-articular loose bodies date back to very ancient times, it is only relatively recently that, thanks to the contribution of some very eminent physicians, it became recognized as a specific orthopaedic condition. The aim of the present manuscript is to trace the main steps in the journey that led to the acknowledgement of OCD as an autonomous clinical entity, and to recall the prominent figures involved.

Knee hemarthros secondary to osteochondritis dissecans (König disease).

A case is presented of a hemarthrosis associated with osteochondritis dissecans in a young man who arrived in the Emergency unit due to tender and swelling of his right knee one hour after a slightly rotational gesture of the lower limb. Many years before the patient suffered a sports injury in the same knee, but it was never assessed. Radiography studies showed bone fragments inside the synovial capsule, and the joint aspiration was compatible with hemarthrosis. A review of the available information of this uncommon condition is also presented.

Lesiones deportivas en niños y adolescentes / Pediatric and adolescent sports injuries

El aumento en la actividad deportiva de niños y adolescentes ha derivado en un aumento de las lesiones esqueléticas atribuidas a la actividad física. El aparato locomotor infantil presenta particularidades que hacen que los patrones de lesión difieran a lo que ocurre en los adultos. Se producen lesiones agudas y de sobrecarga que se presentan en edades y sitios específicos. Debido a la alta frecuencia de aparición de ellas, es necesario que los médicos que atienden niños estén familiarizados con los cuadros más frecuentes. En este artículo se revisan los aspectos más importantes de las principales lesiones deportivas en niños y adolescentes resumiendo las principales consideraciones diagnósticas, terapéuticas y pronósticas.

The increase in sport activity of children and adolescents has led to an increase in skeletal lesions attributed to physical activity. The children’s musculoskeletal system presents particularities that make injury patterns defer to those that occur in adults. Acute and overluse injuries are produced, which occur in specific locations and ages. Due to the high frequency of their occurrence, it is necessary that physicians who treat children are familiar with the most frequent conditions. In this article the most important aspects of major sports injuries in children and adolescents are reviewed by summarizing the main diagnostic, therapeutic and prognostic considerations.

Osteonecrosis de la rodilla: enfoque actual / Knee osteonecrosis: current approach

Fundamento: la Osteonecrosis de la Rodilla se describió por primera vez por Ahlback citado por Adriaensen en el año 1968. Aunque esta enfermedad afecta fundamentalmente al condilo medial, también puede observarse en el cóndilo lateral y los paltillos tibiales. Desarrollo: se realizó una revisión bibliográfica sobre la Osteonecrosis de la Rodilla, con especial énfasis en las teorías involucradas en su fisiopatología, exponemos los distintos estadios de esta enfermedad así como las características radiológicas de cada uno, se realizó el diagnóstico diferencial de esta enfermedad con otras, relacionadas o no con la Osteonecrosis. Conclusiones: se brindó un breve enfoque terapéutico basado fundamentalmente en la edad y extensión de la lesión.

Background: knee osteonecrosis was described for the first time by Ahlback mentioned by Adriaensen in 1968. Although this disease affects fundamentally to the medial condyle, it may also be observed in the lateral condyle and tibial saucers. Development: a bibliographical review was carried out on knee osteonecrosis, with special emphasis in the theories involved in its physiopathology, different stages of this disease as well as the radiological characteristics of each are exposed, differential diagnosis of this disease with other, related or not with osteonecrosis was carried out. Conclusions: it was offered a brief therapeutic approach based fundamentally on the age and extension of the lesion.

Osteonecrosis de la rodilla: enfoque actual / Knee osteonecrosis: current approach

La Osteonecrosis de la Rodilla se describió por primera vez por Ahlback citado por Adriaensen en el año 1968. Aunque esta enfermedad afecta fundamentalmente al condilo medial, también puede observarse en el cóndilo lateral y los paltillos tibiales. Desarrollo: se realizó una revisión bibliográfica sobre la Osteonecrosis de la Rodilla, con especial énfasis en las teorías involucradas en su fisiopatología, exponemos los distintos estadios de esta enfermedad así como las características radiológicas de cada uno, se realizó el diagnóstico diferencial de esta enfermedad con otras, relacionadas o no con la Osteonecrosis. Conclusiones: se brindó un breve enfoque terapéutico basado fundamentalmente en la edad y extensión de la lesión (AU)

Knee osteonecrosis was described for the first time by Ahlback mentioned by Adriaensen in 1968. Although this disease affects fundamentally to the medial condyle, it may also be observed in the lateral condyle and tibial saucers. Development: a bibliographical review was carried out on knee osteonecrosis, with special emphasis in the theories involved in its physiopathology, different stages of this disease as well as the radiological characteristics of each are exposed, differential diagnosis of this disease with other, related or not with osteonecrosis was carried out. Conclusions: it was offered a brief therapeutic approach based fundamentally on the age and extension of the lesion (AU)

Osteocondrite dissecante do côndilo femoral lateral em cão shar-pei: relato de caso / Osteochondritis dissecans in the femoral lateral condylus in the shar-pei dog: case report / Osteocondritis disecante del cóndilo femoral lateral en perro shar-pei: relato de caso

Descreve-se o tratamento cirúrgico de osteocondrite dissecante do côndilo femoral lateral, em um cão macho adulto da raça Shar-Pei, com acesso para-patelar lateral ao joelho. O diagnóstico foi realizado por meio de exame ortopédico e radiográfico. Como tratamento, realizou-se artrotomia e condiloplastia femoral lateral, removendo retalho cartilaginoso e expondo o osso subcondral. Foram perfurados orifícios, com a finalidade de acelerar o processo cicatricial. No período pós-operatório houve restrição de exercícios durante 10 dias, com o retorno gradual às atividades físicas. Indicou-se o uso de tramadol e cetoprofeno durante sete dias, e sulfato de condroitina por 100 dias. Quarenta dias após a cirurgia, o paciente apresentou ausência de dor e claudicação, retornando à ambulação normal.

This paper reports the surgical treatment of osteochondritis dissecans in the femoral lateral condylus in a male adult Shar-Pei dog, with lateral parapatellar access to the knee. Diagnosis was made by physical and radiographic examination. The treatment was arthrotomy and lateral femoral condylar plastia, removing a cartilaginous flap and exposing the subchondral bone, in which there were performed punctures in order to accelerate the healing process. Exercises were restricted during the first 10 days of the post-op period, and then a gradual return to physical activities was recommended. Tramadol and ketoprofen were prescribed for seven days, and chondroitin sulphate for 100 days. Forty days after the surgery the patient showed absence of pain or lameness, returning to normal ambulation.

Se relata el tratamiento quirúrgico de osteocondritis disecante del cóndilo femoral lateral, en un perro Shar-Pei macho adulto, con acceso pararotuliano lateral a la rodilla. El diagnóstico fue realizado por medio de examen ortopédico y radiográfico. Como tratamiento, se realizó artrotomía y condiloplastía femoral lateral, removiéndose colgajo cartilaginoso y exponiendo el hueso subcondral. Se realizaron perforaciones, con objetivo de acelerar el proceso de cicatrización. En el periodo post-operatorio se indicó restricción a los ejercicios por 10 días, y después un retorno gradual a las actividades físicas. Se prescribió tramadol y ketoprofeno durante siete días, y sulfato de condroitina por 100 días. Cuarenta días después de la intervención el paciente no más demostraba dolor y claudicación, retornando a la ambulación normal.

Manejo quirúrgico en osteocondritis disecante de rodilla / Surgical management of knee osteochondritis dissecans

Introduction: Many techniques exist for the surgical treatment of knee Osteochondritis Dissecans (OCD). Objectives: Describe anatomic features and functional results of surgical treatment with different techniques in knee OCD. Methods: Consecutive series, fifteen patients treated surgically for knee OCD, between January 2001 - May 2008. We analyzed stability in MRI and arthroscopy, average surface area of the lesions, surgical techniques and postoperative complications. We followed our series at 29,8 months average with Lysholm and subjective IKDC scores. Results: Average age 18,6 years, 84,6 percent were male; 73,3 percent unstable on MRI; 66,6 percent of lesions located at the medial femoral condyle. Eleven cases treated with osteochondral autografts, 2 with osteochondral synthesis and 2 with microfractures and mechanic chondroplasty. No postoperative complications documented at follow up. Average postop Lysholm 93,3 points, average IKDC 88 points. Conclusion: Surgical treatment of unstable OCD offers good and excellent functional results at mid and long-term follow up.

Existen diversas técnicas para el tratamiento quirúrgico de la Osteocondritis Disecante (OCD) de la rodilla. Objetivos: Describir características anatómicas de la lesión y los resultados funcionales del tratamiento quirúrgico con diferentes técnicas en OCD de rodilla. Método: Serie consecutiva, 15 pacientes (Enero 2001-Mayo 2008). Se analiza estabilidad en Resonancia Magnética (RM), localización y estabilidad de lesión en artroscopia, área de superficie promedio de la lesión, técnica quirúrgica y complicaciones postoperatorias. Seguimiento promedio 29,8 meses con puntajes Lysholm e IKDC subjetivo. Edad promedio 18,6 años, 84,6 por ciento hombres. Resultados: 73,3 por ciento inestables en RM y 100 por ciento inestables en artroscopia; 66,6 por ciento en cóndilo femoral medial; 6 tipo C1, 4 tipo C2, 3 tipo C5 y 2 lesiones en patela. Once casos resueltos con autoinjertos osteocondrales, 2 con osteosíntesis y 2 con microfracturas. Área promedio de lesión 13,1 mm². No documentamos complicaciones. Promedios post operatorios: Lysholm 93,3; IKDC 88 puntos. Conclusión: La resolución quirúrgica de OCD inestables ofrece buenos y excelentes resultados funcionales en seguimiento a mediano y largo plazo en la mayoría de los pacientes.

Osteocondrite dissecante do côndilo femoral medial em quatro cães / Osteochondritis dissecans of the medial femoral condyle in four dogs

A osteocondrite dissecante do côndilo medial do fêmur é condição raramente observada como causa de claudicação em membro pélvico de pequenos animais. Descreve-se a ocorrência de quatro casos de osteocondrite dissecante do côndilo femoral medial em dois cães da raça Rottweiler e dois cães Retriever do Labrador, machos, com idades variando entre 5 e 9 meses e massa corpórea entre 26 e 35Kg. Os animais apresentavam claudicação de aparecimento subagudo, pouco responsiva a drogas antiinflamatórias previamente administradas. Ao exame físico, observou-se claudicação unilateral em três animais e bilateral em um, acompanhada de efusão e crepitação articular discreta, com sensibilidade dolorosa em 2 animais. O exame radiográfico, em projeção cranio-caudal, demonstrou lesão cística radiolucente localizada na superfície articular do côndilo medial sugestiva de osteocondrose, nos quatro cães. Os animais foram submetidos à artrotomia parapatelar lateral, por meio da qual pôde-se confirmar a presença de retalho de cartilagem articular, caracterizando a osteocondrite dissecante. O tratamento consistiu na remoção do ôflapö, seguida de curetagem e perfuração do osso subcondral com fio de Kirschner. Após a cirurgia foi indicado repouso por um período mínimo de 7 dias, com retorno gradual às atividades. Devido ao infreqüente acometimento da articulação femorotibiopatelar pela afecção em tela, torna-se importante o seu reconhecimento e sua inclusão no diagnóstico diferencial das claudicações do membro pélvico em cães em fase de crescimento, de modo que formas auxiliares de diagnóstico e tratamento eficaz sejam realizados no intuito de restabelecer a função do membro e retardar a progressão da doença articular degenerativa