[Simple tibiotalar luxation. Apropos of 16 cases]. / Les luxations tibio-astragaliennes pures. A propos de 16 observations.

Tibiotalar dislocations without fracture are extremely rare lesions. This series included 16 patients, 12 of whom have been examined clinically and radiographically. The purpose of this study was to specify the injury mechanism of the various anatomical types and to assess the long term outcome. The group included eight posteromedial dislocations (50%), four posterior dislocations (25%), one anterior dislocation, one high variety, one of the Huguier type, and one complex dislocation. The sex ratio was 14 males/2 females with an average age of 37 years. In half of the cases, dislocations were open. The average follow-up period was 11 years (range, 1 to 26 years). The eight closed dislocations and the open case type I according to the Cauchoix classification received non-operative treatment by reduction in the emergency room and immobilization in a plaster cast for 6 weeks. The seven patients who presented open dislocations Cauchoix type 2 and type 3 were treated by surgical debridement and ligament repair, followed in all cases by a plaster cast boot, and in two cases by temporary transplantar pinning. Twelve patients were reexamined clinically according to the Gay and Evrard modified score, and were radiographically evaluated with lateral and anteroposterior views focused on the tibiotalar joint, on both sides, static and dynamic. Anatomical factors resulting in predisposition such as medial malleolus shortness or lack of coverage of the talus have been evaluated. No patient presented tibiotalar joint instability. A 5 degrees to 10 degrees loss in the range of dorsiflexion was frequently observed. Two patients presented joint stiffness. In four cases, patients complained about paresthesias in the areas of the anterior tibial nerve or intermediary dorsal cutaneous nerve. Four cases of degenerative arthritis were radiographically observed, two of which presented an overall narrowing of the joint over 50%. Degenerative arthritis had occurred within the first four years in these 4 cases. The talus coverage index was similar to the standard population. Shortness of the medial malleolus was present in only two cases. The long-term prognosis after tibiotalar dislocation without fracture proves to be good. One should favor orthopedic treatment. The absence of tibiotalar instability argues against carrying out emergency ligamentous repair. Evolution towards degenerative arthritis is to be anticipated in 25% of cases, especially following open dislocations, or if transplantar pinning was required due to instability of the initial reduction.

[Influence of the method of measurement of muscle force on results of isolated resections of the head of the radius in the adult]. / Influence de la méthode de mesure de la force musculaire dans les résultats des résections isolées de la tête radiale chez l'adulte.

A statistical study of a group of 50 patients determined the mean difference in grip strength between the dominant and non-dominant hands. For every position of the wrist a mean non-dominant/dominant ratio was calculated. This ratio, 87% in the neutral position, was then used to assess grip strength in relation to the dominance of the injured limb in 15 patients who had undergone 16 radial head excisions, a mean time of 74.4 months earlier. Using this method as a correction factor, results vary considerably according to the functional scoring system used. Loss of grip strength was more frequent and more pronounced in men who had been operated on and in those whom a statistical increase in distal radio-ulnar variance was noted. Loss of grip strength was also greatest when the dominant hand had undergone surgery. Excision of the radial head is still indicated in isolated and comminuted fractures when internal fixation is not possible, especially in less active patients when the non-dominant side is affected.

Infection risk prevention following total knee arthroplasty.

INTRODUCTION: Implant infection is serious; prevention is mandatory, and requires assessment.The present study assessed the incidence of deep surgical-site infection (SSI) at 1 year following total knee arthroplasty (TKA) and adherence to skin preparation, antibiotic prophylaxis,screening and prevention in case of methicillin-resistant S. aureus (MRSA). HYPOTHESIS: Adherence to prevention measures reduces infection risk secondary to TKA. MATERIAL AND METHODS: A prospective study of the incidence of SSI following primary TKA was run from December 1st 2005 to December 31st 2006 in a continuous series of 364 operations in 359 patients, excluding cases of septic or aseptic revision. Each implant was followed up for 12 months. Adherence to practice was assessed by independent observers. Antibiotic prophylaxis was assessed; skin preparation was scored (out of 10); MRSA was systematically screened for, and preventive measures were assessed in positive cases. Median follow-up was 12 months.Patients with less than 11 months' FU were contacted by telephone. Median age was 72 years(range, 45-92 years). Eighty-seven percent of patients had ASA scores of 2; 14% were diabetic,and 42% obese. Mean surgery time was 70 min (range, 30-164 min). Among the implants, 81.5% were cemented. Eighty-six percent of operations had NNIS scores of 0. Infection risk linked to theater environment and teams was under control. RESULTS: Fourteen patients were lost to follow-up and excluded from analysis. The incidence of infection was 1.4% (n = 5/350) (95% CI [0.41-3.22]). Three of the infections were early (

Efectos del consumo elevado de fructosa y sacarosa sobre parámetros metabólicos en ratas obesas y diabéticas / Effects of a high fructose and sucrose intake on metabolic parameters in obese diabetic rats

The relationship between a high consumption of fructose-sweetened foods and obesity and its co-morbidities remains controversial. In this study the effects of three isocaloric and isolipidic diets containing different carbohydrates - fructose, sucrose and starch (AIN 93) - on biomass, abdominal fat depots, blood and liver lipid profile and hepatic histopathology in adult male IIMb/obese and diabetic rats were evaluated. Plasma cholesterol and triacylglycerol were significantly higher in fructose and sucrose groups, while liver lipids showed higher levels in the starch-fed group. There were no differences in hepatic histology in the three groups. The findings of this study support the hypothesis that sugar-rich diets -with fructose or sucrose - replacing starch in equivalent amounts produce similar effects in plasma glucose-lipid profile.

La controversia acerca de si el alto consumo de fructosa ha sido determinante en la prevalencia actual de la obesidad y sus comorbilidades, o si sus efectos son semejantes a los de un consumo equivalente de otros azúcares continúa vigente. En este trabajo se evaluaron los efectos de tres dietas isocalóricas e isolipídicas con fructosa, sacarosa o almidón -como control-, sobre la biomasa, el depósito adiposo abdominal, el perfil glucolipídico sanguíneo y los lípidos y la histología hepáticos en ratas adultas IIMb/β, obesas y diabéticas. Los valores de colesterol y triacilgliceroles plasmáticos fueron mayores en los grupos alimentados con fructosa y sacarosa, mientras que los lípidos hepáticos resultaron mayores en el grupo que consumió almidón. La histología hepática mostró leve esteatosis micro-macro vacuolar en los tres grupos. Los efectos de fructosa y sacarosa sobre las variables evaluadas no fueron diferentes.

La cascarilla de la soja: potencial componente de alimentos funcionales / Soybean hull: potential ingredients for functional foods

The effects of soybean bran, a residue of soybean oil extraction, rich in dietary fiber-both soluble and insoluble -on fat distribution, plasmatic and liver lipids, glycemia and glycemic load, were studied on adult male obese diabetic 0 rats. Two hundred days old ft rats were fed two diets with 15 percent sodium caseinate as protein source and 10 percent dietary fiber from soybean bran (S) or cellulose (C) during 30 and 60 days. Significant diminutions in blood cholesterol levels were registered in group S on day 30 as well as on day 60. Diet S significantly attenuated the characteristic increase in blood triacylglycerols levels and the usual progressive increase in blood glucose levels expressed in this line of rats. Diet S decreased significantly liver total lipids, cholesterol and triacylglycerols compared with C. No differences were registered between groups neither in food intake nor in biomass. These effects are attributed to the combined effects of the soluble and insoluble fiber fractions present in soybean bran. In conclusion, soybean bran may be considered as a useful component of functional foods designed for human nutrition.

Se estudiaron los efectos de la cascarilla o salvado de la soja, con alto contenido de fibra dietaria, de tipo insoluble y soluble, sobre la distribución del tejido adiposo, el perfil lipídico sanguíneo y hepático, la glicemia basal y post sobrecarga glucídica, en ratas adultas de la línea IIMb/p, obesa y diabética. Ejemplares de 200 días fueron alimentados durante 30 y 60 días con dos dietas con caseinato como fuente proteica y 10 g/100g de fibra de salvado de soja (S) o celulosa microcristalina (C). Tanto a los 30 como a los 60 días de tratamiento se constataron niveles de colesterol sérico significativamente menores en el grupo S con respecto a C. Los valores de C fueron asimismo superiores a los del inicio del experimento. La dieta S atenuó el aumento de los triacilgliceroles séricos, manifestado en el grupo C y el progresivo aumento de la glucemia basal habitual en estos roedores. Se registró una significativa disminución de los lípidos totales, el colesterol y los triacilgliceroles hepáticos en el grupo S. Se atribuyen estos efectos, a los mecanismos fisiológicos combinados de las fracciones de fibra del salvado de la soja. Se concluye que este producto podría evaluarse en humanos como un potencial componente de alimentos funcionales.