RESUMEN
Ankle sprains are the most common injuries sustained during sports activities. Most ankle sprains recover fully with non-operative treatment but 20-30% develop chronic ankle instability. Predicting which patients who sustain an ankle sprain will develop instability is difficult. This paper summarises a consensus on identifying which patients may require surgery, the optimal surgical intervention along with treatment of concomitant pathology given the evidence available today. It also discusses the role of arthroscopic treatment and the anatomical basis for individual procedures.
Asunto(s)
Traumatismos del Tobillo/diagnóstico , Artroscopía/métodos , Traumatismos en Atletas/complicaciones , Inestabilidad de la Articulación/diagnóstico , Inestabilidad de la Articulación/cirugía , Traumatismos del Tobillo/etiología , Traumatismos del Tobillo/cirugía , Traumatismos en Atletas/diagnóstico , Enfermedad Crónica , Consenso , Medicina Basada en la Evidencia , Femenino , Estudios de Seguimiento , Humanos , Puntaje de Gravedad del Traumatismo , Ligamentos Laterales del Tobillo/lesiones , Ligamentos Laterales del Tobillo/cirugía , Ligamentos Articulares/lesiones , Ligamentos Articulares/cirugía , Imagen por Resonancia Magnética/métodos , Masculino , Selección de Paciente , Rango del Movimiento Articular/fisiología , Procedimientos de Cirugía Plástica/métodos , Recuperación de la Función , Medición de Riesgo , Transferencia Tendinosa/métodos , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoRESUMEN
The obvious socioeconomic advantages are quite dramatic, with early weight-bearing and AFO immobilization allowing patients an early return to work. Outpatient surgery is a cost-effective benefit. Patient satisfactions as well as comfort are greatly enhanced, requiring only oral pain medication. All patients have tolerated their postoperative regimen and same-day discharge. Arthroscopic subtalar arthrodesis is a technically demanding procedure that requires some rather advanced arthroscopic skills to perform. Joint access is tight, restricted, and requires small instrumentation. Deformities cannot be corrected; therefore, at this stage, a fusion in situ must be considered. The learning curve is certainly far steeper because of the smaller patient population available for enhancing surgical skills. Overall, this procedure has stood the test of time and follow-up. The results appear to be excellent in terms of patient satisfaction, fusion rate time until union, and postoperative morbidity. The recognition and enhancement of this technique as well as the development of more advanced technology will certainly allow this arthroscopic subtalar arthrodesis technique to mature even further over time.
Asunto(s)
Traumatismos del Tobillo/cirugía , Articulación del Tobillo/cirugía , Artrodesis/métodos , Artroscopía/métodos , Artropatías/cirugía , Traumatismos del Tobillo/etiología , Humanos , Artropatías/etiología , Complicaciones Posoperatorias/etiología , Instrumentos Quirúrgicos , Resultado del TratamientoRESUMEN
A roentgenographic review was made of 109 patients with unilateral Legg-Perthes disease, all of whom had experienced onset of symptoms prior to their sixth birthday. Roentgenograms taken at the time of healing and at final follow-up were grouped according to Catterall classification and modified Mose rating. The parameters measured were epiphyseal index, center-edge angle, extrusion index, epiphyseal quotient, and center-edge quotient. Average age at final follow-up was 12 years. A change in Mose rating between assessments at healing and final follow-up occurred in 16% of patients, with most of them showing improvement, supporting the concept that femoral heads in young children have the capacity to remodel. However, 24% of patients with Catterall III and IV disease had a poor result at final follow-up. Despite early onset of Legg-Perthes disease, patients with involvement of greater than half the femoral head are at risk for poor roentgenographic result.
Asunto(s)
Enfermedad de Legg-Calve-Perthes/diagnóstico por imagen , Factores de Edad , Preescolar , Epífisis/diagnóstico por imagen , Femenino , Cabeza Femoral/diagnóstico por imagen , Estudios de Seguimiento , Humanos , Enfermedad de Legg-Calve-Perthes/clasificación , Masculino , Radiografía , Estudios Retrospectivos , Factores de TiempoRESUMEN
The frequent use of arthroscopy has increased the orthopedic community's awareness of meniscoid lesions of the ankle and its ability to treat these lesions. This article defines the pathologic lesion and reviews the literature and case reports.
Asunto(s)
Traumatismos del Tobillo , Articulación del Tobillo/cirugía , Artroscopía , HumanosRESUMEN
Metronidazole is a nitro-imidazole drug which was discovered nearly 30 years ago. Metronidazole has remained the mainstay of anti-anaerobic therapy following a change observation that its activity included anaerobic organisms. The predominant human reservoir of these anaerobic organisms is the gastrointestinal tract. In this review, the anaerobic flora and their pathogenic potential are described. The main characteristics of metronidazole and the role of selective decontamination of the gastrointestinal tract are also discussed.
Asunto(s)
Bacterias Anaerobias/efectos de los fármacos , Sistema Digestivo/microbiología , Metronidazol/farmacología , Animales , HumanosRESUMEN
Six persons with the classical Angelman syndrome (AS) phenotype and de novo deletions of chromosome 15q11-q13 were studied to determine the parental origin of the chromosome deletion. Four of the 6 patients had informative cytogenetic studies and all demonstrated maternal inheritance of the deletion. These findings, together with other reported cases of the origin of the chromosome 15 deletion in AS, suggest that deletion of the maternally contributed chromosome leads to the AS phenotype. This contrasts with the Prader-Willi syndrome (PWS) in which a similar deletion of the paternally contributed chromosome 15 is observed. In deletion cases, a parental gamete effect such as genomic imprinting may be the best model to explain why apparently identical 15q11-q13 deletions may develop the different phenotypes of AS or PWS.
Asunto(s)
Deleción Cromosómica , Cromosomas Humanos Par 15 , Discapacidad Intelectual/genética , Madres , Trastornos del Movimiento/genética , Lengua/anomalías , Expresión Facial , Femenino , Marcha , Humanos , Cariotipificación , Risa , Masculino , SíndromeRESUMEN
A cytogenetic survey of 67 individuals previously identified as having mental retardation and autistic behaviors revealed 1 person (1.5%) with the fragile X chromosome (fra[X]) and 3 (4.5%) with autosome abnormalities. This low prevalence of fra(X) indicates that most persons with fra(X) in this mental retardation center did not have autistic behaviors severe enough to be identified as a secondary psychiatric diagnosis. The presence of other chromosomal abnormalities is consistent with the known causal heterogeneity of autism in mental retardation populations.
Asunto(s)
Trastorno Autístico/genética , Síndrome del Cromosoma X Frágil/genética , Tamización de Portadores Genéticos , Discapacidad Intelectual/genética , Aberraciones Cromosómicas Sexuales/genética , Adulto , Bandeo Cromosómico , Femenino , Síndrome del Cromosoma X Frágil/prevención & control , Pruebas Genéticas , Humanos , MasculinoRESUMEN
Prometaphase chromosome study of 12 persons with an established diagnosis of the Angelman syndrome demonstrated that 5 had a 15q12 deletion appearing similar to that commonly observed in the Prader-Willi syndrome. Phenotype-karyotype correlation did not show any obvious clinical differences between those with and those without the deletion and no clinical overlap between Angelman and Prader-Willi syndrome was apparent. Our survey suggests that 15q12 deletions are frequent in Angelman syndrome but presence of the deletion does not appear to distinguish different clinical phenotypes. Experience with the cytogenetic study of Prader-Willi syndrome predicts that considerable complexity will emerge between the presence of 15 chromosome abnormalities and clinical expression of Angelman syndrome.
Asunto(s)
Anomalías Múltiples/patología , Aberraciones Cromosómicas/patología , Deleción Cromosómica , Cromosomas Humanos Par 15 , Anomalías Múltiples/genética , Adolescente , Adulto , Niño , Preescolar , Bandeo Cromosómico , Trastornos de los Cromosomas , Estudios de Cohortes , Humanos , Lactante , Recién Nacido , Cariotipificación , Fenotipo , SíndromeRESUMEN
The in-vitro activity of cefixime was studied with clinical isolates and compared with that of other agents. Cefixime exhibited good activity against the Enterobacteriaceae, Haemophilus influenzae, and Neisseria gonorrhoeae, including beta-lactamase producing strains. Activity was also high against Streptococcus pneumoniae and group A and group B beta-haemolytic streptococci. Staphylococcus aureus, faecal streptococci, anaerobic bacteria and Pseudomonas aeruginosa were not susceptible. Activity against susceptible isolates was comparable to cefotaxime and was normally superior to cefuroxime, cephalexin and amoxycillin. The pharmacokinetics of cefixime were studied in six healthy male volunteers, each receiving a 400 mg oral dose following an overnight fast. Tissue penetration of the antibiotic was estimated with a cantharides-induced blister method. The mean serum elimination half-life was 3.8 h, the mean peak concentration was 3.7 mg/l. Penetration into tissue fluid was rather slow [Tmax 6.7 h) but percentage penetration was high (132.6%). Urinary excretion was low with a 24 h recovery rate of less than 20%, though the concentrations achieved in urine exceeded the MICs of most common urinary tract pathogens for up to 24 h post-dose.
Asunto(s)
Bacterias/efectos de los fármacos , Cefotaxima/análogos & derivados , Adulto , Cefixima , Cefotaxima/metabolismo , Cefotaxima/farmacocinética , Cefotaxima/farmacología , Humanos , MasculinoRESUMEN
The pharmacokinetics of the quinolone lomefloxacin were determined following a single 400-mg oral dose given to each of six male volunteers. Concentrations in serum, urine, and cantharidin-induced inflammatory fluid were determined by a microbiological assay. Samples from two volunteers were also assayed by high-performance liquid chromatography. The mean peak level in serum, 4.7 micrograms/ml, was attained within 1 h of administration. The mean elimination half-life from serum was 7 h. Inflammatory fluid was penetrated rapidly, with a mean peak level of 3.5 micrograms/ml occurring after 2.7 h. The mean recovery of lomefloxacin from urine over 48 h was 76% of the administered dose. There was a minor peak on the high-performance liquid chromatography trace, suggesting a small amount of unidentified metabolite. This was present only in urine; no detectable metabolites were found in serum. This study suggests that either once-daily or twice-daily dosage of lomefloxacin should be sufficient to treat urinary or systemic infections, respectively, caused by susceptible pathogens.
Asunto(s)
Antiinfecciosos/farmacocinética , Fluoroquinolonas , Quinolonas , 4-Quinolonas , Administración Oral , Adulto , Antiinfecciosos/administración & dosificación , Líquidos Corporales/análisis , Cromatografía Líquida de Alta Presión , Semivida , Humanos , Masculino , Infecciones Urinarias/tratamiento farmacológicoAsunto(s)
Vértebras Cervicales , Luxaciones Articulares/etiología , Neurofibromatosis 1/complicaciones , Neoplasias de los Tejidos Blandos/complicaciones , Vértebras Torácicas , Niño , Humanos , Luxaciones Articulares/diagnóstico por imagen , Luxaciones Articulares/cirugía , Masculino , Fusión Vertebral , Tomografía Computarizada por Rayos X , TracciónRESUMEN
Sixty episodes of pneumonia occurring in 53 immunosuppressed patients were investigated by bronchoalveolar lavage. Pneumocystis carinii was diagnosed on 15 (25%) occasions. In all cases the Papanicolaou stained lavage fluid presented a distinctive appearance and contained abundant, often biphasic, staining, "honeycomb" debris, and few alveolar macrophages. The Grocott methenamine silver technique confirmed the presence of characteristic cystic organisms in the debris in all 15 instances. Cysts containing internal sporozoites were identified in Gram stained material only with difficulty. Neither May-Grünwald-Giemsa stain nor fluorescence microscopy under ultraviolet light were effective for routine investigation.
Asunto(s)
Bronquios/patología , Neumonía por Pneumocystis/diagnóstico , Alveolos Pulmonares/patología , Adolescente , Adulto , Femenino , Humanos , Macrófagos , Masculino , Persona de Mediana Edad , Neumonía por Pneumocystis/patología , Coloración y Etiquetado , Irrigación TerapéuticaRESUMEN
Two groups of compounds, the beta-lactams and the quinolones, account for the main developments in antimicrobials in the last 5 years. Efforts to overcome emerging problems of resistance and to broaden further the spectrum of similar existing agents have been the main impetus to the pharmaceutical industry, though some compounds have also been developed with a narrow spectrum intended for specific pathogens. This article reviews antibiotics that have recently become available in the UK and also discusses compounds that are undergoing clinical trials at present.
Asunto(s)
Antiinfecciosos/uso terapéutico , Aminoglicósidos/uso terapéutico , Antibacterianos/uso terapéutico , Cefalosporinas/uso terapéutico , Humanos , Monobactamas/uso terapéutico , Resistencia a las Penicilinas , Penicilinas/uso terapéuticoRESUMEN
A review is given of current problems in the chemotherapy of infections caused by coagulase-negative staphylococci. Along with the recent increase in the number of these infections has come the realisation that such infections may be difficult to treat. The sites of infection caused by coagulase-negative staphylococci are considered and recent advances in the understanding of the molecular biology of these organisms reviewed. Appropriate antibiotic therapy for individual infections is discussed, likewise the contribution the laboratory can make to ensure that the most effective antibiotics are used.
Asunto(s)
Antibacterianos/uso terapéutico , Infecciones Estafilocócicas/tratamiento farmacológico , Staphylococcus/efectos de los fármacos , Antibacterianos/farmacología , Cefalosporinas/farmacología , Coagulasa/metabolismo , Quimioterapia Combinada , Humanos , Recién Nacido , Meticilina/farmacología , Resistencia a las Penicilinas , Plásmidos , Prótesis e Implantes , Infecciones Estafilocócicas/microbiología , Staphylococcus/clasificación , Staphylococcus/enzimología , Staphylococcus/patogenicidad , Staphylococcus aureus/clasificación , Staphylococcus aureus/patogenicidad , Staphylococcus epidermidis/clasificación , Vancomicina/uso terapéuticoRESUMEN
During a period of 6 months, an 'epidemic strain' of Acinetobacter calcoaceticus was isolated from 10 pre-term neonates in a special care baby unit (scbu). Of these, nine had pulmonary infections. The tenth was found to have conjunctival colonization only. The 'epidemic strain' was characterized by serotyping, biotyping, bacteriocin typing and antibiograms. An identical strain was isolated from an 'Ambu' resuscitation device but not from other environmental samples or from staff on the unit. The outbreak ceased after the colonized resuscitator was removed and an appropriate disinfection policy implemented for the replacement resuscitators.
Asunto(s)
Infecciones por Acinetobacter/microbiología , Enfermedades del Prematuro/microbiología , Unidades de Cuidado Intensivo Neonatal , Acinetobacter/clasificación , Infecciones por Acinetobacter/epidemiología , Bacteriocinas , Infección Hospitalaria/transmisión , Brotes de Enfermedades , Contaminación de Equipos , Técnica del Anticuerpo Fluorescente , Humanos , Recién Nacido , Cuerpo Médico de Hospitales , Pruebas de Sensibilidad Microbiana , Personal de Enfermería en Hospital , Serotipificación , Piel/microbiologíaRESUMEN
The external rhinoplasty approach extends the usual marginal nasal incisions to include a notched transcolumellar incision. This maneuver enhances surgical exposure for the analysis and correction of all types of nasal bone, nasal septum and nasal cartilage deformities. Nasal septal perforation, nasal bone grafting and hypophysectomy my be operated upon through this excellent avenue of exposure.