RESUMEN
INTRODUCTION: The traditional treatment of unstable symptomatic discoid meniscus has been total or subtotal meniscectomy. However, long-term studies show that the results are poor. The aim of this study was to evaluate the clinical outcomes and survival of arthroscopic saucerization combined with peripheral repair for the treatment of symptomatic discoid meniscus in children. METHODS: Patients≤18 years with discoid meniscus and a peripheral lesion treated between January 2012 and January 2018 were analyzed. Clinical results were evaluated using the Ikeuchi, Pedi-IKDC and Lysholm scales. The survival analysis was performed with the Kaplan-Meier method. RESULTS: Eighteen patients (18 knees) were treated in the evaluated period. The average age at the time of surgery was 11.1±3.8 years. The average follow-up was 40.4±21.2 months. An average of 3.4±1 meniscal sutures (range, 2 to 6) was used. Repairs were carried out with a combination of inside-out and outside-inside techniques as dictated by the configuration of the injury. Sixteen patients could be evaluated functionally (2 lost of follow-up). Four patients presented mechanical symptoms. One was treated conservatively with physical therapy and 3 (18.8%) required further surgical treatment (subtotal meniscectomy). According to the Ikeuchi scale 12 (75%) had excellent results, one (6.2%) good and 3 (18.8%) poor (repair failure). The average Pedi-IKDC and Lysholm scores were 98.3±2 and 98.7±2.9 respectively at the last follow-up. The overall Kaplan-Meier survival probabilities after repair were 93.7% at one year, and 85.9% at 2 years. CONCLUSIONS: Mid-term outcomes of saucerization in conjunction with meniscal repair are encouraging for children with a symptomatic unstable discoid meniscus.
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Enfermedades de los Cartílagos/cirugía , Meniscos Tibiales/cirugía , Adolescente , Artroscopía/métodos , Artroscopía/estadística & datos numéricos , Enfermedades de los Cartílagos/diagnóstico por imagen , Niño , Preescolar , Femenino , Humanos , Inestabilidad de la Articulación/cirugía , Masculino , Meniscos Tibiales/diagnóstico por imagen , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Se pretendía conocer qué relaciones predictivas presentaban la motivación, el compromiso a correr, la adicción negativa a correr y la ansiedad precompetitiva, sobre la percepción del éxito en una amplia muestra de 1795 corredores de fondo en ruta (1105 españoles, 690 mexicanos). De ellos el 85.65% fueron hombres con una edad de M=38.98 (DT=10.45), y 14.35% mujeres, con una edad M=37.88 (DT=9.80). La recogida de datos se llevó a cabo mediante las adaptaciones al castellano del Perception of Success Questionnaire (POSQ),Motivations of Marathoners Scales-34 (MOMS-34), Commitment to Running Scale-11 (CR-11) y Revised Competitive State Anxiety Inventory-2 (CSAI-2R). Se obtuvo que los valores en las orientaciones de meta de los corredores son medios y similares, aunque significativamente mayores en la muestra mexicana, debido a su mayor compromiso y motivaciones, así como a las diferencias culturales entre ambas nacionalidades. Los modelos predictores de la percepción del éxito obtenidos resultaron muy similares por nacionalidades, pero diferenciados por sexos, obteniendo altas varianzas explicativas (AU)
We pretended to find out which predictive relationships would be introduced by motivation, commitment to run, negative addiction to run and pre-competition anxiety, concerning the winning perception of a broad sample of 1795 track long-distance runners (1105 Spanish, 690 Mexicans). Of them, 85.65% were men, ages M=37.88 (SD=10.45) and 14.35% were women, ages M=37.88 (SD=9.80). The data was obtained by adapting to Spanish the following: "Perception of Success Questionnaire" (POSQ), "Motivations of Marathoners Scales-34 (MOMS-34)", Commitment to Running Scale-11 (CR-11) and Revised Competitive State Anxiety Inventory-2 (CSAI-2R). The values obtained on the winning orientations of the runners were average and similar, although significantly higher in the Mexican sample, due to their higher commitment and motivation, as well as the cultural differences between these nationalities. The predicting models of the success perception obtained were very similar by nationality, but differentiated by sex, obtaining high explicatory variances (AU)
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Humanos , Masculino , Femenino , Deportes/educación , Deportes/psicología , Ego , Motivación/ética , Ansiedad/complicaciones , Ansiedad/psicología , Carrera/clasificación , Carrera/psicología , España , Estudios Transversales/métodos , Deportes/clasificación , Deportes/fisiología , Motivación/clasificación , Ansiedad/prevención & control , Ansiedad/terapia , Carrera/fisiología , Carrera/normas , España/etnología , Epidemiología Descriptiva , Estudios Transversales/normasRESUMEN
Patients with type 1 diabetes (T1D) who are recipients of pancreas transplants are believed to rarely develop T1D recurrence in the allograft if effectively immunosuppressed. We evaluated a cohort of 223 recipients of simultaneous pancreas-kidney allografts for T1D recurrence and its risk factors. With long-term follow-up, recurrence was observed in approximately 7% of patients. Comparing the therapeutic regimens employed in this cohort over time, lack of induction therapy was associated with recurrence, but this occurs even with the current regimen, which includes induction; there was no influence of maintenance regimens. Longitudinal testing for T1D-associated autoantibodies identified autoantibody positivity, number of autoantibodies, and autoantibody conversion after transplantation as critical risk factors. Autoantibodies to the zinc transporter 8 had the strongest and closest temporal association with recurrence, which was not explained by genetically encoded amino acid sequence donor-recipient mismatches for this autoantigen. Genetic risk factors included the presence of the T1D-predisposing HLA-DR3/DR4 genotype in the recipient and donor-recipient sharing of HLA-DR alleles, especially HLA-DR3. Thus, T1D recurrence is not uncommon and is developing in patients treated with current immunosuppression. The risk factors identified in this study can be assessed in the transplant clinic to identify recurrent T1D and may lead to therapeutic advances.
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Autoanticuerpos/inmunología , Diabetes Mellitus Tipo 1/inmunología , Rechazo de Injerto/etiología , Trasplante de Riñón/efectos adversos , Trasplante de Páncreas/efectos adversos , Complicaciones Posoperatorias , Adolescente , Adulto , Autoanticuerpos/sangre , Niño , Preescolar , Diabetes Mellitus Tipo 1/cirugía , Femenino , Estudios de Seguimiento , Tasa de Filtración Glomerular , Rechazo de Injerto/sangre , Rechazo de Injerto/tratamiento farmacológico , Supervivencia de Injerto , Humanos , Terapia de Inmunosupresión , Inmunosupresores/uso terapéutico , Lactante , Pruebas de Función Renal , Masculino , Pronóstico , Recurrencia , Factores de Riesgo , Receptores de Trasplantes , Adulto JovenAsunto(s)
Humanos , Femenino , Aborto , Aborto Legal , Derechos Humanos , Derechos Sexuales y Reproductivos , Derechos de la Mujer , Argentina , Chile , Salud Reproductiva , UruguayRESUMEN
Estudios previos revelan que una proporción importante de losconsultantes del primer nivel de atención de salud presentanalgún tipo de Trastorno Mental y del Comportamiento, por loque este nivel ofrece una oportunidad en el manejo oportunode esta problemática.Objetivo: Caracterizar la prevalencia de TMyC enconsultantes de un centro de salud de un barrio de la ciudadde Córdoba.Material y Método: Se utilizó CIDI 3.0, en una muestraprobabilística de 100 consultantes adultos del primer nivelde atención.Resultados: El 96,4% de los entrevistados fueron mujeresy la media de edad de 35±2,6. La frecuencia de TMyC a lolargo de la vida fue del 33,33%. 7,1% de los entrevistadospresentó Trastornos Generalizados de la Ansiedad, 3,6%Desorden Obsesivo Compulsivo y 22,22% algún episodio deDepresión. A partir de estos primeros resultados, el equipode salud local podrá orientar estrategias y políticas públicasque aborden integralmente al consultante.
Previous studies have shown that an important proportion of the patients in first levelhealth care present some kind of Mental and Behavioral Disorder (MBD); thus, this leveloffers a possibility to timely deal with this problem.Objective: To characterize the prevalence of MBD in patients who attend a health carecenter in a neighborhood in the city of Cordoba.Material and Method: CIDI 3.0 was used in a probability sample of 100 adult consultantsat primary level of care.Results: Out of the patients interviewed, 96.4% were women and the mean age was35±2.6. The frequency of MBD along lifetime was 33.33%. A 7.1% of the interviewedpatients presented Generalized Anxiety Disorders, 3.6% Obsessive Compulsive Disorderand 22.22% some Depressive episode. Using these first results, the local health team willbe able to direct strategies and public policies to deal with the patients comprehensively.
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Adulto , Argentina , Enfermos Mentales , Trastornos Mentales , Trastornos MentalesAsunto(s)
Humanos , Equidad en Salud , Género y Salud , Chile , Organización Panamericana de la SaludRESUMEN
Objetivo: Identificar la prevalencia de los problemas de comportamiento y salud mental que se relacionan con el primer nivel de atención a partir del análisis de las estadísticas de mortalidad a nivel nacional y el la provincia de Córdoba. Metodología: La fuente analizada fue la Base de Datos de Mortalidad 2005-2006 del Ministerio de Salud de la Nación. Se calcularon tasas de mortalidad bruta (TMB) y específica (TME) según sexo, edad y causa por trastornos mentales y de comportamiento (TMyC), Mortalidad proporcional (MP) y la razón de tasas para país y provincia de Córdoba. Software SPSS e InfoStat. Resultados: En el año 2005, la TMB fué similar entre país y provincia de Córdoba, mientras que la TME por causa y por sexo fueron inferiores en Córdoba. Los TMYC representaron el 0.74 % de MP en Argentina, valores similares se registraron en el 2006. Conclusión: La prevalencia de los TMyC observados en los registros de estadísticas virtuales de Argentina y provincia de Córdoba se relacionan a patologías que están incluidas como necesidades en el primer nivel de atención.
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Humanos , Masculino , Femenino , Atención Primaria de Salud , Mortalidad , Trastornos Mentales/mortalidad , Trastornos Mentales , ArgentinaRESUMEN
AIM/HYPOTHESIS: We investigated whether beta cell neoformation occurs in the transplanted pancreas in patients with type 1 diabetes who had received a simultaneous pancreas-kidney transplant (SPK) and later developed recurrence of autoimmunity. METHODS: We examined pancreas transplant biopsies from nine SPK patients with or without recurrent autoimmunity or recurrent diabetes and from 16 non-diabetic organ donors. Tissues were analysed by immunohistochemistry and immunofluorescence. RESULTS: Numerous cytokeratin-19 (CK-19)(+) pancreatic ductal cells stained for insulin in six SPK recipients with recurrent autoimmunity, in five of whom diabetes requiring insulin therapy recurred. These cells also stained for the transcription factor pancreatic-duodenal homeobox-1 (Pdx-1), which is implicated in pancreatic development and beta cell differentiation. The number of insulin(+) ductal cells varied, being highest in the patient with the most severe beta cell loss and lowest in the normoglycaemic patient. In the patient with the most severe beta cell loss, we detected insulin(+)CK-19(+)Pdx-1(+) cells staining for the proliferation-related Ki-67 antigen (Ki-67), indicating proliferation. We were unable to detect Ki-67(+) beta cells within the islets in any SPK patient. Some insulin(+)CK-19(-) ductal cells contained chromogranin A, suggesting further endocrine differentiation. Insulin(+) cells were rarely noted in the pancreas transplant ducts in three SPK patients without islet autoimmunity and in six of 16 non-diabetic organ donors; these insulin(+) cells were never CK-19(+). CONCLUSIONS/INTERPRETATION: Insulin(+) pancreatic ductal cells, some apparently proliferating, were found in the transplanted pancreas with recurrent islet autoimmunity/diabetes. Replicating beta cells were not detected within islets. The observed changes may represent attempts at tissue remodelling and beta cell regeneration involving ductal cells in the human transplanted pancreas, possibly stimulated by hyperglycaemia and chronic inflammation.
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Autoinmunidad/inmunología , Diabetes Mellitus Tipo 1/cirugía , Trasplante de Páncreas , Páncreas/metabolismo , Adulto , Proliferación Celular , Diabetes Mellitus Tipo 1/inmunología , Diabetes Mellitus Tipo 1/metabolismo , Femenino , Técnica del Anticuerpo Fluorescente , Humanos , Inmunohistoquímica , Insulina/análisis , Antígeno Ki-67/análisis , Masculino , Persona de Mediana Edad , Páncreas/inmunología , Páncreas/patología , Conductos Pancreáticos/inmunología , Conductos Pancreáticos/metabolismo , Conductos Pancreáticos/patologíaRESUMEN
Adrenal transplantation may restore adrenal function after bilateral adrenalectomy or when adrenal function is lost. Thus, animal experiments could provide useful information before clinical application of adrenal transplantation. Using an experimental model of autotransplantion of a complete adrenal gland in the spleen of adrenalectomized rats, several biochemical and hormonal parameters were studied to evaluate the function of transplanted adrenal tissue compared to control and adrenalectomized animals. Three weeks after surgery, the animals were sacrificed and plasma and tissue samples were obtained for biochemical studies. In the autotransplanted rats, plasma glucose, hepatic glycogen, plasma, and hepatic proteins, which were decreased in adrenalectomized rats, increased to values close to those of the control group; whereas muscle and thymus proteins, which were increased in adrenalectomized animals, decreased and reached normal levels. Corticosterone plasma levels in autotransplanted rats showed a 50% recovery compared to control animals, whereas plasma aldosterone concentrations were low, with similar values to those of the adrenalectomized group. These results provide evidence that the adrenal grafts secrete corticosterone in quantities enough to overcome hepatic inactivation. On the other hand, aldosterone plasma concentrations remain very low, plasma potassium levels are increased, and plasma sodium levels are decreased in animals with intrasplenic adrenal grafts, indicating that aldosterone production is insufficient to avoid hypoaldosteronism.
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Glándulas Suprarrenales/trasplante , Regeneración , Bazo , Trasplante Heterotópico , Glándulas Suprarrenales/fisiología , Adrenalectomía , Aldosterona/sangre , Animales , Glucemia/análisis , Proteínas Sanguíneas/análisis , Corticosterona/sangre , Glucógeno/análisis , Hígado/química , Masculino , Potasio/sangre , Proteínas/análisis , Ratas , Ratas Wistar , Sodio/sangre , Trasplante AutólogoRESUMEN
A 66-year-old man with a history of hypertension and ascending aortic replacement because of a type A dissection had 3 successive embolic events (left lower limb, brain, and spleen). Two consecutive transesophageal echocardiography studies showed mobile masses in the ascending aorta. The patient was reoperated without a certain etiologic diagnosis, and an unsuspected fungal endocarditis caused by an unusual germ (Trichoderma species) was found. Transesophageal echocardiography proved very useful in the management of this uncommon case of endocarditis.
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Enfermedades de la Aorta/etiología , Ecocardiografía Transesofágica , Embolia/etiología , Endocarditis/complicaciones , Endocarditis/diagnóstico por imagen , Anciano , Endocarditis/microbiología , Humanos , Masculino , TrichodermaRESUMEN
The effect of adenosine analogues on glucagon-stimulated cyclic AMP accumulation in rat hepatocytes was explored. N6-Cyclopentyladenosine (CPA), 5'-N-ethylcarboxamidoadenosine and N6-(R-phenylisopropyl)adenosine inhibited in a dose-dependent manner the cyclic AMP accumulation induced by glucagon. This effect seems to be mediated through A1 adenosine receptors. Pertussis toxin completely abolished the effect of CPA on glucagon-stimulated cyclic AMP accumulation in whole cells which suggested that a pertussis-toxin-sensitive G-protein was involved. On the other hand, this action of adenosine analogues on glucagon-induced cyclic AMP accumulation was reverted by the selective low-Km cyclic AMP-phosphodiesterase inhibitor Ro 20-1724. Analysis of cyclic AMP-phosphodiesterase activity in purified hepatocyte plasma membranes showed that glucagon in the presence of GTP inhibited basal PDE activity by 45% and that CPA reverted this inhibition in dose-dependent manner. In membranes derived from pertussis-toxin-treated rats, we observed no inhibition of cyclic AMP-phosphodiesterase activity by glucagon in the absence or presence of CPA. Our results indicate that in hepatocyte plasma membranes, stimulation of adenylate cyclase activity and inhibition of a low-Km cyclic AMP phosphodiesterase activity are co-ordinately regulated by glucagon, and that A1 adenosine receptors can inhibit glucagon-stimulated cyclic AMP accumulation by blocking glucagon's effect on phosphodiesterase activity.
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3',5'-AMP Cíclico Fosfodiesterasas/metabolismo , Adenosina/farmacología , Glucagón/farmacología , Hígado/enzimología , Transducción de Señal/efectos de los fármacos , Adenosina/análogos & derivados , Adenosina-5'-(N-etilcarboxamida) , Toxina de Adenilato Ciclasa , Animales , Membrana Celular/enzimología , Guanosina Trifosfato/farmacología , Hígado/efectos de los fármacos , Masculino , Toxina del Pertussis , Fenilisopropiladenosina/farmacología , Ratas , Ratas Wistar , Receptores Purinérgicos P1/fisiología , Factores de Virulencia de Bordetella/farmacologíaRESUMEN
The thermodynamic properties of the agonist [Adenine-2,8-3H, ethyl-2(3)-H]-N6-phenylisopropyladenosine ([3H]R-PIA) and the antagonist 8-Cyclopentyl-1,3-[3H]dipropylxanthine ([3H]DPCPX) binding to membrane-bound and 3-3[-(choloamidopropyl)-dimethylammoniol-1-propanesulfonate/ digitonin- solubilized A1 adenosine receptors from pig brain cortex were evaluated. Rate constants for [3H]R-PIA and [3H]DPCPX association (k+1) and dissociation (k-1) processes to this receptor subtype were measured from association-dissociation experiments at six different temperatures. The values for equilibrium association constant (KA = 1/KD) were derived from rate constant values (k+1/k-1). The antagonist binding to membrane-bound receptors, the agonist binding to fast kinetic component membrane-bound receptors and the agonist binding to soluble receptors showed a linear temperature-dependence of the standard free-energy change. The first two processes are enthalpy- and entropy-driven, and the third process is enthalpy-driven with entropy working against it. On the other hand, a curvilinear temperature-dependence appears in the agonist binding to slow kinetic component membrane-bound receptors and in the antagonist binding to soluble receptors, but analyzing the semireactions (association-dissociation) involved in each case reveals that the thermodynamic behavior is very different. The thermodynamic similarities and differences are discussed in terms of receptor--G protein interaction.
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Fenilisopropiladenosina/química , Fenilisopropiladenosina/metabolismo , Receptores Purinérgicos/metabolismo , Xantinas/química , Xantinas/metabolismo , Animales , Cinética , Membranas/metabolismo , Membranas/ultraestructura , Equilibrio Postural , Receptores Purinérgicos/química , Receptores Purinérgicos/fisiología , Soluciones , Porcinos , Temperatura , Termodinámica , TritioRESUMEN
The influence of pH on the equilibrium dissociation constant and on kinetic association and dissociation constants was studied for adenosine receptor agonist L-N6-[adenine-2,8-3H, ethyl-2-3H]phenylisopropyladenosine ([3H]R-PIA) and antagonist 8-cyclopentyl-1,3-[3H]-dipropylxanthine ([3H]DPCPX). Two ionizable groups, of pK 7.0 and pK 7.4, are involved in the [3H]R-PIA associations with high- and low-affinity states of the receptor, and another group, of pK 6.0, is involved in the association with the low-affinity state. No ionizable group is involved in the dissociation process for the high-affinity state, whereas two ionizable groups, of pK 6.0 and 6.5, are involved in the low-affinity state. For [3H]DPCPX, three ionizable groups (pK 6.0, 7.4, and 8.0) are involved in the association process and only one group, (pK 6.0), is involved in the dissociation step. The apparent pK values obtained agree with histidine residues. We thus studied the effect of diethylpyrocarbonate (DEP), which reacts irreversibly with histidine residues, on agonist and antagonist binding to A1 adenosine receptors from pig brain cortical membranes. DEP treatment of membrane reduced the affinity (KD) and the total binding (R) of the agonist and the antagonist. Membrane preincubation with unlabeled ligand (R-PIA or DPCPX) prevented the effect of DEP modification observed when the same ligand, but with label, is added to the same membranes, but did not prevent the DEP modification on different, labeled ligand.(ABSTRACT TRUNCATED AT 250 WORDS)
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Histidina/metabolismo , Receptores Purinérgicos/metabolismo , Animales , Sitios de Unión , Membrana Celular/metabolismo , Corteza Cerebral/metabolismo , Dietil Pirocarbonato/farmacología , Guanilil Imidodifosfato/fisiología , Histidina/química , Concentración de Iones de Hidrógeno , Cinética , Fenilisopropiladenosina/metabolismo , Fenilisopropiladenosina/farmacología , Receptores Purinérgicos/química , Porcinos , Xantinas/metabolismo , Xantinas/farmacologíaRESUMEN
The effect of sulphydryl reagents (N-ethylmaleimide-NEM-4- hydroxymercuriobenzoate-HMB- and 5-5'-dithio-bis-2-nitrobenzoate-DTNB-) on agonist and antagonist binding to A1 adenosine receptors from pig brain was studied. The action of the mercurial agent HMB was found to be strong and seemed to be nonspecific. The effects of either NEM or DTNB were milder and more specific. The characterization of the agonist binding in membranes pretreated with moderate concentrations of DTNB and NEM led to reduced affinities for both high- and low-affinity sites without marked modifications of maximal binding or of proportion of affinity states. These results for NEM are surprising since the compound is usually used to mimick the effects of Gpp(NH)p, i.e. to shift high-affinity states to low-affinity states. It was found that this Gpp(NH)p-like effect of NEM is only possible when the compound is included in the assay medium. Similarly, Gpp(NH)p produces the uncoupling of the receptor molecule from G protein if included in the assay medium. Thus, membranes pretreated with Gpp(NH)p exhibited both affinity states and with similar equilibrium binding parameter values to those of the crude membranes.