The Short-Term Effects of Rhythmic Vibrotactile and Auditory Biofeedback on the Gait of Individuals After Weight-Induced Asymmetry.

BACKGROUND: Biofeedback (BFB), the practice of providing real-time sensory feedback has been shown to improve gait rehabilitation outcomes. BFB training through rhythmic stimulation has the potential to improve spatiotemporal gait asymmetries while minimizing cognitive load by encouraging a synchronization between the user's gait cycle and an external rhythm. OBJECTIVE: The purpose of this work was to evaluate if rhythmic stimulation can improve the stance time symmetry ratio (STSR) and to compare vibrotactile to auditory stimulation. Gait parameters including velocity, cadence, stride length, double support time, and step length symmetry, were also examined. METHODOLOGY: An experimental rhythmic stimulation system was developed, and twelve healthy adults (5 males), age 28.42 ± 10.93 years, were recruited to participate in walking trials. A unilateral ankle weight was used to induce a gait asymmetry to simulate asymmetry as commonly exhibited by individuals with lower limb amputation and other clinical disorders. Four conditions were evaluated: 1) No ankle weight baseline, 2) ankle weight without rhythmic stimulation, 3) ankle weight + rhythmic vibrotactile stimulation (RVS) using alternating motors and 4) ankle weight + rhythmic auditory stimulation (RAS) using a singletone metronome at the participant's self-selected cadence. FINDINGS: As expected the STSR became significantly more asymmetrical with the ankle weight (i.e. induced asymmetry condition). STSR improved significantly with RVS and RAS when compared to the ankle weight without rhythmic stimulation. Cadence also significantly improved with RVS and RAS compared to ankle weight without rhythmic stimulation. With the exception of double support time, the other gait parameters were unchanged from the ankle weight condition. There were no statistically significant differences between RVS and RAS. CONCLUSION: This study found that rhythmic stimulation can improve the STSR when an asymmetry is induced. Moreover, RVS is at least as effective as auditory stimulation in improving STSR in healthy adults with an induced gait asymmetry. Future work should be extended to populations with mobility impairments and outside of laboratory settings.

Paratricipital approach for distal humerus fractures.

OBJECTIVE: To report functional outcomes in a case series of distal shaft and distal humeral fractures (AO type 12 and 13) managed with open reduction and internal fixation using paratricipital approach. METHODS: Patients who were intervened between May 2006 and December 2015 were included in the analysis. The Mayo Elbow Performance Score (MEPS), the Disabilities of the Arm, Shoulder and Hand (DASH) score and the visual analogue scale (VAS) were used for functional assessment. RESULTS: Twelve patients were included in this case series, eight (67%) of them were women. The average age was 46 (SD 22). Regarding the type of fracture, three (25%) were classified as 12A1, two (17%) as 12B1, two (17%) as 12B2, three (25%) as 13C1 and two (17%) as 13C2. At most recent average follow-up of 3, 4 years (DS 1,62), the results were: elbow range of flexion-extension 138,3º (SD 15,18), MEPS reached 85,8 (DS 11,7), DASH of 11,8 (SD 10,6) and the mean VAS 1,3 (SD 1,1). At the final evaluation, all fractures had healed. One case presented radial nerve neuropraxia, three cases paresthesias at the ulnar nerve territory, and all of these evolved positively and spontaneously. CONCLUSIONS: In our experience, posterior paratricipital approach is useful and safe for managing the open reduction and internal fixation. It may provide preservation of the triceps and promote an earlier rehabilitation. Functional outcomes were satisfactory in this case series.

Hidatidosis pulmonar bilateral: Reporte de caso / 0 BILATERAL PULMONARY HYDATID DISEASE: CASE REPORT AND REVISION

La hidatidosis es una zoonosis de distribución mundial producida por cestodos del género Echinococcus. Afecta principalmente regiones agrícolas y ganaderas. Es una enfermedad endémica en nuestro país, las mayores incidencias reportadas en Sudamérica corresponden Argentina, Chile, Uruguay y Brasil. El hígado es el principal órgano en el humano, le sigue en frecuencia el pulmón. La clínica suele ser inespecífica. Los síntomas más frecuentes son la tos y el dolor torácico, siendo un hallazgo en estudios imagenológicos. El diagnóstico de sospecha es a través de imágenes, apoyado en antecedentes epidemiológicos y serológicos. La radiografía de tórax asociada a la clínica permite el diagnóstico certero en hasta el 95% de los casos, sin embargo, los avances en la TC y su capacidad de caracterización la han hecho parte habitual del estudio preoperatorio. El tratamiento de la hidatidosis pulmonar es quirúrgico y consiste en la erradicación de los quistes, la corrección de los efectos de la presencia del quiste en el órgano (periquística y cavidad residual) y tratar las complicaciones que el quiste ha provocado en su evolución (fístulas bronquiales y siembra pleural). El tratamiento médico está reservado para quistes múltiples, únicos univesiculares menores de 5cm, pacientes de alto riesgo quirúrgico o inoperables y como quimioprofilaxis pre y postoperatoria. Existe consenso en que la cirugía con preservación de parénquima pulmonar es la elección, reservándose las resecciones pulmonares para aquellos casos en los que el tejido adyacente se encuentra seriamente dañado o infectado o cuando las aéreas de atelectasias son presumiblemente irrecuperables

Hydatidosis is a worldwide distribution zoonosis caused by Cestodes of the genus echinococcus. Mainly affects agricultural and livestock regions. Is an endemic disease in our country, the highest reports in South America correspond to Argentina, Chile, Uruguay and Brazil. The liver is the main target of the parasite, followed in frequency by the lungs. The clinical signs are usually non-specific. Most common symptons are cough and pain chest, being a finding in imaging studies. The presumptive diagnosis is made trough images, support by epidemiological and serological records. The chest x-Ray associated with the clinical symptons allows 95% of accuracy, however advances in CT allows to visualize the difference between the cyst and the normal tissue, this has turned it into a usual step in preoperative studies. The treatment of pulmonary hydatidosis is surgical and consists of the elimination of the cysts, the correction of the effects made by the presence of them in the organ (pericysts and residual cavity) and heal the complications the cysts may have done during the evolution (bronchial fistulas and pleural seeding). The medical treatment (non surgical) is only indicated in multiple cysts or unique uni vesiculares cysts under 5 cm, high risk surgical or inoperable patients and as pre and postoperative chemoprophylaxis. There is general agreement that lung parenchymal preservation surgery is the choice, reserving the pulmonary resections in cases that adjacent tissue is severely damaged of infected or when areas of atelectasis are presumably lost

Tratamiento hormonal del carcinoma avanzado de la glandula mamaria. / Hormonal therapy of advanced breast carcinoma

La hormonoterapia en el carcinoma avanzado de mama ha hallado fundamento en la posibilidad de estudiar los "receptores hormonales" (RE: receptores estrogenicos, RPg: receptores a progesterona, RP: receptores a prolactina) en el tumor primitivo o en las metastasis y establecer un tratamiento hormonal selectivo. Asimismo ellos permitem valorar el pronostico de la enfermedad o relacionarlos con la indicacion de una terapeutica adyuvante con quimioterapicos u hormonas. En 1.690 carcinomas mamarios se efectuo tratamiento hormonal en 310.La determinacion de receptores se realizo en 187 pacientes y se establecio la incidencia de los mismmos de acuerdo a ciertos parametros clinicos con evaluacion de la respuesta al tratamiento endocrino y quimioterapico