lunes, 18 de septiembre de 2017

Ruptura traumática aguda del tendón rotuliano en población pediátrica: series de casos y revisión de la literatura.


Acute traumatic rupture of the patellar tendon in pediatric population: Case series and review of the literature.

Fuente
Este artículo es publicado originalmente en:
De:
2017 Sep 1. pii: S0020-1383(17)30588-0. doi: 10.1016/j.injury.2017.08.069. [Epub ahead of print]
Todos los derechos reservados para:
Copyright © 2017 Elsevier Ltd. All rights reserved.

Abstract
BACKGROUND:
Intact knee extensor mechanism is required for the normal function of the lower extremity. Patellar tendon rupture is a relatively rare injury with peak age incidence around 40 years and usually occurs midsubstance. The occurrence of pure patellar tendon rupture without bony avulsion is an extremely rare injury in the pediatric population with few cases reported in the literature with limited information regarding frequency, complications, and outcomes in children. However, due to increased participation in sports and high-energy recreational activities during childhood, the frequency of such injuries has progressively increased.
OBJECTIVE:
To evaluate the frequency of pediatric patellar tendon rupture injuries and describe the radiological findings, treatment modalities, and outcome of such injuries.
CONCLUSION:
Patellar tendon rupture is rare in the pediatric population and represents 7% of pediatric patients who sustained acute traumatic injury of the knee extensor mechanism. Ruptures may occur midsubstance, or from proximal or distal insertions. High riding patella is the hallmark diagnostic sign for such injury. Although rare, it is considered a serious injury that necessitates early diagnosis and surgical intervention. Functional range of motion was obtained in all patients with different modalities of treatment.
Copyright © 2017 Elsevier Ltd. All rights reserved.
KEYWORDS:
Knee injuries; Patellar tendon avulsión



Resumen
ANTECEDENTES:
Se requiere un mecanismo extensor intacto de la rodilla para la función normal de la extremidad inferior. La ruptura del tendón rotuliano es una lesión relativamente rara con una incidencia de edad máxima alrededor de los 40 años y suele ocurrir en la parte media del abdomen. La aparición de ruptura pura del tendón rotuliano sin avulsión ósea es una lesión extremadamente rara en la población pediátrica, con pocos casos reportados en la literatura con información limitada sobre frecuencia, complicaciones y resultados en niños. Sin embargo, debido a una mayor participación en deportes y actividades recreativas de alta energía durante la infancia, la frecuencia de tales lesiones ha aumentado progresivamente.

OBJETIVO:
Evaluar la frecuencia de las lesiones pediátricas de ruptura del tendón rotuliano y describir los hallazgos radiológicos, las modalidades de tratamiento y el resultado de dichas lesiones.
CONCLUSIÓN:
La ruptura del tendón rotuliano es rara en la población pediátrica y representa el 7% de los pacientes pediátricos que sufrieron una lesión traumática aguda del mecanismo extensor de la rodilla. Pueden producirse rupturas en la superficie media, o por inserciones proximales o distales. La rótula de alta altura es el signo distintivo del diagnóstico para esta lesión. Aunque es poco frecuente, se considera una lesión grave que requiere diagnóstico precoz e intervención quirúrgica. El rango de movimiento funcional se obtuvo en todos los pacientes con diferentes modalidades de tratamiento.

Copyright © 2017 Elsevier Ltd. Todos los derechos reservados.

PALABRAS CLAVE:
Lesiones de rodilla; Tendón patelar avulsión
PMID:  28888715   DOI:  

Dolor referido alrededor del hombro


Referred pain around the Shoulder

Este artículo y/o video es originalmente publicado en:
De y todos los derechos reservados para:
Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA
Publicado el 15 sept. 2017 Dr. Ebraheim’s animated educational video describing referred pain around the shoulder and neck.
Donate to the University of Toledo Foundation Department of Orthopaedic Surgery Endowed Chair Fund:
https://www.utfoundation.org/foundati…
Categoría
LicenciaLicencia de YouTube estándar

Los arcos de Gilula de la articulación de la muñeca


Gilula’s Arcs of the Wrist Joint

Fuente
Este artículo y/o video es originalmente publicado en:
De y Todos los derechos reservados para:
Courtesy: Harry Benjamin Laing MRCS, Ortho M8, FRCS(Tr and Orth) TutorialsOrtho M8
Publicado el 16 sept. 2017
SUSCRIBIRSE 607
A step in Gilula’s Arcs can often signal ligamentous disruption or carpal bone fracture

sábado, 16 de septiembre de 2017

Fracturas sobre el codo pediátrico que a menudo no se aprecian



http://www.mihombroycodo.com.mx/academia/fracturas-sobre-el-codo-pediatrico-que-a-menudo-no-se-aprecian/

Fractures About The Pediatric Elbow That Are Often “Unappreciated”

Fuente
Este artículo y/o video es originalmente publicado en:



De y Todos los derechos reservados para:

Courtesy: Kaye Wilkins MD

Lynn Staheli MD
www.global-help.org






GlobalHELPorg


Publicado el 21 ago. 2017




By Dr. Kaye Wilkins. A look at how some pediatric elbow fractures are often “unappreciated”. For more information and videos, please visit http://global-help.org and http://www.pedorthoacademy.org.


Categoría


Ciencia y tecnología
Licencia


Licencia Atribución de Creative Commons (reutilización permitida)


Anestesia en cirugía cardiaca / Cardiac anaesthesia

Septiembre 13, 2017. No. 2810






Ensayo clínico aleatorizado que compara las respuestas hemodinámicas a ketamina-propofol ón (Ketofol) versus etomidato durante la inducción de la anestesia en pacientes con disfunción ventricular izquierda sometidos a cirugía de bypass coronario.
A randomized clinical trial comparing hemodynamic responses to ketamine-propofol combination (ketofol) versus etomidate during anesthesia induction in patients with left ventricular dysfunction undergoing coronary artery bypass graft surgery.
Arch Med Sci. 2017 Aug;13(5):1102-1110. doi: 10.5114/aoms.2016.63193. Epub 2016 Oct 25.
Abstract
INTRODUCTION: Anesthesia induction is often accompanied by a period of hemodynamic instability, which could be a significant problem in patients with compromised ventricular function. The aim of this study is to compare the hemodynamic responses to etomidate versus a combination of ketamine and propofol (ketofol) for anesthetic induction in patients with left ventricular dysfunction undergoing coronary artery bypass graft (CABG) surgery. MATERIAL AND METHODS: In a double-blind randomized clinical study, a total of 84 patients with ischemic left ventricular dysfunction (EF < 40%) were randomly assigned to two groups (A and B). Patients in group A received etomidate 0.2 mg/kg and a placebo (normal saline); group B received a combination of ketamine (1 mg/kg) and propofol (1.5 mg/kg) at the induction of anesthesia. Two minutes after induction, hemodynamic variables, including systolic, diastolic, mean arterial pressure (SAP, DAP, MAP) and heart rate (HR), were measured immediately before and after the laryngoscopy, and before intubation and post-intubation at 1, 2, and 3 min. RESULTS: The decrease in all hemodynamic parameters (SBP, DBP, MAP and HR) from induction time to laryngoscopy was greater in the ketofol group (group B) than in the etomidate group (group A) (p < 0.05). The ephedrine prescription rate due to hemodynamic changes was 24.4% (10 patients) and 5% (2 patients) in group B and group A, respectively (p = 0.03). CONCLUSIONS: We found that etomidate provides superior hemodynamic stability as compared to ketofol in patients with left ventricular dysfunction undergoing CABG surgery under general anesthesia.
KEYWORDS: etomidate; hemodynamics; ketamine; ketofol; propofol; ventricular dysfunction
Leucocitosis asintomática preoperatoria y evolución postoperatoria en pacientes con cirugía cardíaca.
Preoperative asymptomatic leukocytosis and postoperative outcome in cardiac surgery patients.
PLoS One. 2017 Sep 5;12(9):e0182118. doi: 10.1371/journal.pone.0182118. eCollection 2017.
Abstract
BACKGROUND: Despite showing a prognostic value in general surgical patients, preoperative asymptomatic elevated white blood cell (WBC) count is not considered a risk factor for cardiac surgery. Whereas there is sporadic evidence of its value as a preoperative risk marker, it has not been looked at methodically as a specific index of outcome during cardiac surgery. Using a national database we sought to determine the relationship between preoperative WBC count and postoperative outcome in cardiac surgical patients. METHODS: Cardiac surgeries were extracted from the 2007-2013 American College of Surgeons National Surgical Quality Improvement Program database. Leukocytosis was defined by a preoperative WBC count greater than 11,000 cells/μL. A univariate analysis compared the incidence of adverse outcomes for patients with and without leukocytosis. A multivariate logistic regression model was constructed in order to test whether leukocytosis was an independent predictor of morbidity and mortality. RESULTS: Out of a total of 10,979 cardiac surgery patients 863 (7.8%) had preoperative leukocytosis. On univariate analysis, patients with leukocytosis experienced greater incidences of 30-day mortality, wound complications, and medical complications. Wound complications included surgical site infection as well as wound dehiscence. The medical complications included all other non-surgical causes of increased morbidity and infection leading to urinary tract infection, pneumonia, ventilator dependence, sepsis and septic shock. After stepwise model adjustment, leukocytosis was a strong predictor of medical complications (OR 1.22, 95% CI: 1.09-1.36, p = 0.002) with c-statistic of 0.667. However, after stepwise model adjustment leukocytosis was not a significant predictor of 30-day mortality and wound complications. CONCLUSION: Preoperative leukocytosis is associated with adverse postoperative outcome after cardiac surgery and is an independent predictor of infection-related postoperative complications.


XIV Congreso Virtual Mexicano de Anestesiología 2017
Octubre 1-Diciembre 31, 2017
Información / Information
Convocatoria para el Curso de Posgrado en Medicina del Dolor y Paliativa 2018 para Mexicanos y extranjeros.
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
Informes (52) 55 5487 0900 ext. 5011 de lunes a viernes de 9.00 a 14 h (hora de Ciudad de México). 
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Anestesiología y Medicina del Dolor

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