lunes, 9 de octubre de 2017

Tratamiento artroscópico de la inestabilidad ósea del hombro


Arthroscopic Treatment of Osseous Instability of the Shoulder

Fuente
Este artículo es publicado originalmente en:
De:
HSS J.2017 Oct;13(3):292-301. doi: 10.1007/s11420-017-9553-9. Epub 2017 May 22.
Todos los derechos reservados para:

Copyright information

© Hospital for Special Surgery 2017

Abstract
BACKGROUND:
Bony deficiency of the anteroinferior glenoid rim as a result of a dislocation can lead to recurrent glenohumeral instability. These lesions, traditionally treated by open techniques, are increasingly being treated arthroscopically as our understanding of the pathophysiology and anatomy of the glenohumeral joint becomes clearer. Different techniques for arthroscopic management have been described and continue to evolve. While the success of the repair is surgeon dependent, the recent advances in arthroscopic shoulder surgery have contributed to the growing acceptance of arthroscopic reconstruction of glenoid bone defects to restore stability.
QUESTIONS/PURPOSES:
The purpose of this study was to describe arthroscopic surgical management options for patients with glenohumeral osseous lesions and instability.
CONCLUSION:
Management of glenohumeral instability can be challenging but more recent advances in arthroscopic techniques have provided improved means of treating this diagnosis. This manuscript provides a comprehensive review of the arthroscopic treatment of osseous instability of the shoulder. It provides an in depth look at the various treatment options and describes techniques for each.
KEYWORDS:
Hill-Sachs lesion; arthroscopy; bony Bankart lesion; glenoid fracture; shoulder instability
Resumen
ANTECEDENTES:
La deficiencia ósea del borde glenoideo anteroinferior como resultado de una dislocación puede conducir a inestabilidad glenohumeral recurrente. Estas lesiones, tradicionalmente tratadas con técnicas abiertas, son cada vez más tratadas artroscópicamente a medida que nuestra comprensión de la fisiopatología y anatomía de la articulación glenohumeral se vuelve más clara. Se han descrito y siguen evolucionando diferentes técnicas para el manejo artroscópico. Aunque el éxito de la reparación depende del cirujano, los recientes avances en la cirugía artroscópica del hombro han contribuido a la creciente aceptación de la reconstrucción artroscópica de los defectos óseos glenoides para restablecer la estabilidad.
PREGUNTAS / PROPÓSITOS:
El propósito de este estudio fue describir las opciones de tratamiento quirúrgico artroscópico para pacientes con lesiones óseas glenohumerales e inestabilidad.
CONCLUSIÓN:
El manejo de la inestabilidad glenohumeral puede ser un desafío, pero avances más recientes en las técnicas artroscópicas han proporcionado mejores medios para tratar este diagnóstico. Este manuscrito proporciona una revisión completa del tratamiento artroscópico de la inestabilidad ósea del hombro. Proporciona una mirada en profundidad a las diversas opciones de tratamiento y describe técnicas para cada una.
PALABRAS CLAVE:
Lesión de Hill-Sachs; artroscopia; lesión ósea de Bankart; fractura glenoidea; inestabilidad del hombro
PMID:  28983224  PMCID:  PMC5617819   [Available on 2018-10-01]  DOI:  

Dislocaciones después del uso de copas de movilidad dual en artroplastia total de cadera primaria sin cemento: series multicéntricas prospectivas


Dislocations after use of dual-mobility cups in cementless primary total hiparthroplasty: prospective multicentre series

Fuente
Este artículo es originalmente publicado en:
De:
2017 Oct 7. doi: 10.1007/s00264-017-3660-6. [Epub ahead of print]
Todos los derechos reservados para:

Copyright information

© SICOT aisbl 2017

Abstract
BACKGROUND:
The purpose of this study was to investigate the incidence of dislocation and specific complications of the dual-mobility cup.
CONCLUSION:
The incidence of dislocation in total hip arthroplasty (THA) using a dual-mobility cup was acceptable, and cup diameter of the dislocation group was substantially larger than that of no-dislocation group. Based on clinical outcomes of our study, we conclude that the dual-mobility cup is a reliable option in THA, and further studies are necessary.
KEYWORDS:
Dislocation; Dual mobility cup; Hip; Total hip arthroplasty
Resumen
ANTECEDENTES:
El propósito de este estudio fue investigar la incidencia de dislocaciones y complicaciones específicas de la copa de movilidad dual.
CONCLUSIÓN:
La incidencia de dislocación en la artroplastia total de cadera (THA) utilizando una copa de movilidad dual fue aceptable, y el diámetro de la copa del grupo de dislocación fue sustancialmente mayor que el del grupo sin dislocación. Basándonos en los resultados clínicos de nuestro estudio, concluimos que la copa de movilidad dual es una opción confiable en THA, y se necesitan más estudios.
PALABRAS CLAVE:
Dislocación; Copa de movilidad dual; Cadera; Artroplastia total de cadera
PMID:  28986663   DOI:  

Historia y examen de lesiones dolorosas de la rodilla



History & Examination Of Painful Injuried Knee
Fuente
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 5 oct. 2017
Dr. Ebraheim’s animated educational video describes the history and examination of painful and injured knee. ACL, PCL, MCL, and LCL.
Donate to the University of Toledo Foundation Department of Orthopaedic Surgery Endowed Chair Fund:
https://www.utfoundation.org/foundati…
Categoría
LicenciaLicencia de YouTube estándar

Cuidados palitivos pediátricos /Pediatric paliative care

Octubre 9, 2017. No. 2836



Eutanasia involuntaria de recién nacidos gravemente enfermos: ¿es realmente peligroso el Protocolo de Groninga?
Involuntary euthanasia of severely ill newborns: is the Groningen Protocol really dangerous?
Hippokratia. 2014 Jul-Sep;18(3):193-203.
Abstract
Advances in medicine can reduce active euthanasia of newborns with severe anomalies or unusual prematurity, but they cannot eliminate it. In the Netherlands, voluntary active euthanasia among adults and adolescents has been allowed since 2002, when the so-called Groningen Protocol (GP) was formulated as an extension of the law on extremely premature and severely ill newborns. It is maintained that, at bioethical level, it serves the principle of beneficence. Other European countries do not accept the GP, including Belgium. Admissibility of active euthanasia is a necessary, though inadequate, condition for acceptance of the GP. Greece generally prohibits euthanasia, although the legal doctrine considers some of the forms of euthanasia permissible, but not active or involuntary euthanasia. The wide acceptance of passive newborns euthanasia, especially when the gestational age of the newborns is 22-25 weeks ("grey zone"), admissibility of practices within the limits between active and passive euthanasia (e.g., withholding/withdrawing), of "indirect active euthanasia" and abortion of the late fetus, the tendency to accept after-birth-abortion (infanticide) in the bioethical theory, the lower threshold for application of withdrawing in neonatal intensive care units compared with pediatric intensive care units, all the above advocate wider acceptance of the GP. However, the GP paves the way for a wide application of involuntary (or pseudo-voluntary) euthanasia (slippery slope) and contains some ambiguous concepts and requirements (e.g., "unbearable suffering"). It is suggested that the approach to the sensitive and controversial ethical dilemmas concerning the severely ill newborns is done not through the GP, but rather, through a combination of virtue bioethics (especially in the countries of the so-called "Mediterranean bioethical zone") and of the principles of principlism which is enriched, however, with the "principle of mutuality" (enhancement of all values and principles, especially with the principles of "beneficence" and "justice"), in order to achieve the "maximal" bioethical approach, along with the establishment of circumstances and alternatives that minimize or eliminate the relevant bioethical dilemmas and conflicts between the fundamental principles. Thus, the most appropriate/fairest choices are made (by trained parents and physicians), considering all interests involved as much as possible. Hippokratia 2014; 18 (3): 196-203.
KEYWORDS: Active euthanasia; Groningen Protocol; beneficence; bioethics; neonatal; newborn; principlism; virtue ethics; withdrawing; withholding
Los mejores intereses de los bebés en el cuidado al final de la vida de los recién nacidos.
Infants' best interests in end-of-life care for newborns.
Pediatrics. 2014 Oct;134(4):e1163-8. doi: 10.1542/peds.2014-0780. Epub 2014 Sep 22.
Abstract
BACKGROUND AND OBJECTIVES: Pediatric bioethics presumes that decisions should be taken in the child's best interest. If it's ambiguous whether a decision is in the child's interest, we defer to parents. Should parents be permitted to consider their own interests in making decisions for their child? In the Netherlands, where neonatal euthanasia is legal, such questions sometimes arise in deciding whether to hasten the death of a critically ill, suffering child. We describe the recommendations of a national Dutch committee. Our objectives were to analyze the role of competing child and family interests and to provide guidance on end-of-life decisions for doctors caring for severely ill newborns. METHODS: We undertook literature review, 7 consensus meetings in a multidisciplinary expert commission, and invited comments on draft report by specialists' associations. RESULTS: Initial treatment is mandatory for most ill newborns, to clarify the prognosis. Continuation of treatment is conditional on further diagnostic and prognostic data. Muscle relaxants can sometimes be continued after withdrawal of artificial respiration without aiming to shorten the child's life. When gasping causes suffering, or protracted dying is unbearable for the parents, muscle relaxants may be used to end a newborn's life. Whenever muscle relaxants are used, cases should be reported to the national review committee. CONCLUSIONS: New national recommendations in the Netherlands for end-of-life decisions in newborns suggest that treatment should generally be seen as conditional. If treatment fails, it should be abandoned. In those cases, palliative care should be directed at both infant and parental suffering. Sometimes, this may permit interventions that hasten death.
KEYWORDS: clinical bioethics; end-of-life decisions; neonatal intensive care; palliative care
¿Podría ser aceptable la eutanasia infantil?
J.P. Beca, A. Leiva
Rev Chil Pediatr 2014; 85 (5): 608-612
Resumen
La reciente promulgación de una ley que permite la eutanasia infantil en Bélgica plantea interrogantes que admiten respuestas diversas. Para contribuir a una mejor comprensión del tema se describen los conceptos de eutanasia y la legislación pertinente. Después de hacer un análisis bioético, se plantea como conclusión que la eutanasia de niños podría ser aceptable sólo de manera muy excepcional ante situaciones en las cuales hubiesen fracasado las medidas de cuidado paliativo. Para nuestro medio la respuesta debería ser que no es aceptable, al menos mientras no existan políticas públicas, protocolos y servicios de cuidados paliativos para niños con enfermedades terminales. (Palabras clave: Eutanasia, cuidados paliativos, suicidio, enfermedad terminal
El derecho a la muerte digna de los niños
Este manifiesto fue elaborado en Santander en el Seminario de la Universidad Internacional Menéndez Pelayo (UIMP) 'Muerte digna, asistencia ante la muerte' y presentado públicamente el 11 de julio de 2008.
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