martes, 16 de enero de 2018

Resultados después de la artroplastia de cabeza radial en fracturas inestables

www.mihombroycodo.com.mx/academia/resultados-despues-de-la-artroplastia-de-cabeza-radial-en-fracturas-inestables/

Results after radial head arthroplasty in unstable fractures


Fuente
Este artículo

https://www.ncbi.nlm.nih.gov/pubmed/29332663

http://www.jshoulderelbow.org/article/S1058-2746(17)30671-7/fulltext


De:

Lott A1, Broder K1, Goch A1, Konda SR1, Egol KA2.

2018 Feb;27(2):270-275. doi: 10.1016/j.jse.2017.10.011.


Todos los derechos reservados para:

Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.



Abstract

BACKGROUND:

Whereas most radial head fractures are stable injuries, they sometimes occur as part of complex injury patterns with associated elbow instability. Radial head arthroplasty has been favored in patients with unreconstructable radial head fractures and unstable elbow injuries. The purpose of this study was to review radiographic outcomes, functional outcomes, and complications after radial head arthroplasty for radial head fracture in unstable elbow injuries.

CONCLUSIONS:

Radial head arthroplasty is an effective option for treatment of unstable elbow injuries, with recovery of functional elbow range of motion and no difference in complication rate or implant survivorship compared with those patients with stable injuries.

KEYWORDS:

Radial head arthroplasty; complications; elbow instability; flexion arc of elbow motion; rotational arc of elbow motion; unstable elbow injuries



Resumen


ANTECEDENTES:

Mientras que la mayoría de las fracturas de cabeza radial son lesiones estables, a veces ocurren como parte de patrones de lesión complejos con inestabilidad asociada del codo. La artroplastia de cabeza radial se ha visto favorecida en pacientes con fracturas de cabeza radial irreconstruibles y lesiones inestables del codo. El propósito de este estudio fue revisar los resultados radiográficos, los resultados funcionales y las complicaciones después de la artroplastia radial de cabeza para la fractura de la cabeza radial en lesiones inestables del codo.

CONCLUSIONES:

La artroplastia de cabeza radial es una opción efectiva para el tratamiento de lesiones inestables del codo, con recuperación del rango de movimiento funcional del codo y sin diferencias en la tasa de complicaciones o la supervivencia del implante en comparación con los pacientes con lesiones estables.

PALABRAS CLAVE:

Artroplastia de cabeza radial; complicaciones; inestabilidad del codo; arco de flexión del movimiento del codo; arco rotacional de movimiento del codo; lesiones inestables del codo

Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

PMID:  29332663   DOI:  10.1016/j.jse.2017.10.011

LAS "MILAGROSAS" CÉLULAS MADRE

Un estudio de supervivencia de 838 reemplazos totales del codo: un informe del Registro Noruego de Artroplastia 1994-2016.

http://www.mihombroycodo.com.mx/academia/un-estudio-de-supervivencia-de-838-reemplazos-totales-del-codo-un-informe-del-registro-noruego-de-artroplastia-1994-2016/


A survivorship study of 838 total elbow replacements: a report from the Norwegian Arthroplasty Register 1994-2016.


Fuente
Este artículo es publicado originalmente en:

https://www.ncbi.nlm.nih.gov/pubmed/29332662

http://www.jshoulderelbow.org/article/S1058-2746(17)30678-X/fulltext


De:

Krukhaug Y1, Hallan G2, Dybvik E3, Lie SA2, Furnes ON2.

2018 Feb;27(2):260-269. doi: 10.1016/j.jse.2017.10.018.


Todos los derechos reservados para:

Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.


Abstract

BACKGROUND:

The aim of this study was to present the long-term survivorship (20 years) of total elbow arthroplasty (TEA) for a relatively large population and to compare different prosthesis brands and patient subgroups.

CONCLUSION:

Fairly good results in terms of prosthesis survival were obtained with TEA, although results were poorer than for knee and hip arthroplasties.

KEYWORDS:

Elbow arthroplasty; acute elbow fracture; fixation method; inflammatory arthritis; national arthroplasty register; osteoarthritis; prosthesis survival



Resumen


ANTECEDENTES:

El objetivo de este estudio fue presentar la supervivencia a largo plazo (20 años) de la artroplastia total de codo (TEA) para una población relativamente grande y comparar diferentes marcas de prótesis y subgrupos de pacientes.

CONCLUSIÓN:

Se obtuvieron resultados bastante buenos en términos de supervivencia de la prótesis con TEA, aunque los resultados fueron más pobres que para las artroplastias de rodilla y cadera.

PALABRAS CLAVE:

Artroplastia de codo; fractura aguda del codo; método de fijación; artritis inflamatoria; registro nacional de artroplastia; osteoartritis; prótesis de supervivencia

Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

PMID:  29332662   DOI:   10.1016/j.jse.2017.10.018

Ketamina en depresión mayor / Ketamina for major depression

Enero 16, 2018. No. 2965

Con este tercer envío consecutivo sobre ketamina en depresión mayor esperamos que hayamos motivado su interés y curiosidad científica sobre este apasionante tema. Hay mucha información disponible y actualizada que con seguridad terminará en la aprobación de este anestésico general como una novel droga antidepresiva de rápido inicio. 

With this third consecutive e-mail on ketamine in major depression, we hope that we have motivated your interest and scientific curiosity on this exciting topic. There is a lot of information available and updated that will surely end in the approval of this general anesthetic as a novel fast-acting antidepressant drug.

Avec cette troisième expédition consécutive sur la kétamine dans la dépression majeure, nous espérons que nous avons motivé votre intérêt et votre curiosité scientifique sur ce sujet passionnant. Il y a beaucoup d'informations disponibles et mises à jour qui finiront sûrement par l'approbation de cette anesthésie générale en tant que nouveau médicament antidépresseur à action rapide.
Disección molecular y celular de subtipos de receptores NMDA como dianas antidepresivas.
Molecular and cellular dissection of NMDA receptor subtypes as antidepressant targets.
Neurosci Biobehav Rev. 2018 Jan;84:352-358. doi: 10.1016/j.neubiorev.2017.08.012. Epub 2017 Aug 23.
Abstract
A growing body of evidence supports the idea that drugs targeting the glutamate system may represent a valuable therapeutic alternative in major depressive disorders (MDD). The rapid and prolonged mood elevating effect of the NMDA receptor (NMDAR) antagonist ketamine has been studied intensely. However, its clinical use is hampered by deleterious side-effects, such as psychosis. Therefore, a better understanding of the mechanisms of the psychotropic effects after NMDAR blockade is necessary to develop glutamatergic antidepressants with improved therapeutic profile. Here we review recent experimental data that addressed molecular/cellular determinants of the antidepressant effect mediated by inactivating NMDAR subtypes. We refer to results obtained both in pharmacological and genetic animal models, ranging from global to conditional NMDAR manipulation. Our main focus is on the contribution of different NMDAR subtypes to the psychoactive effects induced by NMDAR ablation/blockade. We review data analyzing the effect of NMDAR subtype deletions limited to specific neuronal populations/brain areas in the regulation of mood. Altogether, these studies suggest effective and putative specific NMDAR drug targets for MDD treatment.
KEYWORDS: Depression; GluN2 subunits; Glutamate; Ketamine; Molecular biology; NMDA receptors
Uso de terapia repetida con ketamina intravenosa en la depresión bipolar resistente al tratamiento con comportamiento suicida: informe de un caso de España.
Use of repeated intravenous ketamine therapy in treatment-resistant bipolar depression with suicidal behaviour: a case report from Spain.
Ther Adv Psychopharmacol. 2017 Apr;7(4):137-140. doi: 10.1177/2045125316675578. Epub 2017 Jan 1.
Abstract
The rapidly-acting antidepressant properties of ketamine are a trend topic in psychiatry. Despite its robust effects, these are ephemeral and can lead to certain adverse events. For this reason, there is still a general concern around the off-label use of ketamine in clinical practice settings. Nonetheless, for refractory depression, it should be an indication to consider. We report the case of a female patient admitted for several months due to a treatment-resistant depressive bipolar episode with chronic suicidal behaviour. After repeated intravenous ketamine infusions without remarkable side effects, the patient experienced a complete clinical recovery during the 4 weeks following hospital discharge. Unfortunately, depressive symptoms reappeared in the 5th week, and the patient was finally readmitted to hospital as a result of a suicide attempt.
KEYWORDS: antidepressive agents; bipolar disorder; depression; ketamine; suicide
La administración aguda de ketamina corrige los marcadores óseos inflamatorios anormales en el trastorno depresivo mayor.
Acute ketamine administration corrects abnormal inflammatory bone markers in major depressive disorder.
Mol Psychiatry. 2017 May 30. doi: 10.1038/mp.2017.109. [Epub ahead of print]
Abstract
Patients with major depressive disorder (MDD) have clinically relevant, significant decreases in bone mineral density (BMD). We sought to determine if predictive markers of bone inflammation-the osteoprotegerin (OPG)-RANK-RANKL system or osteopontin (OPN)-play a role in the bone abnormalities associated with MDD and, if so, whether ketamine treatment corrected the abnormalities. The OPG-RANK-RANKL system plays the principal role in determining the balance between bone resorption and bone formation. RANKL is the osteoclast differentiating factor and diminishes BMD. OPG is a decoy receptor for RANKL, thereby increasing BMD. OPN is the bone glue that acts as a scaffold between bone tissues matrix composition to bind them together and is an important component of bone strength and fracture resistance. ...
We conclude that the OPG-RANK-RANKL system and the OPN system play important roles in the serious bone abnormalities associated with MDD. These data suggest that, in addition to its antidepressant effects, ketamine also has a salutary effect on a major medical complication of depressive illness. 
Nuevas estrategias de tratamiento de la depresión: basadas en mecanismos relacionados con la neuroplasticidad.
New Treatment Strategies of Depression: Based on Mechanisms Related to Neuroplasticity.
Huang YJ1, Lane HY1,2,3, Lin CH2,4,5.
Neural Plast. 2017;2017:4605971. doi: 10.1155/2017/4605971. Epub 2017 Apr 11.
Abstract
Major depressive disorder is a severe and complex mental disorder. Impaired neurotransmission and disrupted signalling pathways may influence neuroplasticity, which is involved in the brain dysfunction in depression. Traditional neurobiological theories of depression, such as monoamine hypothesis, cannot fully explain the whole picture of depressive disorders. In this review, we discussed new treatment directions of depression, including modulation of glutamatergic system and noninvasive brain stimulation. Dysfunction of glutamatergic neurotransmission plays an important role in the pathophysiology of depression. Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, has rapid and lasting antidepressive effects in previous studies. In addition to ketamine, other glutamatergic modulators, such as sarcosine, also show potential antidepressant effect in animal models or clinical trials. Noninvasive brain stimulation is another new treatment strategy beyond pharmacotherapy. Growing evidence has demonstrated that superficial brain stimulations, such as transcranial magnetic stimulation, transcranial direct current stimulation, cranial electrotherapy stimulation, and magnetic seizure therapy, can improve depressive symptoms. The antidepressive effect of these brain stimulations may be through modulating neuroplasticity. In conclusion, drugs that modulate neurotransmission via NMDA receptor and noninvasive brain stimulation may provide new directions of treatment for depression. Furthermore, exploring the underlying mechanisms will help in developing novel therapies for depression in the future.
¿ENCENDIDO o APAGADO ?: Modulando el Receptor de N-Metil-D-Aspartato en la Depresión Mayor.
ON or OFF?: Modulating the N-Methyl-D-Aspartate Receptor in Major Depression.
Front Mol Neurosci. 2017 Jan 13;9:169. doi: 10.3389/fnmol.2016.00169. eCollection 2016.
Abstract
Since the discovery that a single dose of ketamine, an N-methyl-D-aspartate receptor (NMDAR) antagonist, had rapid and long-lasting antidepressant effects, there has been increased interest in using NMDAR modulators in the pharmacotherapy of depression. Ketamine's efficacy seems to imply that depression is a disorder of NMDAR hyperfunctionality. However, studies showing that not all NMDAR antagonists are able to act as antidepressants challenge this notion. Furthermore, NMDAR co-agonists have also been gaining attention as possible treatments. Co-agonists such as D-serine and sarcosine have shown efficacy in both pre-clinical models and human trials. This raises the question of how both NMDAR antagonists and agonists are able to have converging behavioral effects. Here we critically review the evidence and proposed therapeutic mechanisms for both NMDAR antagonists and agonists, and collate several theories on how both activation and inhibition of NMDARs appear to have antidepressant effects.
KEYWORDS: NMDAR antagonist; depression; glycine site; mTOR; subuni

Safe Anaesthesia Worldwide
Delivering safe anaesthesia to the world's poorest people
World Congress on Regional Anesthesia & Pain Medicine
April 19-21, 2018, New York City, USA
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Anestesiología y Medicina del Dolor

52 664 6848905

jueves, 11 de enero de 2018

Luxación anterior de hombro / ¡La educación del paciente es clave! / Anterior shoulder dislocation / Patient education is key!

http://www.lesionesdeportivas.com.mx/academia/luxacion-anterior-de-hombro-la-educacion-del-paciente-es-clave/


Desafortunadamente, viviendo en un país con tales disparidades culturales y económicas, no es infrecuente tratar este tipo de patologías. ¡Paciente femenino, 64 años, con una luxación anterior de hombro de 2 años! Después de pasar de “huesero” a “huesero” (sanador de huesos tradicional mexicano sin educación “formal”), ella decide consultarme. Lo que se pudo haber resuelto hace dos años con una radiografía simple de hombro y diagnóstico y reducción cerrada bajo anestesia, se necesitó una angiografía por CT (para evitar tener una lesión en la arteria axilar durante la cirugía debido a una planificación preoperatoria deficiente) y una artroplastia reversa de hombro. ¡La educación del paciente es clave!


Unfortunately, living in a country with such cultural and economic disparities, it is not infrequent to treat these kind of pathologies. This a 64 y.o. Female patient with a 2-year anterior shoulder dislocation! After going from “huesero” to “huesero” (Mexican traditional bone healer without “formal” education), she decides to consult me. What could have been solved two years ago with a diagnostic simple shoulder x-ray and closed reduction under anesthesia, needed a CT-angiogram (in order to avoid having an axillary artery injury during surgery due to a deficient pre-op planning) and a reverse shoulder arthroplasty. Patient education is key!!!



#shouldersurgery #shoulderdislocation #happyshoulder #patienteducation #cirugiadehombro #dislocación #luxación