Use of semi-constrained total knee arthroplasty in gonarthrosis with collateral ligament insufficiency: clinical and functional outcomes.

INTRODUCTION: Achieving stability in total knee arthroplasty (TKA) is crucial for long-term implant survival. In cases of severe deformity or ligament laxity, constrained implants may be required. Traditionally, increasing constraint involved intramedullary stems. However, there are intermediary alternatives, including employing a constrained polyethylene insert without stems, thereby avoiding complications related to them. The study aims to evaluate our experience with a non-modular constrained (NMC) implant in primary TKA. MATERIAL AND METHODS: We conducted a retrospective review of the clinical and radiographic outcomes of 108 non-stemmed primary TKAs performed at our institution between 2013 and 2021 in patients with at least 10º deformity or 10mm ligament laxity. Data included demographics, preoperative and postoperative deformities, clinical outcomes and revision rates. RESULTS: A total of 103 patients (108 knees) with a mean age of 74 were followed up for a minimum of 2 years. The mean postoperative range of motion was 105º/0º. The median Oxford Knee Score, Knee Society Score and Knee Society Function Score were 43.5, 92 and 90, respectively. 17 knees had varus deformity (mean tibiofemoral angle of 2.7º), and 87 knees had excessive valgus deformity (mean tibiofemoral angle of 15.1º). The remaining 4 knees had a neutral alignment. The mean postoperative tibiofemoral angle was 6.8º. The overall revision rate was 6.5% (7 patients): 3 deep periprosthetic infections, 2 patellar dislocations, 1 stiffness and 1 aseptic loosening. CONCLUSION: Our experience demonstrates favorable mid-term outcomes with the NMC implant, providing a safe alternative to stemmed implants in primary TKA, particularly in cases of severe deformity or ligament laxity.

Infección de prótesis aórtica abdominal: tratamiento alternativo / Infected abdominal aortic prosthesis: an alternative therapy

Introducción: la infección de prótesis aórtica en la cirugía vascular convencional es un evento catastrófico, con una alta tasa de morbilidad y de mortalidad. El tratamiento tradicional ha sido la remoción de la prótesis y la reconstrucción con bypass extraanatómico. En algunos casos, se ha llevado a cabo el reemplazo con prótesis impregnadas en antibiótico; en otros, el reemplazo con vena femoral superficial y también la cirugía abierta con drenaje de las colecciones asociadas y antibioticoterapia de por vida. Caso clínico: se presenta el reporte de un caso de infección protésica tratada con drenajes de las colecciones y antibioticoterapia de larga duración, con un resultado favorable un año después de su complicación. Discusión: en algunos casos, dada la severidad del paciente, es posible intentar un tratamiento conservador de esta nefasta complicación.(AU)

Introduction: in traditional vascular surgery, aortic prosthesis infection is a catastrophic event with high morbidity andmortality rates. Traditional treatment is the removal of the valve followed by extra-anatomic bypass reconstruction. Insome cases, antibiotic-impregnated prosthesis replacement has been performed. In others, superficial femoral veinreplacement, and open surgery with drainage of the associated collections and lifelong antibiotic therapy.Case report: this is the case of a patient with aortic prosthesis infection undergoing draining collections and lifelongantibiotic therapy with a favorable outcome 1 year after the complication.Discussion: in some cases, given the severity of the patient, we can try to treat this dreaded complication conservativel.(AU)

Pectus excavatum. Surgical treatment: Structural or aesthetic?

INTRODUCTION: Pectus excavatum is a wall deformity that often warrants medical evaluation. In most cases, it's a purely visual aesthetic alteration, while in others, it comes with symptoms. Several surgical techniques have been described, but their outcomes are difficult to assess due to the heterogeneity of presentations and the lack of long-term follow-up. We present our experience as thoracic surgeons, assessing correction as either structural (remodeling of the thoracic cage through open surgery) or aesthetic (design and implantation of a customized 3D prosthesis). MATERIAL AND METHODS: Retrospective observational study of the indication for surgical treatment of pectus excavatum carried out by a team of thoracic surgeons and the short- to mid-term results. RESULTS: Between 2021 and 2023, we treated 36 cases surgically, either through thoracic cage remodeling techniques or with 3D prostheses. There were few minor complications, and the short- to mid-term results were positive: alleviation of symptoms or compression of structures when present, or aesthetic correction of the defect in other cases. CONCLUSIONS: Surgery for pectus excavatum should be evaluated for structural correction of the wall or aesthetics. In the former, thoracic cage remodeling requiring cartilage excision and possibly osteotomies is necessary. In the latter, the defect is corrected with a customized 3D prosthesis.

AVIP Project (Prosthetic Virtual Friend): Study of clinical-functional outcomes and satisfaction with a mobile application in the perioperative management and follow-up of hip arthroplasty. / Proyecto AVIP (Amigo VIrtual Protésico): estudio de resultados clínico-funcionales y de satisfacción con una aplicación móvil en el manejo perioperatorio y seguimiento de implantes protésicos de cadera.

OBJECTIVE: To analyze the clinical, quality of life, and healthcare quality outcomes obtained in a series of patients undergoing total hip arthroplasty (THA), who were empowered and monitored using the AVIP application. These results will be compared with a control group followed through a standard protocol. MATERIAL AND METHOD: Randomized clinical trial with parallel groups involving patients with an indication for THA. Clinical variables were measured and compared using the WOMAC and mHHS, pain assessed by the VAS, quality of life with the SF-12 test. Walking capabilities were analyzed using the Functional Gait Assessment Scale, along with satisfaction levels assessed through the SUCE questionnaire, and perceived anxiety levels related to the process. RESULTS: A total of 68 patients were evaluated, with 31 patients in the AVIP group and 33 in the Control group completing the follow-up. Both groups demonstrated improvement in clinical outcomes based on the WOMAC and mHHS hip tests, a reduction in perceived pain, and an enhancement in quality of life according to the SF-12 test. Patients in the AVIP study group exhibited non-inferiority in clinical outcomes and satisfaction compared to the control group, as well as lower anxiety levels and improved walking capabilities after the first month of follow-up. Notably, 82.25% of the follow-up visits for this group were conducted remotely. CONCLUSION: The implementation of a mHealth application like AVIP can be safely offered to selected patients undergoing hip arthroplasty, enabling effective monitoring and providing continuous information and training.

Factores sociodemográficos, audiológicos y audioprotésicos relacionados con la calidad de vida en pacientes con prótesis auditivas en Madrid (España) / Sociodemographic, audiological and audioprosthetic factors related to quality of life in patients with hearing aids, in Madrid, Spain

Antecedentes y objetivo: El propósito de una adaptación protésica no es únicamente mejorar el entendimiento del lenguaje, sino mejorar la calidad de vida. El objetivo de esta investigación es medir la calidad de vida de los pacientes con prótesis auditivas e indagar qué variables sociodemográficas, audiológicas y audioprotésicas la afectan. Material y métodos: Estudio descriptivo transversal multicéntrico en la Comunidad de Madrid (España). Muestra formada por 54 pacientes. Se usó la escala Effectiveness of auditory rehabilitation (EAR). Resultados: Edad media de 66.4 años; el 55.6% eran hombres. La puntuación media de 10 ítems de la escala EAR audiológica fue 64.54 (DE 16.43). La puntuación media de 10 ítems de la EAR audioprotésica fue 71.84 (DE 13.49). La edad, sexo, actividad laboral, nivel de estudios, grado de pérdida auditiva, resultados de logoaudiometría, campo libre, número y formato de prótesis auditivas, prescriptor de las prótesis y año de fabricación de las prótesis se asocian con diferentes ítems de la escala EAR (p<.05). Conclusiones: La calidad de vida audiológica oscila entre regular y buena, y la audioprotésica se acerca a buena. Tener menor edad, ser de sexo femenino y tener actividad laboral se asocian con mejor calidad de vida. Las personas con buenos resultados logoaudiométricos se asocian con mejor calidad de vida. Las adaptaciones monoaurales, los audífonos retroauriculares, los audífonos más modernos y que el paciente no se autoprescriba prótesis auditivas se asocian con mejor calidad de vida. Las prótesis auditivas mejoran la calidad de vida de los pacientes siempre que se tengan en cuenta las características sociodemográficas, audiológicas y audioprotésicas específicas de cada paciente para realizar un ajuste audioprotésico personalizado y óptimo.(AU)

Background and objective: The purpose of a prosthetic adaptation is not only to improve language understanding and sound recognition, but to improve the patient's quality of life. The purpose of this investigation is to measure quality of life of patients with hearing aids, and investigate which sociodemographic, audiological and audioprosthetic variables affect it. Material and methods: Multicenter cross-sectional descriptive study in the Community of Madrid (España). Sample 54 patients and Effectiveness of Auditory Rehabilitation (EAR) scale was used. Results: Mean age 66.4 years; 55.6% men. The mean score of 10 audiological EAR items was 64.54 (SD 16.43). The mean score of 10 ear audioprosthetic items was 71.84 (SD 13.49). Age, sex, work activity, level of education, degree of hearing loss, logoaudiometry results, free field, number and format of hearing aids, prescriber of the prostheses and year of manufacture of the prostheses, are associated with different items of the EAR scale (P<.05). Conclusions: The audiological quality of life ranges from regular to good, and audioprosthetics is close to good.Younger age, female sex and work activity are associated with better quality of life. People with good logoaudiometric results are associated with better quality of life. Monaural adaptations, retroauricular hearing aids, more modern hearing aids and that the patient does not self-describe hearing aids, are associated with better quality of life. Hearing aids improve the quality of life of patients, provided that sociodemographic, audiological and audioprosthetic characteristics, specific to each patient are taken into account to make a personalized and optimal audioprosthetic adjustment.(AU)

Prótesis colónicas en el tratamiento paliativo del cáncer colónico. Nuestra evaluación tras 10 años de experiencia / Self-expanding metal stents in the palliative treatmentof coloncancer. Results of 10 years of experience

Introducción: la colocación de prótesis metálicas autoexpansibles (PAE) por vía endoscópica surge como opción terapéutica para la obstrucción colónica neoplásica en dos situaciones: como tratamiento paliativo y como puente a la cirugía curativa. Este procedimiento evita cirugías en dos tiempos y disminuye la probabilidad de colostomía definitiva y sus complicaciones con el consecuente deterioro de la calidad de vida. Objetivo: comunicar nuestra experiencia en la colocación de PAE para el tratamiento paliativo de la obstrucción colorrectal neoplásica. Diseño: retrospectivo, longitudinal, descriptivo y observacional. Material y métodos: se incluyeron todos los pacientes a quienes el mismo grupo de endoscopistas les colocó PAE con intención paliativa por cáncer colorrectal avanzado entre agosto de 2008 y diciembre de 2019. Fueron analizadas las variables demográficas y clínicas, el éxito técnico y clínico, las complicaciones tempranas y tardías y la supervivencia. Resultados: se colocó PAE en 54 pacientes. La media de edad fue 71 años. El 85% de las lesiones se localizó en el colon izquierdo. En el 57% de los pacientes se realizó en forma ambulatoria. El éxito técnico y clínico fue del 92 y 90%, respectivamente y la supervivencia media de 209 días. La tasa de complicaciones fue del 29,6%, incluyendo un 14,8% de obstrucción y un 5,6% de migración. La mortalidad tardía atribuible al procedimiento fue del 5,6%, ocasionada por 3 perforaciones tardías: 2 abiertas y 1 microperforación con formación de absceso localizado. Conclusiones: la colocación de PAE como tratamiento paliativo de la obstrucción neoplásica colónica es factible, eficaz y segura. Permitió el manejo ambulatorio o con internación breve y la realimentación temprana, mejorando las condiciones para afrontar un eventual tratamiento quimioterápico paliativo. Las mayoría de las complicaciones fueron tardías y resueltas endoscópicamente en forma ambulatoria. (AU)

Introduction: endoscopic placement of self-expanding metal stents (SEMS) emerges as a therapeutic option for neoplastic obstruction of the colon in two situations: as palliative treatment and as a bridge to curative surgery. This procedure avoids two-stage surgeries and reduces the probability of permanent colostomy and its complications with the consequent deterioration in quality of life. Objective: to report our experience in the placement of SEMS as palliative treatment in neoplastic colorectal obstruction. Design: retrospective, longitudinal, descriptive and observational study. Methods: all patients in whom the same group of endoscopists performed SEMS placement with palliative intent for advanced colorectal cancer between August 2008 and December 2019 were analyzed. Data collected were demographic and clinical variables, technical and clinical success, early and late complications, and survival. Results: SEMS were placed in 54 patients. The average age was 71 years. Eighty-five percent were left-sided tumors. In 57% of the patients the procedure was performed on an outpatient basis. Technical and clinical success was 92 and 90%, respectively, and median survival was 209 days. The complication rate was 29.6%, including 14.8% obstruction and 5.6% migration. Late mortality attributable to the procedure was 5.6%, caused by 3 late perforations: 2 open and 1 microperforation with localized abscess formation. Conclusions: The placement of SEMS as a palliative treatment for neoplastic colonic obstruction is feasible, effective and safe. It allowed outpa-tient management or brief hospitalization and early refeeding, improving the conditions to face an eventual palliative chemotherapy treatment. Most complications were late and resolved endoscopically on an outpatient basis. (AU)

Satisfaction assessment study in patients (and their partners) with/without Peyronie's disease and penile prosthesis implantation.

INTRODUCTION AND OBJECTIVE: Among the many treatments for erectile dysfunction, implantation of a penile prosthesis has been associated with high patient satisfaction rates. However, patients with coexistent Peyronie's disease (PD) and refractory erectile dysfunction and/or severe deformities may show different results. The aim of our study was to assess and to compare the level of satisfaction, with an inflatable penile prosthesis (IPP), in men with/without coexistent PD. MATERIAL AND METHODS: A survey study based on a five-item satisfaction questionnaire was submitted to all those live patients implanted in the period 1992-2022 at our center (n = 570) and their partners. Ninety-two percent of implants were inflatable devices. Surgeries were mainly performed by two surgeons. The main outcome measure used was the level of patient and partner satisfaction with sexual intercourse after IPP. RESULTS: Of the 570 eligible patients, 479 (84%) completed the survey (393 Non-PD: GROUP 1; 70 non-complex PD-Group 2; 16 complex PD). Eighty-six per cent of patients in Group 1 reported satisfactory sexual intercourse (very or moderately satisfied). Non-complex PD implanted patients (Group 2) reported a global 81% satisfactory sexual intercourse (very or moderately satisfied) (p > 0.05). However, when we evaluated the PD subgroup of patients with severe PD who require incision/excision/grafting at the time of implant (Group 3: n = 20), only 61% reported satisfactory sexual intercourse (p < 0.01) with predominance of moderately satisfied patients over very satisfied: 78% vs. 22%). Additionally, 84% (Group 1), 80% (Group 2) and 54% (Group 3) of partners reported satisfactory intercourses, respectively (p < 0.01). Overall, 84% of Group 1 implants and 79% of Group 2 reported that they would undergo the procedure again if the IPP failed (p > 0.05; ns). Only 50% of Group 3 patients would do it again. With regard to cosmetic aspects, 48% of the Group 3 implant reported penile shortness or soft glans as the main causes of their dissatisfaction. Only 2.4% of total PP patients expressed difficulty in manipulating the device. CONCLUSION: The presence of PD alone may not impact PP patient and partner satisfaction, but patients with more severe baseline deformity who require incision/grafting may be less satisfied with outcomes including penile length and glans sensation.

[Translated article] Study of femoral component malrotation as a cause of pain after total knee arthroplasty.

INTRODUCTION: The total knee arthroplasty (TKA) has been shown to be a successful and cost-benefit procedure in terms of pain improvement in patient with symptomatic knee osteoarthritis. However, almost a 20% of the patients are not satisfied with the result of the surgery. MATERIAL AND METHOD: We have carried out a transversal unicentric cases controls study with clinical cases of the own hospital, obtained by a clinical records revision. A total of 160 patients with a TKA with at least 1 year of follow-up were selected. Demographic variables, functional scales (WOMAC and VAS) and rotation of the femoral component through the analysis of the images obtained by CT scan were collected. RESULTS: The total was 133 patients that was divided in two groups. A control group and pain group. The Control group was made up of 70 patients with a mean age of 69.59 years (23 men and 47 women) and the pain group was made up of 63 patients with a mean age of 69.48 years (13 men and 50 women). We didn't find difference regarding the analysis of the rotation of the femoral component. In addition, we were not found significant differences when applying a stratification by sex. And, the analysis of the malrotation of the femoral component, previously defining limits of value rotation considered as extreme, in any of the case did not show significant differences. CONCLUSION: The results of the study confirm that malrotation of the femoral component had no influence on the presence of pain at a minimum of one year of follow-up after TKA implantation.

[Translated article] A systematic review of the literature: The use of metaphyseal sleeves in revision total knee arthroplasty.

BACKGROUND AND OBJECTIVES: The purpose of this study is to analyse the indications, complications, survivorship and clinical/functional outcome of metaphyseal sleeves as a treatment option in revision total knee arthroplasty. MATERIAL AND METHOD: A systematic review was made following the PRISMA recommendations on the use of metaphyseal sleeves for revision total knee arthroplasty. We included prospective and retrospective studies published in the last 10 years looking at implant survivorship, clinical and functional outcome with a minimum follow-up of 2 years. RESULTS: The included studies showed good both functional and clinical outcomes. The overall reoperation rate was 16.2%, with an overall survival rate of 92.2% and aseptic survivorship of 98.2%. CONCLUSIONS: Metaphyseal sleeves are a good treatment option for this surgery, especially in AORI II or III type bone defects, achieving good intraoperative and primary stability of the implant, with good and rapid osseointegration.

How to create by your own a customized hip cement mega-spacer for a hip megaprosthesis two-stage revision surgery after oncologic limb-salvage surgery - Surgical technique and case report.

Managing chronic periprosthetic infections in patients who have undergone limb-salvage surgery following a malignant bone tumor with megaprosthesis often involves a two-stage revision surgery with the use of a cement-spacer. This paper show details the preparation of a self-made intramedullary metal-stabilized mega-cement spacer for patients needing a two-stage revision surgery due to infection after oncologic bone tumor resection and limb-salvage surgery with megaprosthesis and present two clinical cases treated with this technique. The report provides a practical surgical technique to create a cement hip mega-spacer using readily available tools in most orthopedic surgical settings.

Perforación colónica por endoprótesis biliar impactada / Colonic perforation due to impacted biliary stent

Introducción. La colocación de endoprótesis biliares es cada día más frecuente por ser actualmente una de las mejores opciones para el tratamiento de patologías de la vía biliar. La migración de las endoprótesis es una de las complicaciones que puede ocurrir en hasta un 10,8 % de los pacientes, pero en muy raras ocasiones llegan a causar una perforación intestinal. Caso clínico. Se trata de una paciente de 61 años, a quien cinco años atrás se le realizó una colangiopancreatografía retrógrada endoscópica por coledocolitiasis. Consultó por presentar dolor abdominal, y al examen físico se encontraron abdomen agudo y plastrón en fosa ilíaca izquierda a la palpación. La tomografía computarizada informó un cuerpo extraño a nivel del colon descendente, con perforación del mismo. Se realizó laparotomía exploratoria y colostomía por perforación del colon sigmoides secundaria a prótesis biliar migrada. Resultados. La paciente evolucionó favorablemente y a los seis meses se realizó el cierre de la colostomía, sin complicaciones. Conclusión. Los pacientes a quienes se les colocan prótesis biliares requieren un seguimiento adecuado para evitar complicaciones que, aunque raras, pueden ocurrir, como la migración intestinal con perforación. El tratamiento de dichas complicaciones se hace por vía endoscópica, laparoscópica o laparotomía en caso de complicación severa.

Introduction. Endoscopic placement of biliary stents is becoming more common every day, as it is currently one of the best options for the treatment of bile duct pathologies. One of the complications that can occur is the migration of the endoprostheses in up to 10.8% of patients, which in very rare cases can cause intestinal perforation. Clinical case. This is a 61-year-old female patient, who underwent endoscopic retrograde cholangiopancreatography five years ago for choledocholithiasis. She consulted due to abdominal pain, with a physical examination that upon palpation documented an acute abdomen and a palpable plastron in the left iliac fossa. The computed tomography revealed a foreign body at the level of the descending colon, with perforation. Exploratory laparotomy and colostomy were performed due to perforation of the sigmoid colon secondary to migrated biliary prosthesis. Results. The patient progressed favorably and six months later the colostomy was closed without complications. Conclusions. Patients who receive biliary stents require adequate follow-up to avoid complications that, although rare, may occur, such as intestinal migration with intestinal perforation. The treatment of these complications can be endoscopic, laparoscopic or laparotomy in case of severe complication.

O acesso à prótese dentária na atenção primária no Brasil / Access to dental prosthesis in primary care in Brazil / Acceso a prótesis dental en atención primaria en Brasil

Este artigo tem como objetivo avaliar o acesso à prótese dentária na Atenção Primária em Saúde (APS) no Brasil. É um estudo transversal, em que foram utilizados dados do Programa de Melhoria do Acesso e da Qualidade Atenção Básica (PMAQ-AB), segundo e terceiro ciclos, com enfoque em saúde bucal e atendimento à prótese dentária por estado brasileiro. Ao comparar as Unidades Básicas de Saúde (UBS) que fazem instalações de prótese nos dois ciclos de avaliação, foi observada diferença estatisticamente significativa (teste Mann Whitney, p = 0,04), mostrando maior número de instalações no terceiro ciclo. O percentual de UBS que instalavam prótese dentária no segundo ciclo foi de 8,4% e no terceiro ciclo, 14,1%. Ao se avaliar os locais em que os pacientes fizeram a prótese dentária, verifica-se que a maioria fez suas próteses no serviço privado. Conclui-se, então, que a APS não consegue suprir a demanda por prótese dentária.

This cross-sectional study evaluates access to dental prosthesis in Primary Health Care (PHC) in Brazil. Data were obtained from the Access and Quality Improvement Program (PMAQ-AB), second and third cycles, focusing on oral health and dental care provided by the Brazilian State. Comparison of the Basic Health Units (BHU) that perform prosthesis installations in the two evaluation cycles (Mann Whitney test, p = 0.04) revealed a statistically significant difference, showing a greater number of installations in the third cycle. In the second and third cycles 8.4% and 14.1% of UBS, respectively, installed dental prostheses. When evaluating where patients acquired their dental prosthesis, most sought the private service. In conclusion, PHC cannot meet the demand for dental prosthesis.

Este artículo tuvo por objetivo evaluar el acceso a las prótesis dentales en la atención primaria de salud (APS) en Brasil. Se trata de un estudio transversal que utiliza datos del Programa de Mejoramiento del Acceso y Calidad de la Atención Primaria (PMAQ-AB, por sus siglas en portugués), segundo y tercer ciclo, con foco en salud bucal y atención con prótesis dental por estado brasileño. Al comparar las Unidades Básicas de Salud (UBS) que instalan prótesis en los dos ciclos de evaluación, se observó diferencia estadísticamente significativa (prueba de Mann Whitney, p = 0,04), con un mayor número de instalaciones en el tercer ciclo. El 8,4% de las UBS instalaron prótesis dental en el segundo ciclo, y el 14,1% en el tercer ciclo. En cuanto a los locales donde los pacientes hicieron su prótesis dental, la mayoría fue realizada por el servicio privado. Se concluye que la APS no logra satisfacer la demanda de prótesis dentales.

[Translated article] Experience in major complications with total trapezometacarpal prostheses.

INTRODUCTION: The treatment of rhizarthrosis using trapeziometacarpal prostheses (TMP) is increasing. Complications may lead to loss of the implant and result in salvage surgery. Our aim was to assess major complications with the use of some TMP models and their rescue. MATERIAL AND METHOD: Retrospective study on TMP implanted between 2006 and 2021. Models studied: Arpe®, Elektra®, Ivory®, Maïa®, Isis® and Touch®. Demographic data were assessed, implant placement by radiographic study, technical data, complications, salvage surgeries and final survival. RESULTS: Review of 224 TMP, 45 Arpe® (95.5% survival, rate follow-up [R] 6-16 years), 5 Elektra® (80% survival, R 13-14), 14 Ivory® (92.8% survival, R 9-11), 7 Maïa® (100% survival, R 8-9), 115 Isis® (99.1% survival, R 1-8), 38 Touch® (100% survival, R 1-4). The medial angle of the dome with the proximal articular surface of the trapezium in the lateral plane, was: Arpe®: 8.85°, Elektra®: not assessable, Ivory®: 6.6°, Maïa®: 14.4°, Isis®: 3.8°, and Touch®: 5.95°. The Isis® was placed 100% with scopic guidance presenting a significantly lower angle respect to the medial angle of the dome with the proximal articular surface of the trapezium. As main complications, we observed 3.5% of dislocations and 4% of mobilisations, with the Elektra® being responsible for 47% of these. Nineteen salvage surgeries were performed, with 3% of the implants being lost. CONCLUSIONS: Dislocation and mobilisation are the most observed complications, the Elektra® responsible for almost half of them. Correct placement and implant design appear to be crucial to avoid them in the short and long term.

Sedation with propofol/remifentanil versus dexmedetomidine / remifentanil for patients undergoing transcatheter aortic valve implant: A retrospective study between 2012 and 2019.

BACKGROUND AND OBJECTIVES: Percutaneous implantation of an aortic valve prosthesis is a therapeutic alternative for patients with severe aortic stenosis. The procedure is traditionally performed under general anaesthesia; however, sedation is now gaining in popularity because it reduces the need for vasoactive drugs and shortens the patient's stay in the critical care unit and on the ward. The aim of this study is to evaluate the clinical efficacy, safety and potential benefits of sedation with dexmedetomidine in patients undergoing percutaneous implantation of an aortic valve prosthesis in terms of haemodynamic and respiratory complications. MATERIALS AND METHODS: We performed a retrospective study of 222 patients that had undergone percutaneous implantation of an aortic valve prosthesis between 2012 and 2019 under sedation with either dexmedetomidine plus remifentanil (DEX-RMF) or propofol plus remifentanil (PROPO-RMF). We collected data on complications, mainly haemodynamic and respiratory, during and after the procedure. RESULTS: No significant differences were found between sedation with dexmedetomidine and propofol (in combination with remifentanil) in terms of haemodynamic stability and intraprocedural cerebral blood oxygen. In the DEX-RMF group, however, mean blood pressure, midazolam dose, and duration of anaesthesia were lower compared with the PROPO-RMF group, but the incidence of haemodynamic and respiratory complications did not differ significantly between groups. CONCLUSIONS: Our results show that sedation, particularly with adjuvant dexmedetomidine, is a valid anaesthetic techniques in percutaneous aortic valve prosthesis implantation.

Percutaneous cementoplasty of periprosthetic aseptic hip loosening.

Progressive population aging and improved healthcare have led to a significant increase in patients with hip arthroplasty (HA). In this patient group, the proportion of those who require a new arthroplasty (prosthetic replacement or secondary revision of the hip), has also increased. For this subgroup of patients in whom surgical prosthetic replacement should be considered but is contraindicated, a new technique has been developed since 2010: percutaneous injection of periprosthetic cement under fluoroscopic or CT control ("femoroplasty; FMP") as an alternative and less invasive treatment compared to surgery to stabilize the HA without replacing it, with excellent results on patients' quality of life. In this brief communication, we describe our positive experience regarding FMP, which we have performed for the first time in Spain on four patients (age range between 74-83 years, 2 female and 2 male patients, 3 right HA and 1 left HA), without post-complications. We highlight both the relative simplicity of this technique, which can be incorporated into radiological intervention even in regional hospitals, and the significant clinical improvement observed in all patients. In conclusion, we hope that our experience can contribute to the increased adoption of this innovative technique within the scientific community.

Comparación de prótesis removibles parciales y totales entregadas según sus características clínicas en el servicio de odontología del hospital nacional de geriatría y gerontología, en el período de tiempo comprendido del 1 de enero 2005 al 31 de diciembre del 2008 / Comparison of partial and total removable prosthesis delivered according to their clinical characteristics in the dentistry service of the national hospital of geriatry and gerontology, in the period under january 1 of 2005 to december 31 of 2008

RESUMEN Objetivo: Comparar la cantidad y características de las prótesis dentales removibles parciales y totales, en el servicio de odontología del Hospital Nacional de Geriatría y Gerontología, en el periodo de tiempo comprendido del 1 de enero 2005 al 31 de diciembre 2008, equivalentes a 326 expedientes. Se tomó la base de datos del servicio de odontología de consulta externa especializada de los pacientes atendidos de los años 2005 al 2008, en los cuales se entregaron un total de 2786 prótesis dentales removibles. Materiales y métodos: Con base en el dato anterior se seleccionó la muestra no aleatoria a conveniencia hasta alcanzar el tamaño de 599 prótesis entregadas, examinando 326 expedientes del periodo de enero del 2005 a diciembre del 2008, con un nivel de confianza de 99% y un error de muestreo de 0.0466. La recolección de datos se realizó por medio del programa Microsoft Excel donde se utilizó una tabla en la que se anotó el número de expediente, fecha de inicio y conclusión de prótesis, tipo de prótesis, cantidad y color de prótesis, edad, género y domicilio del paciente por distrito, cantón y provincia. El procesamiento se realizó por medio de estadística descriptiva utilizando cuadros y gráficos. Resultados: Se determinó que el mayor porcentaje de rango de edad de personas que solicitaron prótesis removibles fue de 62 a 65 años, independiente si eran prótesis totales o parciales, los pacientes que requirieron dos prótesis fueron 273 de 326, en su mayoría los pacientes solicitaron prótesis totales para un total de 372 de 599 prótesis entregadas. De la guía de color utilizada en el HRBC los colores más requeridos fueron los tonos claros blanco amarillentos que corresponde al número 62 y 65; de los expedientes analizados la mayoría de los pacientes residían en San José con un total de 200 pacientes. Se concluye que el mayor porcentaje de edentulismo que se presento es el edentulismo total con un 62%, la prótesis más utilizada es la prótesis total superior removible y en su mayoría los pacientes requieren dos prótesis, con respecto al color no es concluyente para este estudio debido a los datos no disponibles en los expedientes analizados.

ABSTRACT Objective: Compare the quantity and characteristics of partial and total removable dental prostheses, in the dentistry service of the National Hospital of Geriatrics and Gerontology, in the period from January 1, 2005 to December 31, 2008. The database of the specialized outpatient dentistry service of the patients treated from 2005 to 2008 was taken, in which a total of 2786 removable dentures were delivered. Materials and methods: Based on the previous data, the non-random sample was selected for convenience until reaching the size of 599 protheses of 326 files, with a confidence level of 99% and a sampling error of 0.0466. Data collection was carried out through the Microsoft Excel program where a table was used in which the file number, date of start and conclusion of the prosthesis, type of prosthesis, amount and color of prosthesis, age, gender and address were used of the patient by district, canton and province. The processing was carried out by means of descriptive statistics using tables and graphs. Results: It was determined that the highest percentage of the age range of people who requested removable prostheses was 62 to 65 years, the patients that required two prostheses were 273 of 326. In their majority, the patients requested total prostheses for a total of 372 of 599 prostheses delivered. Of the color guide used in the HRBC, the most requested colors were the light yellowish-white tones corresponding to the number 62 and 65; of the files analyzed, most of the patients resided in San José with a total of 200 patients. Conclusion: It is concluded that the highest percentage of edentulism that is presented is total edentulism with 62%, the most commonly used prosthesis is the removable upper total prosthesis and for the most part patients require two prostheses, with respect to color it is inconclusive for this study due to data not available in the analyzed files.

Colocación de prótesis esofágica para el fracaso del tratamiento endoscópico / Esophageal stent placement for endoscopic treatment failure

Up until approximately 10 years ago, the treatment for acute refractory esophageal variceal bleeding was balloon tamponading. Esophageal fully covered self-expanding stents are considered as effective as balloons and also much safer. They are kept in situ for longer periods, what eases the access to more definitive treatments with a low complication rate. We present 6 cases of patients with cirrhosis and massive bleeding due to esophageal varices refractory to conventional treatment, successfully treated with an esophageal fully covered self-expanding stent. There were no major complications, achieving an effective bleeding control in all cases.(AU)

Utilidad de la tecnología CAD/CAM en la fabricación de prótesis dentales

La tecnología CAD/CAM es una forma innovadora relacionada con la implementación de técnicas digitales para mejorar las restauraciones prostéticas en un paciente, entre ellas, las destinadas a la estética dental. El presente estudio tiene el objetivo de describir la utilidad de la tecnología CAD/CAM en la fabricación de prótesis dentales. Para ello se realizó una revisión de la literatura médica disponible en las bases de datos PubMed/Medline, Scopus y SciELO, mediante fórmulas de búsqueda avanzada; se seleccionaron artículos en idioma español e inglés. En la actualidad, con esta tecnología se ha logrado combinar estética, resistencia y precisión en la restauración directa, además de garantizarse una mayor duración y años de funcionalidad para cada una de las prótesis, coronas e implantes. La calidad de vida y satisfacción referidas por los pacientes portadores de piezas producidas con esta tecnología, es superior a las manifestadas por aquellos tratados con piezas de fabricación tradicional. El uso de técnicas de inteligencia artificial y biomateriales representará un cambio cualitativo y cuantitativo en el uso de los sistemas CAD/CAM.

CAD/CAM technology is an innovative way related to the implementation of digital techniques to improve prosthetic restorations in a patient, including those intended for dental aesthetics. The objective of this study is to describe the usefulness of CAD/CAM technology in the dental prostheses manufacture. A review of the medical literature available in the PubMed/Medline, Scopus and SciELO databases was carried out, using advanced search formulas; Articles in Spanish and English were selected. Currently, with this technology it has been possible to combine aesthetics, resistance and precision in direct restoration, in addition to guaranteeing greater duration and years of functionality for each of the prostheses, crowns and implants. The quality of life and satisfaction reported by patients wearing parts produced with this technology is higher than those reported by those treated with traditionally manufactured parts. The use of artificial intelligence and biomaterials techniques will represent a qualitative and quantitative change in the use of CAD/CAM systems.

Effectiveness of pancreatic stent placement in pediatric patients with acute recurrent and chronic pancreatitis.

BACKGROUND: The use of pancreatic prostheses in children with acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) has evolved. The main established indication is the treatment of persistent abdominal pain. This study aimed to evaluate the efficacy of pancreatic stenting for refractory abdominal pain in pediatric patients with ARP and CP. METHODS: We conducted a retrospective case series study. We included patients under 16 years of age diagnosed with ARP and CP in the study. Endoscopic retrograde cholangiopancreatography (ERCP) was performed with the insertion of one and later two pancreatic stents. We evaluated abdominal symptoms before and after treatment, number of changes, duration of treatment, and complications with follow-up at 24 months and after withdrawal. RESULTS: Nine patients with ARP and CP were included in the study: six with undetermined etiology and three with pancreas divisum. The mean age was 12.4 years. Prosthesis placement relieved abdominal pain in 100% of cases, with 3.2 replacement sessions every 6.2 months for 27.4 months, and mild complications (15.7%). One patient experienced pain on removal of the prosthesis and required bypass surgery. CONCLUSION: Pancreatic stent placement in patients with refractory abdominal pain with ARP and CP proved to be effective and safe, providing medium-term symptom relief and minimal complications.

INTRODUCCIÓN: El uso de prótesis pancreáticas en niños con pancreatitis aguda recurrente (PAR) y crónica (PC) ha evolucionado. La principal indicación establecida es el tratamiento del dolor abdominal persistente. El objetivo de este estudio fue evaluar la eficacia del uso prótesis pancreática para el dolor abdominal refractario en pacientes pediátricos con PAR y PC, sin respuesta a manejo conservador. MÉTODOS: Se llevó a cabo un estudio retrospectivo de serie de casos. Se incluyeron pacientes menores de 16 años con diagnóstico de PAR y PC. Se realizó una colangio pancreatografía retrograda endoscópica (CPRE) para introducir inicialmente una y posteriormente dos prótesis pancreáticas. Se evaluaron síntomas abdominales antes y después del tratamiento, número de recambios, duración del tratamiento y complicaciones con seguimiento a 24 meses y posterior a su retiro. RESULTADOS: Se incluyeron 9 pacientes con PAR y PC: seis de etiología no determinada y tres con páncreas divisum. La edad promedio fue de 12.4 años. La colocación de prótesis alivió el dolor abdominal en el 100%, con 3.2 sesiones de recambio cada 6.2 meses en 27.4 meses, y complicaciones leves (15.7%). Un paciente presentó dolor al retirar las prótesis y requirió cirugía derivativa. CONCLUSIONES: El uso de prótesis pancreática en pacientes con dolor abdominal refractario con PAR y PC demostró ser eficaz y seguro al aliviar los síntomas a mediano plazo con mínimas complicaciones.

Experience in major complications with total trapezometacarpal prostheses. / Experiencia en complicaciones mayores con las prótesis totales trapeciometacarpianas.

INTRODUCTION: The treatment of rhizarthrosis using trapeziometacarpal prostheses (TMP) is increasing. Complications may lead to loss of the implant and result in salvage surgery. Our aim was to assess major complications with the use of some TMP models and their rescue. MATERIAL AND METHOD: Retrospective study on TMP implanted between 2006 and 2021. Models studied: Arpe®, Elektra®, Ivory®, Maïa®, Isis® and Touch®. Demographic data were assessed, implant placement by radiographic study, technical data, complications, salvage surgeries and final survival. RESULTS: Review of 224 TMP, 45 Arpe® (95.5% survival, rate follow-up [R] 6-16 years), 5 Elektra® (80% survival, R 13-14), 14 Ivory® (92.8% survival, R 9-11), 7 Maïa® (100% survival, R 8-9), 115 Isis® (99.1% survival, R 1-8), 38 Touch® (100% survival, R 1-4). The medial angle of the dome with the proximal articular surface of the trapezium in the lateral plane, was: Arpe®: 8.85°, Elektra®: not assessable, Ivory®: 6.6°, Maïa®: 14.4°, Isis®: 3.8°, and Touch®: 5.95°. The Isis® was placed 100% with scopic guidance presenting a significantly lower angle respect to the medial angle of the dome with the proximal articular surface of the trapezium. As main complications, we observed 3.5% of dislocations and 4% of mobilisations, with the Elektra® being responsible for 47% of these. Nineteen salvage surgeries were performed, with 3% of the implants being lost. CONCLUSIONS: Dislocation and mobilisation are the most observed complications, the Elektra® responsible for almost half of them. Correct placement and implant design appear to be crucial to avoid them in the short and long term.