Pericentromeric heterochromatin is hierarchically organized and spatially contacts H3K9me2 islands in euchromatin.

Membraneless pericentromeric heterochromatin (PCH) domains play vital roles in chromosome dynamics and genome stability. However, our current understanding of 3D genome organization does not include PCH domains because of technical challenges associated with repetitive sequences enriched in PCH genomic regions. We investigated the 3D architecture of Drosophila melanogaster PCH domains and their spatial associations with the euchromatic genome by developing a novel analysis method that incorporates genome-wide Hi-C reads originating from PCH DNA. Combined with cytogenetic analysis, we reveal a hierarchical organization of the PCH domains into distinct "territories." Strikingly, H3K9me2-enriched regions embedded in the euchromatic genome show prevalent 3D interactions with the PCH domain. These spatial contacts require H3K9me2 enrichment, are likely mediated by liquid-liquid phase separation, and may influence organismal fitness. Our findings have important implications for how PCH architecture influences the function and evolution of both repetitive heterochromatin and the gene-rich euchromatin.

Monitoring of the Implementation of a Breastfeeding Guideline for 6 Years: A Mixed-Methods Study Using an Interrupted Time Series Approach.

BACKGROUND: Current literature provides poor information about the implementation of health-promoting clinical practice guidelines (CPGs) and their longitudinal monitoring. PURPOSE: The aim of this study was to evaluate the longitudinal impact of a CPG implementation program that promotes breastfeeding, its associated quantitative and qualitative indicators, and direct costs. DESIGN: A mixed-methods design with a longitudinal approach was utilized, with an interrupted time series design and the analysis of reports from the implementation program as the qualitative approach. METHODS: The study setting was maternity and pediatric units of a health area in the Spanish health system. The implementation of a CPG for the promotion of breastfeeding was evaluated, which included a pre-implementation year (2011), 3 years of implementation (2012-2014), and 2 years of post-implementation (2015-2016). The sample was composed of mother-infant dyads. A segmented logistic regression analysis was utilized to evaluate the changes in the most important breastfeeding indicators. A deductive thematic content analysis was performed starting with quality indicators and a descriptive economic analysis. FINDINGS: In the 6 years of monitoring, 7,842 mother-infant dyads were recorded. The results of the quantitative indicators showed the presence of four stages: baseline, gain, adjustment, and sustainability or saturation. The breast milk at the first feeding had an increasing slope in the gain stage (24% per quarter; odds ratio [OR] = 1.24, 95% confidence interval [CI] 1.12-1.37). The exclusive breastfeeding at hospital discharge showed significant changes in the period of gain (OR = 2.45, 95% CI 1.95-3.08), which was maintained in the adjustment period, with an increase of 18% in the slope of the gain stage (OR = 1.18, 95% CI 1.06-1.32). The longitudinal distribution of the qualitative indicators showed a greater concentration of indicators towards the first half of each phase. The total cost was 209,575€ ($248,670.17). CONCLUSIONS: The implementation of the breastfeeding CPG showed early, positive, and sustained results in the exclusive breastfeeding rates. The implementation implied the application of a complex intervention, with its qualitative indicators showing a wave-shaped dynamic. CLINICAL RELEVANCE: Our findings contribute to the understanding and evolution of the main indicators of the implementation of a breastfeeding CPG, providing details on the magnitude of the effect, the process of change, and the associated costs.

Using the Knowledge-to-Action Framework to understand experiences of breastfeeding guideline implementation: A qualitative study.

AIM: To examine the perceptions and experiences of health care professionals and mothers in relation to the implementation of a breastfeeding clinical practice guideline (CPG). BACKGROUND: Breastfeeding CPG applications remain limited, and qualitative studies have indicated the need to overcome the perception by professionals of difficulties in applying recommendations. METHODS: A qualitative study was conducted in a Spanish public hospital that implemented the Registered Nurses´ Association of Ontario breastfeeding CPG from 2012 through 2015. Between May and August 2017, 27 semi-structured interviews were conducted with managers, with professionals in maternity and paediatric departments and with mothers. Deductive content analysis was performed following the stages in the Knowledge-To-Action (KTA) Framework. RESULTS: We obtained five main categories: (a) problem as opportunity; (b) adequate context and adapted recommendations; (c) extent of implementation; (d) impact of results; and (e) knowledge use normalization. CONCLUSIONS: The KTA Framework assists understanding of the participation of the main actors in breastfeeding CPG implementation. IMPLICATIONS FOR NURSING MANAGEMENT: The nature of the interventions and the participation of managers, different professionals and mothers in a multi-unit setting generate a complex implementation process that reveals key factors to be taken into account in future CPG implementations.

Factors associated with breastfeeding support from health care professionals by implementing a Clinical Practice Guideline.

BACKGROUND: The prevalence and duration of breastfeeding are at low levels and may be improved by the support of health care professionals. Our objective was to determine the effect of implementing a breastfeeding clinical practice guideline on factors associated with breastfeeding support by health care professionals, adopting a Theory of Planned Behavior approach. METHODS: We conducted an observational, cross-sectional study during 2016 in a health area with implemented clinical practice guideline on breastfeeding, comparing the results with data from a previous cross-sectional study (2011) in the same area, in a standard-care area, and in a Baby-Friendly Hospital Initiative (BFHI)-accredited area. A validated questionnaire (four scales: attitudes, beliefs, subjective norms, and behavioral intention) was completed by professionals in each area. Descriptive analysis was followed by comparisons among the different settings using the chi-square test. RESULTS: In the area with the implemented clinical practice guideline, the professionals scored significantly higher in subjective norms and beliefs than had been recorded in 2011 (preimplementation), and their scores for all four scales were significantly higher than in the standard-care area. Professionals obtained significantly higher scores for subjective norms in the BFHI-accredited area than in the other settings. CONCLUSIONS: Clinical practice guideline implementation improved the responses of professionals on breastfeeding support in subjective norms and beliefs scales. There is a need for activities to assist breastfeeding in a practical manner and for more effective measures to ensure compliance with the International Code of Marketing of Breast-milk Substitutes.

Evaluation of three approaches for real-time monitoring of roller compaction with near-infrared spectroscopy.

Three different approaches have been evaluated for monitoring ribbon density through real-time near-infrared spectroscopy measurements. The roll compactor was operated to produce microcrystalline cellulose (MCC) ribbons of varying densities. The first approach used the slope of the spectra which showed a variation through the ribbon that could be attributed to density. A second qualitative approach was also developed with a principal component analysis (PCA) model with spectra taken in-line during the production of ribbons in an ideal roll pressure range. The PCA (i.e., real-time) density scans show that the model was able to qualitatively capture the density responses resulting from variation in process parameters. The third approach involved multivariate partial least squares (PLS) calibration models developed at wavelength regions of 1,120-1,310 and 1,305-2,205 nm. Also, various PLS models were developed using three reference methods: caliper, pycnometer, and in-line laser. The third approach shows a quantitative difference between the model-predicted and the measured densities. Models developed at high-wavelength region showed highest accuracy compared with models at low-wavelength region. All the PLS models showed a high accuracy along the spectra collected throughout the production of the ribbons. The three methods showed applicability to process control monitoring by describing the changes in density during in-line sampling.

Case Report: Laparoscopic Management of Acute Appendicitis Resulting from Ascaris lumbricoides.

Appendicitis is one of the most common conditions that leads to an acute abdomen. Surgical management is the gold standard for therapy. The main cause of appendicitis is an obstruction in the appendicular lumen. Intestinal ascariasis infection is undoubtedly one of the least frequent. We present a female patient with acute appendicitis resulting from Ascaris lumbricoides as an incidental intraoperative diagnosis.

Pseudotumor of the Maxillary Sinus in a Child with Von Willebrand Disease.

Introduction: Mandibular pseudotumors, also known as blood cysts, are rare complications which occur more frequently in patients with an associated bleeding disorder such as hemophilia. Case Report: We present a case of a 2-year and 6-month-old patient with a hemophilic pseudotumor associated with Von Willebrand's disease, who consulted the emergency room due to spontaneous increase in volume of the left maxillary region, with no previous relevant medical history. Conclusions: Different imaging studies were carried out to characterize the lesion, providing the necessary information for the correct approach. Due to the low prevalence of this complication, we believe it is of vital importance to understand the adequate management in this patient population.

Endoscopy mitigation strategy with telemedicine and low-cost device use for COVID-19 prevention: A fourth-level Colombian center experience.

BACKGROUND AND STUDY AIMS: The COVID-19 outbreak has reorganized surgical team conditions regarding endoscopy. The number of interventions has been reduced, the number of healthcare professionals must be limited, and both the patients and physicians are more protected than ever. PATIENTS AND METHODS: In the highest peak of contagion in Colombia, endoscopy, colonoscopy, and esophagogastroduodenoscopy were performed using a low-cost disposable device. A total of 1388 procedures were performed. Every patient was assessed for symptoms via a telephone call, at the health center, and after the procedure, following specific attention routes. RESULTS: After procedure follow-up, no positive cases of COVID-19 were noted. CONCLUSION: The methodology reduced the risk of infection during the COVID-19 pandemic.

Laparoscopic management of gastric liposarcoma: A case report and review of the literature.

INTRODUCTION: Liposarcoma is one of the most common mesenchymal neoplasms in adults. Predominant locations are the retroperitoneum and limbs, it rarely occurs in the gastrointestinal tract. Gastric liposarcoma is extremely rare, with fewer than 30 cases reported around the world. PRESENTATION OF CASE: Here we present the case of a 70-year-old female patient who was diagnosed with gastric liposarcoma and managed with laparoscopic surgical resection. The patient is currently being followed up and is alive without recurrence 12 months after the operation. DISCUSSION: Gastric liposarcoma approach requires proper diagnosis with computed tomography and endoscopy, in order to develop an adequate surgical plan. Laparoscopic en-bloc resection and gastrointestinal reconstruction is the ideal management in this type of patient. CONCLUSION: Gastric liposarcoma is an extremely rare entity, his management consists of wide en-bloc resection with a gastrointestinal reconstruction.

Barriers Perceived by Managers and Clinical Professionals Related to the Implementation of Clinical Practice Guidelines for Breastfeeding through the Best Practice Spotlight Organization Program.

International institutions facilitate the contact of health professionals to evidence-based recommendations for promoting exclusive breast feeding (BF). However, the achievement of good rates of exclusive BF is still far from the optimum. The intention of the present work is to determine the barriers identified by managers and health professionals involved in the implementation and sustainability of Clinical Practice Guidelines (CPG) for breastfeeding under the auspices of the Best Practice Spotlight Organization program. A qualitative research study was carried out. The participants were managers, healthcare assistants, nurses, midwives, pediatricians and gynecologists. Semi-structured interviews were conducted which were transcribed and analyzed using the six steps of thematic analysis. Twenty interviews were conducted, which defined four major themes: (1) Lack of resources and their adaptation; (2) Where, Who and How; (3) Dissemination and reach of the project to the professionals; and (4) The mother and her surroundings. This research identifies the barriers perceived by the health professionals involved in the implementation, with the addition of the managers as well. Novel barriers appeared such as the ambivalent role of the midwives and the fact that this CPG is about promoting health. The efforts for promoting the implementation program should be continuous, and the services should be extended to primary care.

[Nursing mothers satisfaction with the promotion of breastfeeding and professionals adherence to the recommendations. Multi-center study.] / Satisfacción de madres lactantes con la promoción de la lactancia materna y adherencia de los profesionales a las recomendaciones. Estudio multicéntrico.

OBJECTIVE: The Baby-friendly Hospital Initiative or clinical practice guideline implementation programs have a positive impact on the promotion of breastfeeding (BF). There are knowledge gaps regarding the perceptions of new mothers towards these initiatives, and their degree of satisfaction. Our objective was to describe the satisfaction of BF mothers and adherence to the recommendations of the "Breastfeeding" guide from the Registered Nurses' Association of Ontario (RNAO). METHODS: Between 2018-2019, in 9 Spanish hospitals that implemented the guide, 2,397 nursing mothers were surveyed who met inclusion criteria. A self-administered survey was designed with sociodemographic data, mother-child, BF promotion interventions carried out and degree of satisfaction. Descriptive and bivariate analysis was performed. RESULTS: The recommendations for skin-to-skin contact, help in breastfeeding, observation of a breastfeeding session and resolution of doubts presented adhesions >84%. Information about support groups, rooming-in and recognize signs of baby satisfaction obtained adhesions <40%. The exclusive BF rate at discharge was 77.5%. The mean satisfaction with skin-to-skin contact and the percentage of satisfaction at discharge were 5.8 and 96.8% respectively. The differences were significant between the degree of satisfaction and the educational level, age, work situation, type of delivery and type of hospital (p<0.05). CONCLUSIONS: According to puerperal women, adherence to the recommendations of the Clinical Practice Guide is good for most interventions and the degree of satisfaction is high.

OBJETIVO: La Iniciativa para la Humanización de la Asistencia al Nacimiento y la Lactancia (IHAN) o programas de implantación de Guías de Práctica Clínica tienen impacto positivo en la promoción de la lactancia materna (LM). Existen lagunas respecto a percepciones de las puérperas hacia estas iniciativas y el grado de satisfacción. Nuestro objetivo fue describir la satisfacción de las madres lactantes y la adherencia a las recomendaciones de la guía "Lactancia Materna" de la Registered Nurses´Association of Ontario (RNAO). METODOS: Entre 2018-2019, en 9 hospitales españoles que implantaban la guía se encuestaron 2.397 madres lactantes que cumplieron criterios de inclusión. Se diseñó una encuesta autoadministrada con datos sociodemográficos madre-hijo, intervenciones de promoción de LM realizadas y grado de satisfacción. Se realizó análisis descriptivo y bivariado. RESULTADOS: Las recomendaciones de contacto piel-con-piel, ayuda en el amamantamiento, observación de la toma y resolución de dudas presentaron adherencias >84%. La información sobre grupos de apoyo, alojamiento conjunto y reconocer signos de satisfacción del bebé obtuvieron adherencias <40%. La tasa de LM exclusiva al alta fue 77,5%. La satisfacción media con el contacto piel con piel y el porcentaje de satisfacción al alta fueron 5,8 y 96,8% respectivamente. Las diferencias fueron significativas entre el grado de satisfacción y el nivel de estudios, la edad, la situación laboral, tipo de parto y tipo de hospital (p<0,05). CONCLUSIONES: Según las puérperas, la adherencia a las recomendaciones de la Guía de Práctica Clínica es buena para la mayoría de intervenciones y el grado de satisfacción elevado.

Genetics of P-element transposition into Drosophila melanogaster centric heterochromatin.

Heterochromatin is a major component of higher eukaryotic genomes, but progress in understanding the molecular structure and composition of heterochromatin has lagged behind the production of relatively complete euchromatic genome sequences. The introduction of single-copy molecular-genetic entry points can greatly facilitate structure and sequence analysis of heterochromatic regions that are rich in repeated DNA. In this study, we report the isolation of 502 new P-element insertions into Drosophila melanogaster centric heterochromatin, generated in nine different genetic screens that relied on mosaic silencing (position-effect variegation, or PEV) of the yellow gene present in the transposon. The highest frequencies of recovery of variegating insertions were observed when centric insertions were used as the source for mobilization. We propose that the increased recovery of variegating insertions from heterochromatic starting sites may result from the physical proximity of different heterochromatic regions in germline nuclei or from the association of mobilizing elements with heterochromatin proteins. High frequencies of variegating insertions were also recovered when a potent suppressor of PEV (an extra Y chromosome) was present in both the mobilization and selection generations, presumably due to the effects of chromatin structure on P-element mobilization, insertion, and phenotypic selection. Finally, fewer variegating insertions were recovered after mobilization in females, in comparison to males, which may reflect differences in heterochromatin structure in the female and male germlines. FISH localization of a subset of the insertions confirmed that 98% of the variegating lines contain heterochromatic insertions and that these schemes produce a broader distribution of insertion sites. The results of these schemes have identified the most efficient methods for generating centric heterochromatin P insertions. In addition, the large collection of insertions produced by these screens provides molecular-genetic entry points for mapping, sequencing, and functional analysis of Drosophila heterochromatin.

La filosofía de los cuidados centrados en el desarrollo del recién nacido prematuro (NIDCAP): una revisión de la literatura / The philosophy of the developmental centred care of the premature infant (NIDCAP): a literature review

Objetivo. Conocer las intervenciones de la filosofía de los cuidados centrados en el desarrollo del recién nacido prematuro (NIDCAP) dirigidas a optimizar el macroambiente y el microambiente, junto a las actuaciones orientadas a la familia a fin de favorecer la estabilidad y la organización del desarrollo y la conducta del recién nacido prematuro; y a partir de aquí, evaluar la eficacia de su aplicación. Metodología. Se lleva a cabo una búsqueda bibliográfica (a partir de una serie de criterios de inclusión y exclusión específicos) en castellano y en inglés, durante el periodo 2010 a 2015, en las siguientes bases de datos: PUBMED, THE COCHRANE LIBRARY, SCOPUS, CUIDEN, DIALNET, LILACS, TDR y GOOGLE ACADÉMICO (se recurrió también a determinadas páginas web oficiales). Resultados. Se han centrado en la revisión del Macroambiente (luces, ruidos), el Microambiente (postura, manipulaciones, dolor), la Familia (padres principales cuidadores, método canguro, lactancia materna), y de la Evaluación de la eficacia de la aplicación del NIDCAP. Discusión. Se orienta, fundamentalmente, en la consideración del NIDCAP desde la perspectiva de la realidad (la prematuridad como primera causa de morbimortalidad neonatal e infantil), de la evidencia de la literatura, de la calidad/calidez de los cuidados, del coste económico, y del papel de los profesionales. Conclusiones. No hay evidencia de que el programa NIDCAP mejore el desarrollo neurológico a largo plazo o los resultados médicos a corto plazo, por lo que no se puede recomendar la aplicación del NIDCAP en su forma actual como atención estándar en recién nacidos prematuros. Si bien, al analizar las intervenciones que forman parte de los CCD o del NIDCAP de forma aislada, la mayoría de ellas se justifican desde el sentido común, la sensibilidad en los cuidados y el respeto a la familia y al niño (AU)

Objective: The purpose of this bibliographic revision is to have a better understanding of the philosophy of developmental centered care of the premature infant: NIDCAP. These interventions are aimed at optimising the macroenvironment and microenvironment, together with actions aimed at the family in order to promote stability and the organisation of the development and behaviour of the premature newborn; and from here, to evaluate the effectiveness of its application. Methodology: The methodology stems from a bibliographic research (using inclusion and exclusion criteria) in Spanish and English language, during the period between 2010 and 2015. The data bases used are the following: PUBMED, THE COCHRANE LIBRARY, SCOPUS, CUIDEN, DIALNET, LILACS, TDR y GOOGLE ACADÉMICO (certain official web pages have also been used). Results: They have been focused on the revision of macroenvironment (light, noise), microenvironment (posture, manipulation, pain) ,the family (parents as main caretakers of the premature infant, Kangaroo Method, breastfeeding) and the evaluation of the effectiveness of NIDCAP implementation. Discussion: It is basically aimed at the consideration of NIDCAP from the perspective of reality (prematurity as the main cause of neonatal and infant morbidity and mortality), the literature evidence, quality/warmth of the cares, economic cost, and the professional roles. Conclusions: There is no evidence that NIDCAP programme improves the neurologic development in the long term or the medical results in the short term, therefore, NIDCAP implementation in its current form as standard care in premature infants cannot be recommended. However, when we analyze the interventions that take part of the CCD or NIDCAP in isolation, most of them are justified in terms of common sense, sensitivity in cares and respect to the family and child (AU)

Satisfacción de madres lactantes con la promoción de la lactancia materna y adherencia de los profesionales a las recomendaciones. Estudio multicéntrico / Nursing mothers satisfaction with the promotion of breastfeeding and professionals adherence to the recommendations. Multi-center study

OBJETIVO: La Iniciativa para la Humanización de la Asistencia al Nacimiento y la Lactancia (IHAN) o programas de implantación de Guías de Práctica Clínica tienen impacto positivo en la promoción de la lactancia materna (LM). Existen lagunas respecto a percepciones de las puérperas hacia estas iniciativas y el grado de satisfacción. Nuestro objetivo fue describir la satisfacción de las madres lactantes y la adherencia a las recomendaciones de la guía "Lactancia Materna" de la Registered Nurses'Association of Ontario (RNAO). MÉTODOS: Entre 2018-2019, en 9 hospitales españoles que implantaban la guía se encuestaron 2.397 madres lactantes que cumplieron criterios de inclusión. Se diseñó una encuesta autoadministrada con datos sociodemográficos madre-hijo, intervenciones de promoción de LM realizadas y grado de satisfacción. Se realizó análisis descriptivo y bivariado. RESULTADOS: Las recomendaciones de contacto piel-con-piel, ayuda en el amamantamiento, observación de la toma y resolución de dudas presentaron adherencias >84%. La información sobre grupos de apoyo, alojamiento conjunto y reconocer signos de satisfacción del bebé obtuvieron adherencias <40%. La tasa de LM exclusiva al alta fue 77,5%. La satisfacción media con el contacto piel con piel y el porcentaje de satisfacción al alta fueron 5,8 y 96,8% respectivamente. Las diferencias fueron significativas entre el grado de satisfacción y el nivel de estudios, la edad, la situación laboral, tipo de parto y tipo de hospital (p < 0,05). CONCLUSIONES: Según las puérperas, la adherencia a las recomendaciones de la Guía de Práctica Clínica es buena para la mayoría de intervenciones y el grado de satisfacción elevado

OBJECTIVE: The Baby-friendly Hospital Initiative or clinical practice guideline implementation programs have a positive impact on the promotion of breastfeeding (BF). There are knowledge gaps regarding the perceptions of new mothers towards these initiatives, and their degree of satisfaction. Our objective was to describe the satisfaction of BF mothers and adherence to the recommendations of the "Breastfeeding" guide from the Registered Nurses' Association of Ontario (RNAO). METHODS: Between 2018-2019, in 9 Spanish hospitals that implemented the guide, 2,397 nursing mothers were surveyed who met inclusion criteria. A self-administered survey was designed with sociodemographic data, mother-child, BF promotion interventions carried out and degree of satisfaction. Descriptive and bivariate analysis was performed. RESULTS: The recommendations for skin-to-skin contact, help in breastfeeding, observation of a breastfeeding session and resolution of doubts presented adhesions >84%. Information about support groups, rooming-in and recognize signs of baby satisfaction obtained adhesions <40%. The exclusive BF rate at discharge was 77.5%. The mean satisfaction with skin-to-skin contact and the percentage of satisfaction at discharge were 5.8 and 96.8% respectively. The differences were significant between the degree of satisfaction and the educational level, age, work situation, type of delivery and type of hospital (p < 0.05). CONCLUSIONS: According to puerperal women, adherence to the recommendations of the Clinical Practice Guide is good for most interventions and the degree of satisfaction is high

Sequence finishing and mapping of Drosophila melanogaster heterochromatin.

Genome sequences for most metazoans and plants are incomplete because of the presence of repeated DNA in the heterochromatin. The heterochromatic regions of Drosophila melanogaster contain 20 million bases (Mb) of sequence amenable to mapping, sequence assembly, and finishing. We describe the generation of 15 Mb of finished or improved heterochromatic sequence with the use of available clone resources and assembly methods. We also constructed a bacterial artificial chromosome-based physical map that spans 13 Mb of the pericentromeric heterochromatin and a cytogenetic map that positions 11 Mb in specific chromosomal locations. We have approached a complete assembly and mapping of the nonsatellite component of Drosophila heterochromatin. The strategy we describe is also applicable to generating substantially more information about heterochromatin in other species, including humans.

Salvamento del pie diabético / Salvatage for diabetic foot

Se revisaron 27 pacientes diabèticos con enfermedad arterial documentada por angiografía y pie diabètico infectado, en un periodo de 42 meses. Todos fueron manejados inicialmente con medidas de higiene venosa, desbridación de tejido desvitalizado e infectado, antibioticoterapia y control metabólico. La cirugía reconstructora siempre se realiza cuando las condiciones locales y generales han mejorado. En ningún paciente se realizó procedimiento vascular y reconstructor en forma simultànea. De los 27 pacientes: 8 se presentaron con exposición del dorso del pie (tendones y hueso), 5 con úlceras plantares, 5 con necrosis parcial de la punta de los ortejos, 3 con exposición de mal,olo y 6 con exposición de tibia y rodilla. Las cirugías incluyeron 3 colgajos de músculo gemelo, 3 fasciocut neos, 5 colgajos locales de piel y 27 injertos. No hubo fallecimientos. Como complicaciones hubo un paciente con lisis del injerto por candida, neoformación de úlceras en 3 ocasiones en un mismo paciente en nuevas àreas anatómicas, 3 pacientes con sepsis. El tratamiento combinado para reconstrucción de úlceras en extremidad inferior ha dado excelentes resultados en la mayoría de los pacientes.

Lesión de Monteggia. Experiencia del Hospital Infantil de México "Federico Gómez" / The Monteggia lesion. the experience of the Mexico Childrens Hospital \"Dr. Federico Gómez\"

Se presenta una serie de 13 casos de lesión de Monteggia de los cuales 7 correspondieron al tipo III, 5 al tipo I y uno al tipo II. En la presente serie no hubo del tipo IV. El tratamiento consistió en manipulación cerrada inicial en todos, excepto en uno que se negó a ser tratado. De los 12 restantes en 8 el tratamiento cerrado fue suficiente y en 4 se requirió reducción abierta del cúbito y su fijación con un clavo intramedular de Steinmann por 6 semanas en promedio. En un caso persistio subluxación de la cabeza radial, que requirió revisión quirúrgica. En 3 ocurrió neuropraxia del nervio radial que se recuperó después de rehabilitación y órtesis. El movimiento se recuperó en 9 casos. En los restantes 3 quedó limitada al prono-supinación, 2 del tipo III y uno del tipo I

Osteotomía innominada de Salter y cotiloplastía de Michel Salmon en la luxación congénita de cadera. Experiencia de 30 años / Salter innominate osteotomy and the Michel-Salmon classic shelf for treatment of developmental dysplasia of the hip. Our 30-year experience

Se presenta un estudio comparativo entre dos procedimientos quirúrgicos realizados para el tratamiento de la displasia acetabular en 48 pacientes con displasia de desarrollo de la cadera, que fueron tratados entre 1964 y 1994. Los enfermos se distribuyeron en 2 grupos, en el primero, a 27 se les hizo osteotomía iliaca tipo Salter con un índice acetabular en promedio de 34 grados (DE 5.6 grados). Después de un periodo de 6.4 años en promedio de postoperatorio el índice acetabular fue de 22 grados (DE 4 grados). El segundo grupo estuvo integrado por 27 enfermos a quienes se les hizo la cotiloplastía de Michel-Salmon, con un índice acetabular preoperatorio de 30 grados en promedio (DE 4.3 grados) y postoperatorio de 20 grados (DE 4.1 grados)

Tumores óseos malignos en niños. Tratamiento quirúrgico / Bone malignant tumors in children: Surgical treatment. epidemiologic review

Se revisaron 41 pacientes con tumores óseos malignos y un paciente con tumor benigno (tumor de células gigantes) con alto grado de agresividad, los cuales fueron tratados por el Servicio de Oncología, Patología y Ortopedia Pediátrica, en un periodo comprendido de enero de 1989 a octubre de 1995, en el Hospital Infantil de México "Federico Gómez". El osteosarcoma fue el tumor más representativo con 32 casos, le siguió el sarcoma de Ewing con 4 casos, el fibrosarcoma infantil con 2 casos, el rabdomiosarcoma con 2 casos, un linfoma de Hodgkin y un tumor de células gigantes. El sexo más afectado fue el masculino con 23 casos, por 19 femeninos. La edad de presentación fue de 2 menores de 5 años, 17 de 6 a 10 años, 19 de 11 a 15 años y 4 de 16 a 20 años. El segmento óseo más afectado fue el fémur con 28 casos, siguiendo la tibia con 6 casos, el iliaco con 3 casos, el pie con 2 casos, húmero y escápula con un caso. El síntoma principal fue el dolor en 33 casos, aumento de volumen en 40 casos, trauma previo en 18 casos. El tratamiento quirúrgico fue: 7 desarticulaciones, 6 amputaciones, 1 resección quirúrgica, 1 hemipelvectomía, 5 pendientes de tratamiento quirúrgico, 7 prótesis no convencionales, 1 endoprótesis tumoral tibial y 2 clavos centromedulares especiales la cirugía se llevó a cabo despúes de quimio y/o radioterápia

Hemofilia y osteosarcoma. Informe de un caso / hemophilia and osteosarcoma. Case report

La hemofilia es una enfermedad relativamente rara, puede haber pacientes portadores, que si nunca sufren un traumatismo grave pueden no ser descubiertos. Tanto la hemofilia ®A¼ como la ®B¼ o enfermedad de Christmas se heredan de modo recesivo ligado al cromosoma ®X¼, con un incidencia de 10 hemofílicos, por cada 100 varones nacidos. El pseudotumor es un hecho relativamente raro, su incidencia se ha calculado en 1 por ciento al 2 por ciento en hemofílicos graves, en el pseudotumor que se origina a partir de una hemorragia subperióstica puede ocurrir una significativa destrucción ósea, se reporta el caso de un paciente masculino de 17 años de edad con el diagnóstico de hemofilia tipo ®B¼, tratada desde los 6 años, a esta edad presentó un pseudotumor en fémur izquierdo, a la edad de 17 años presenta probable pseudotumora en húmero izquierdo, posterior a la biopsia se reporta sarcoma osteogénico, iniciándose quimioterapia (2 ciclos a base de adriamicina y cisplatino), practicándosele desarticulación de dicho miembro, falleció 8 meses después de la cirugía con metástasis múltiples