viernes, 20 de enero de 2017

Los adultos con genu valgum no corregido son típicamente propensos a lesiones y problemas crónicos de rodilla como condromalacia y osteoartritis

Tibial pilon fractures 1

Tibial pilon fractures 1



http://www.traumayortopedia.website/academia/tibial-pilon-fractures-1/





Fuente
Este artículo es originalmente publicado en:




https://youtu.be/Qbdrakuz1QQ



De y Todos los derechos reservados para:




Courtesy: Dr Saqib Rehman MD
Director of Orthopaedic Trauma
Temple University,
Philadelphia, Pennsylvania, USA




Assessment and management of tibial pilon fractures for orthopaedic surgery residents. Lecture 1 of 3. Narrated, annotated video lecture from OrthoClips.com


Scarf de brazo corto

Scarf de brazo corto



http://www.ortopediaenpediatrica.com.mx/academia/scarf-de-brazo-corto/



Fuente
Este artículo es originalmente publicado en:



http://doctoroscarizquierdo.blogspot.mx/2017/01/scarf-de-brazo-corto.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed:+BlogDelDrJoaquinOscarIzquierdo+(Blog+del+Dr.+Joaquin+Oscar+Izquierdo)





De y todos los derechos reservados:

Dr. Joaquin Oscar Izquierdo Cases. 918915057 y 918915040 Centro Clinico Quirurgico Aranjuez

Cirugia Avanzada del Pie y Tobillo CENTRO CLINICO QUIRURGICO C/Foso 156 Aranjuez (Madrid)

www.centroclinicoquirurgico.com





La técnica Scarf es un procedimiento con una gran versatilidad, ya que podemos conseguir corregir la gran mayoría de las deformidades de Hallux Abductus Valgus. Podemos corregir el ángulo intermetatarsal, plantarflexionar, dorsiflexionar, corregir el PASA, acortar o alargar el primer metatarsiano. Por lo tanto estamos ante una de las técnicas que si sabemos manejar correctamente, podemos solucionar muchas de las deformidades que se nos presentan en nuestras clínicas……



Lee el artículo completo AQUÍ

¿Pueden los instrumentos de cribado determinar con precisión un pobre resultado en los adultos con dolor lumbar de aparición reciente? Una revisión sistemática y meta-análisis

¿Pueden los instrumentos de cribado determinar con precisión un pobre resultado en los adultos con dolor lumbar de aparición reciente? Una revisión sistemática y meta-análisis



http://www.columnayortopedia.com.mx/academia/pueden-los-instrumentos-de-cribado-determinar-con-precision-un-pobre-resultado-en-los-adultos-con-dolor-lumbar-de-aparicion-reciente-una-revision-sistematica-y-meta-analisis/



Can screening instruments accurately determine poor outcome risk in adults with recent onset low backpain? A systematic review and meta-analysis



Fuente
Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/?term=Can+screening+instruments+accurately+determine+poor+outcome+risk+in+adults+with+recent+onset+low+back+pain%3F+A+systematic+review+and+meta-analysis

https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-016-0774-4

http://link.springer.com/article/10.1186/s12916-016-0774-4



De:

Karran EL1McAuley JH2,3Traeger AC2,3Hillier SL1Grabherr L1Russek LN4Moseley GL5,6.



Todos los derechos reservados para:



Copyright information

© The Author(s). 2017
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Abstract

BACKGROUND:

Delivering efficient and effective healthcare is crucial for a condition as burdensome as low back pain (LBP). Stratified care strategies may be worthwhile, but rely on early and accurate patient screening using a valid and reliable instrument. The purpose of this study was to evaluate the performance of LBP screening instruments for determining risk of poor outcome in adults with LBP of less than 3 months duration.

CONCLUSIONS:

LBP screening instruments administered in primary care perform poorly at assigning higher risk scores to individuals who develop chronic pain than to those who do not. Risks of a poor disability outcome and prolonged absenteeism are likely to be estimated with greater accuracy. It is important that clinicians who use screening tools to obtain prognostic information consider the potential for misclassification of patient risk and its consequences for care decisions based on screening. However, it needs to be acknowledged that the outcomes on which we evaluated these screening instruments in some cases had a different threshold, outcome, and time period than those they were designed to predict.


Resumen
ANTECEDENTES:
La prestación de asistencia sanitaria eficiente y eficaz es crucial para una condición tan onerosa como el dolor lumbar (LBP). Estrategias de atención estratificadas pueden valer la pena, pero se basan en la detección temprana y precisa del paciente utilizando un instrumento válido y confiable. El propósito de este estudio fue evaluar el desempeño de los instrumentos de cribado LBP para determinar el riesgo de mal resultado en adultos con LBP de menos de 3 meses de duración.


CONCLUSIONES:
LBP instrumentos de detección administrados en atención primaria desempeñan mal en la asignación de mayor puntaje de riesgo a las personas que desarrollan dolor crónico que a los que no lo hacen. Es probable que los riesgos de un resultado de discapacidad deficiente y un absentismo prolongado se estimen con mayor precisión. Es importante que los médicos que usan las herramientas de cribado para obtener información pronóstica consideren la posibilidad de una clasificación errónea del riesgo del paciente y sus consecuencias en las decisiones de atención basadas en el cribado. Sin embargo, hay que reconocer que los resultados en los que evaluamos estos instrumentos de cribado en algunos casos tuvieron un umbral, un resultado y un período de tiempo diferentes de los que fueron diseñados para predecir.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO international prospective register of systematic reviews registration number CRD42015015778 .

KEYWORDS:

Low back pain; Predictive validity; Prognosis; RiskScreening

PMID: 28100231  DOI: 10.1186/s12916-016-0774-4

[PubMed – in process]

Reconstrucción artroscopica de la capsula superior para desgarres irreparables del manguito rotador

Reconstrucción artroscopica de la capsula superior para desgarres irreparables del manguito rotador



Reconstrucción artroscopica de la capsula superior para desgarres irreparables del manguito rotador

Arthroscopic Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears


Fuente
Este artículo es originalmente publicado en:
De:
Todos los derechos reservados:
© 2016 by the Arthroscopy Association of North America.

Abstract
Massive irreparable rotator cuff tears in young patients are a particular challenge for the orthopaedic surgeon. Surgical treatment options include debridement, partial rotator cuff repair, patch-augmented rotator cuff repair, bridging rotator cuff reconstruction with graft interposition, tendon transfer, and reverse total shoulder arthroplasty. Recently, reconstruction of the superior glenohumeral capsule using a fascia lata autograft has been suggested to reduce superior glenohumeral translation and restore superior stability. Promising clinical results have been reported in 1 case series of 23 patients, indicating that superior capsular reconstruction may be a promising tool to manage massive irreparable rotator cuff tears. This article describes our preferred technique for arthroscopic superior capsule reconstruction.
Resumen
Las lesiones irreparables del manguito rotador en pacientes jóvenes son un reto particular para el cirujano ortopédico. Las opciones de tratamiento quirúrgico incluyen desbridamiento, reparación parcial del manguito rotador, reparación del manguito rotador aumentada con parche, reconstrucción del manguito rotador con interposición de injerto, transferencia de tendones y artroplastia total del hombro. Recientemente, se ha sugerido la reconstrucción de la cápsula glenohumeral superior usando un autoinjerto de fascia lata para reducir la traducción glenohumeral superior y restaurar la estabilidad superior. Se han publicado resultados clínicos prometedores en 1 serie de casos de 23 pacientes, lo que indica que la reconstrucción capsular superior puede ser una herramienta prometedora para manejar roturas irrefutables masivas del manguito de los rotadores. Este artículo describe nuestra técnica preferida para la reconstrucción de la cápsula superior artroscópica.
PMID: 27284506   PMCID:  
DOI:  
[PubMed]

Desarrollo psicosexual infantil: información para orientar la práctica clínica

Estimado Ciberpediatra te invito al Seminario de Pediatría, Cirugía Pediátrica y Lactancia Materna. El día 25 de Enero 2017 las 21hrs (Centro, México DF, Guadalajara y Lima Perú) a la Conferencia: “Desarrollo psicosexual infantil: información para orientar la práctica clínica”, por la Dra. “Corina Aracely García Piña”, Pediatra de la Cd de México. La sesión inicia puntualmente las 21 hrs.


Para entrar a la Sala de Conferencia:

1.- hacer click en la siguiente liga, o cópiala y escríbela en tu buscador
http://connectpro60196372.adobeconnect.com/desarrollo_psicosexual/
2.- “Entra como Invitado” Escribes tu nombre y apellido en el espacio en blanco
3.- Hacer click en el espacio que dice “Entrar en la Sala”
5.- A disfrutar la conferencia
6.- Recomendamos que dejes tu Nombre Completo, Correo electrónico y que participes.

Henrys


Dr. Enrique Mendoza López Webmaster: CONAPEME Coordinador Nacional: Seminario Ciberpeds-Conapeme Av La clinica 2520-310 Colonia Sertoma ,Mty N.L. México CP 64710 Tel-Fax 52 81 83482940 y 52 81 81146053 Celular 8183094806 www.conapeme.org www.pediatramendoza.com enrique@pediatramendoza.com emendozal@yahoo.com.mx

Resultados posteriores a un reemplazo de rodilla unicompartimental medial no cementado “Oxford”- Incidencia de lineas radio lucidas.

Resultados posteriores a un reemplazo de rodilla unicompartimental medial no cementado “Oxford”- Incidencia de lineas radio lucidas.



http://www.mishuesosyarticulaciones.com.mx/academia/resultados-posteriores-a-un-reemplazo-de-rodilla-unicompartimental-medial-no-cementado-oxford-incidencia-de-lineas-radio-lucidas/



Results after Cementless Medial Oxford Unicompartmental Knee Replacement – Incidence of Radiolucent Lines

Fuente
Este artículo es originalmente publicado en:



https://www.ncbi.nlm.nih.gov/pubmed/28103308

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0170324



De:

Panzram B1Bertlich I1Reiner T1Walker T1Hagmann S1Weber MA2Gotterbarm T1.



Todos los derechos reservados para:

REPRODUCTION OF ARTICLES

Articles and accompanying materials published by PLOS on the PLOS Sites, unless otherwise indicated, are licensed by the respective authors of such articles for use and distribution by you subject to citation of the original source in accordance with the Creative Commons Attribution (CC BY) license.



Abstract

PURPOSE:

Tibial radiolucent lines (RL) are commonly seen in cemented unicompartmental knee replacement (UKR). In the postoperative course, they can be misinterpreted as signs of loosening, thus leading to unnecessary revision. Since 2004, a cementless OUKR is available. First studies and registry data have shown equally good clinical results of cementless OUKR compared to the cemented version and a significantly reduced incidence of RL in cementless implants.

CONCLUSIONS:

After cementless implantation RL were limited to the tibia, partial and never progressive. During short term follow-up the incidence of RL decreased significantly. RL seem to have no influence on clinical outcome and revision.


Resumen
PROPÓSITO:
Las líneas radiolúcidas tibiales (RL) se observan comúnmente en el reemplazo de rodilla unicompartimental cementado (UKR). En el postoperatorio, pueden ser mal interpretados como signos de aflojamiento, lo que conduce a una revisión innecesaria. Desde 2004, un OUKR sin cemento está disponible. Los primeros estudios y datos de registro han mostrado resultados clínicos igualmente buenos de OUKR sin cemento en comparación con la versión cementada y una incidencia significativamente reducida de RL en implantes sin cemento.


CONCLUSIONES:
Después de la implantación sin cemento RL se limitaron a la tibia, parcial y nunca progresiva. Durante el seguimiento a corto plazo la incidencia de RL disminuyó significativamente. RL parecen no tener influencia en el resultado clínico y la revisión.


PMID: 28103308 DOI:   10.1371/journal.pone.0170324

Dexmedetomidina en UCI / Dexmedetomidine in ICU

Enero 20, 2017. No. 2575







Dosis bajas de dexmedetomidina para la profilaxis de delirio perioperatorio en UCI. ¿Cuánta evidencia es suficiente?
Low dose dexmedetomidine for the prophylaxis of perioperative ICU delirium-how much evidence is enough?
J Thorac Dis. 2016 Nov;8(11):3020-3023. doi: 10.21037/jtd.2016.11.30.

Uso no autorizado de dexmedetomidina para el tratamiento del delirio en la Unidad de Cuidados Intensivos.
Off-Label Use of Dexmedetomidine for the Treatment of Delirium in the Intensive Care Unit.
P T. 2016 Oct;41(10):642-643.
Abstract
OBJECTIVE: Evaluate recent clinical studies involving the use of dexmedetomidine (DEX) infusion for the treatment of delirium in the intensive care unit (ICU). METHODS: A literature search was conducted to identify peer-reviewed articles in MEDLINE (1966-June 2016) using the terms sedation, analgesic, dexmedetomidine, delirium, and critically ill adult patients. RESULTS: Two studies in the ICU setting reported the potential benefits of DEX for managing agitation during weaning from mechanical ventilation. One pilot study and a clinical trial reported the use of DEX in the treatment of ICU delirium. CONCLUSION: Further studies are required to evaluate the use of DEX treatment in critically ill patients presenting with delirium.
KEYWORDS: critically ill patients; delirium; dexmedetomidine
Agonistas alfa2 para sedación prolongada durante ventilación mecánica en pacienytes graves
Alpha-2 agonists for long-term sedation during mechanical ventilation in critically ill patients.
Cochrane Database Syst Rev. 2015 Jan 6;1:CD010269. doi: 10.1002/14651858.CD010269.pub2.
Abstract
BACKGROUND: Sedation reduces patient levels of anxiety and stress, facilitates the delivery of care and ensures safety. Alpha-2 agonists have a range of effects including sedation, analgesia and antianxiety. They sedate, but allow staff to interact with patients and do not suppress respiration. They are attractive alternatives for long-term sedation during mechanical ventilation in critically ill patients. OBJECTIVES: To assess the safety and efficacy of alpha-2 agonists for sedation of more than 24 hours, compared with traditional sedatives, in mechanically-ventilated critically ill patients. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 10, 2014), MEDLINE (1946 to 9 October 2014), EMBASE (1980 to 9 October 2014), CINAHL (1982 to 9 October 2014), Latin American and Caribbean Health Sciences Literature (1982 to 9 October 2014), ISI Web of Science (1987 to 9 October 2014), Chinese Biological Medical Database (1978 to 9 October 2014) and China National Knowledge Infrastructure (1979 to 9 October 2014), the World Health Organization international clinical trials registry platform (to 9 October 2014), Current Controlled Trials metaRegister of controlled trials active registers (to 9 October 2014), the ClinicalTrials.gov database (to 9 October 2014), the conference proceedings citation index (to 9 October 2014) and the reference lists of included studies and previously published meta-analyses and systematic reviews for relevant studies. We imposed no language restriction. SELECTION CRITERIA: We included all randomized and quasi-randomized controlled trials comparing alpha-2 agonists (clonidine or dexmedetomidine) versus alternative sedatives for long-term sedation (more than 24 hours) during mechanical ventilation in critically ill patients. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study quality and extracted data. We contacted study authors for additional information. We performed meta-analyses when more than three studies were included, and selected a random-effects model due to expected clinical heterogeneity. We calculated the geometric mean difference for continuous outcomes and the risk ratio for dichotomous outcomes. We described the effects by values and 95% confidence intervals (CIs). We considered two-sided P < 0.05 to be statistically significant. MAIN RESULTS: Seven studies, covering 1624 participants, met the inclusion criteria. All included studies investigated adults and compared dexmedetomidine with traditional sedatives, including propofol, midazolam and lorazepam. Compared with traditional sedatives, dexmedetomidine reduced the geometric mean duration of mechanical ventilation by 22% (95% CI 10% to 33%; four studies, 1120 participants, low quality evidence), and consequently the length of stay in the intensive care unit (ICU) by 14% (95% CI 1% to 24%; five studies, 1223 participants, very low quality evidence). There was no evidence that dexmedetomidine decreased the risk of delirium (RR 0.85; 95% CI 0.63 to 1.14; seven studies, 1624 participants, very low quality evidence) as results were consistent with both no effect and appreciable benefit. Only one study assessed the risk of coma, but lacked methodological reliability (RR 0.69; 95% CI 0.55 to 0.86, very low quality evidence). Of all the adverse events included, the most commonly reported one was bradycardia, and we observed a doubled (111%) increase in the incidence of bradycardia (RR 2.11; 95% CI 1.39 to 3.20; six studies, 1587 participants, very low quality evidence). Our meta-analysis provided no evidence that dexmedetomidine had any impact on mortality (RR 0.99; 95% CI 0.79 to 1.24; six studies, 1584 participants, very low quality evidence). We observed high levels of heterogeneity in risk of delirium (I² = 70%), but due to the limited number of studies we were unable to determine the source of heterogeneity through subgroup analyses or meta-regression. We judged six of the seven studies to be at high risk of bias.
AUTHORS' CONCLUSIONS:
In this review, we found no eligible studies for children or for clonidine. Compared with traditional sedatives, long-term sedation using dexmedetomidine in critically ill adults reduced the duration of mechanical ventilation and ICU length of stay. There was no evidence for a beneficial effect on risk of delirium and the heterogeneity was high. The evidence for risk of coma was inadequate. The most common adverse event was bradycardia. No evidence indicated that dexmedetomidine changed mortality. The general quality of evidence ranged from very low to low, due to high risks of bias, serious inconsistency and imprecision, and strongly suspected publication bias. Future studies could pay more attention to children and to using clonidine

Predictores de hipotensión asociada a dexmedetomidina en pacientes graves
Predictors of dexmedetomidine-associated hypotension in critically ill patients.
Int J Crit Illn Inj Sci. 2016 Jul-Sep;6(3):109-114.
Abstract
BACKGROUND: Dexmedetomidine is commonly used for sedation in the Intensive Care Unit (ICU), and its use may be associated with hypotension. We sought to determine predictors of dexmedetomidine-associated hypotension. METHODS: Retrospective, single-center study of 283 ICU patients in four adults ICUs over a 12 month period. Univariate analyses were performed to determine factors associated with dexmedetomidine-related hypotension. Risk factors significant at the 0.20 level in the univariate analysis were considered for inclusion into a step-wise multiple logistical regression model. RESULTS: Hypotension occurred in 121 (42.8%) patients with a median mean arterial pressure (MAP) nadir of 54 mmHg. Univariate analyses showed an association between hypotension and age (P = 0.03), Acute Physiology and Chronic Health Evaluation II (APACHE II) score (P = 0.02), baseline MAP (<0.001), admission to the cardiothoracic ICU (P = 0.05), history of coronary artery disease (P = 0.02), and postcardiac surgery (P = 0.0009). Admission to the medical ICU was associated with a decrease in development in hypotension (P = 0.03). There was a trend for hypotension with weight (P = 0.09) and history of congestive heart failure (P = 0.12) Only MAP prior to initiation (odds ratio [OR] 0.97, 95% confidence interval [95% CI] 0.95-0.99; P < 0.0001), APACHE II scores (OR 1.06, 95% CI 1.01-1.12; P = 0.017), and history of coronary artery disease (OR 0.48, 95% CI 0.26-0.90, P = 0.022) were independently associated with hypotension by multivariable analysis. CONCLUSIONS: Dexmedetomidine-associated hypotension is common. Preexisting low blood pressure, history of coronary artery disease, and higher acuity were identified as independent risk factors for dexmedetomidine-associated hypotension.
5to curso internacional Anestesiologia cardiotoracica_ vascular_ ecocardiografia y circulaci_n extracorporea.


Regional Anesthesiology and Acute Pain Medicine Meeting
April 6-8, 2017, San Francisco, California, USA
ASRA American Society of Regional Anesthesia and Pain Medicine
California Society of Anesthesiologists
Annual Meeting April 27-30, 2017
San Francisco California
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