Search

Background: Studies evaluating secondary meniscectomy rates and risk factors for failure of ramp repair are sparse and limited by small numbers and heterogeneity., Purposes/hypothesis: The purposes were to determine the secondary meniscectomy rate for failure of ramp repair performed using a posteromedial portal suture hook at the time of anterior cruciate ligament reconstruction (ACLR) and to identify risk factors for secondary meniscectomy. It was hypothesized that patients who underwent ACLR combined with a lateral extra-articular procedure (LEAP) would experience significantly lower rates of secondary meniscectomy compared with those undergoing isolated ACLR., Study Design: Case-control study; Level of evidence, 3., Methods: Patients undergoing primary ACLR and ramp repair between 2013 and 2020 were included in the study. Final follow-up for each patient was defined by his or her last appointment recorded in a prospective database (with a study end date of March 2023). The database and medical records were used to determine whether patients had undergone secondary meniscectomy for failure of ramp repair. Survivorship of ramp repair (using secondary meniscectomy as an endpoint) was determined using the Kaplan-Meier method. Multivariate analysis was used to investigate possible risk factors., Results: A total of 1037 patients were included in the study. The secondary meniscectomy rate after ramp repair was 7.7% at a mean final follow-up of 72.4 months. Patients without combined ACLR + LEAP were >2-fold more likely to undergo a secondary medial meniscectomy compared with those with combined ACLR + LEAP (hazard ratio, 2.455; 95% CI, 1.457-4.135; P = .0007). Age, sex, preoperative Tegner score, and time between injury and surgery were not significant risk factors for failure., Conclusion: The rate of secondary meniscectomy after ramp repair performed through a posteromedial portal at the time of primary ACLR was low. Patients who underwent isolated ACLR (rather than ACLR + LEAP) were >2-fold more likely to undergo a secondary medial meniscectomy for failure of ramp repair. Additional risk factors for failure of ramp repair were not identified., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: GCS Ramsay Sante funds the scientific activity at the Santy center. Arthrex cofunds studies at the Santy center through research grants. B.S-C. has received consulting fees and royalties from Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Acute compartment syndrome of the thigh is an exceptionally uncommon condition that can have severe consequences if not promptly and effectively treated. A 19-year-old man presented to our emergency department with severe and progressive pain in his left thigh after sustaining a direct trauma during a football game 24 hours prior. Compartment pressure was assessed, confirming the diagnosis of compartment syndrome arising from a sizable intramuscular hematoma without detection of any other contributing factors. Fasciotomy incisions were closed using the shoelace technique with excellent functional results. This case highlights the importance of high suspicion and intra-compartmental pressure measurement to diagnose this condition accurately., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Correia et al.)

Background: A shortage of kidney grafts has led to the implementation of various strategies, including donations after circulatory death. The in situ normothermic regional perfusion technique has been introduced to improve graft quality by reducing warm ischemia times. However, there is limited evidence available on its mid- and long-term outcomes. Therefore, this study aimed to compare the incidence of delayed graft function, graft function, and survival at three years among three groups: brain death donors, rapid recovery, and normothermic regional perfusion., Methods: A retrospective analysis of a cohort of kidney transplantations was conducted at a single referral center between January 1, 2015, and December 31, 2019. Univariate and multivariate regression models and propensity score matching analysis were performed to compare recipient-related, transplantation procedure-related, donor-related, and kidney function variables., Results: A total of 327 patients were included, with 256 kidneys from brain death donors, 52 kidneys from rapid recovery, and 19 patients from normothermic regional perfusion. After propensity score matching, univariate and multivariate analyses showed a higher incidence of delayed graft function in the rapid recovery group compared to the others (OR: 2.39 CI95%: 1.19, 4.77) with a longer hospital stay (median 11, 15 and 10 days, respectively). However, no differences in 1- and 3-year graft function and survival were found., Conclusions: Normothermic regional perfusion offers advantages over rapid recovery, with a reduced incidence of delayed graft function and a shorter hospital stay. However, no differences in mid-term graft function and survival were found.

Background: Medial meniscal (MM) lesions (MMLs) are a common finding at the time of anterior cruciate ligament reconstruction (ACLR). It is recognized that evaluation of the posteromedial compartment reduces the rate of missed MML diagnoses., Purpose: To determine the incidence of MMLs in patients undergoing ACLR, when using a standardized arthroscopic approach that included posteromedial compartment evaluation, as well as to determine how the incidence of MMLs changed with increasing time intervals between injury and surgery, and to investigate what risk factors were associated with their presence., Study Design: Case series; Level of evidence, 4., Methods: A retrospective analysis of prospectively collected data was performed. All patients who underwent primary ACLR between January 2013 and March 2023 were considered for study eligibility. The epidemiology was defined by categorizing and reporting the incidence and categorizing the spectrum of MM tear types. Risk factors associated with MMLs were analyzed using a logistic regression model., Results: MMLs were identified in 1851 (39.4%) of 4697 consecutive patients undergoing ACLR. The overall incidence of MMLs was 33.1% for the period of 0 to 3 months, 38.7% for the period of 3 to 12 months, and 59.6% for the period of >12 months. The overall incidence of MMLs increased with longer durations of time between injury and surgery, along with significant increases in complex, bucket-handle, ramp, and/or flap lesions. The largest increase in incidence of MMLs was observed for complex MM tear patterns. Risk factors associated with MMLs included time between injury and surgery >3 months (odds ratio [OR], 1.320; 95% CI, 1.155-1.509; P < .0001) and >12 months (OR, 3.052; 95% CI, 2.553-3.649; P < .0001), male sex (OR, 1.501; 95% CI, 1.304-1.729; P < .0001), body mass index (BMI) ≥25 (OR, 1.193; 95% CI, 1.046-1.362; P = .0088), and lateral meniscal lesion (OR, 1.737; 95% CI, 1.519-1.986; P < .0001)., Conclusion: Overall, MMLs were identified in 39.4% of 4697 patients undergoing ACLR when posteromedial compartment evaluation was performed in addition to standard anterior viewing. The incidence of MMLs and the complexity of tear types increased significantly with increasing time intervals between the index injury and ACLR. Secondary risk factors associated with an increased incidence of medial meniscal tears include male sex, increased BMI, and lateral meniscal lesions., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: B.S.-C. has received consulting fees and royalties from Arthrex. J.-S.A. received a fellowship grant from Arthrex during his fellowship. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Background: Delayed graft function (DGF) is a significant challenge in renal transplantation, particularly with deceased donors, necessitating early postoperative dialysis. The prolonged effects of medium- and long-term DGF remain uncertain, marked by contradictory graft survival outcomes. This incongruity might arise from the inherent graft resilience and regenerative capacity during transplantation. This study investigates DGF's impact on graft survival, focusing on grafts displaying favorable (KDRI < 1) and unfavorable outcomes (KDRI ≥ 1)., Methods: In this retrospective cohort study (January 2015-December 2019), we assessed kidney transplants at our center, excluding multiorgan simultaneous cases, primary non-functioning grafts, and surgical complications causing graft loss. Patients were categorized into DGF presence or absence groups. Univariate and multivariate analyses, alongside propensity score matching (PSM), were performed., Results: The study encompassed 322 deceased donor kidneys, with 83 encountering DGF. Grafts with higher KDRI indices (KDRI ≥ 1) and DGF exhibited a notably increased graft loss risk (HR: 4.17, 95% CI: 1.93-9.01). However, lower-KDRI donor grafts displayed no significant disparities between the DGF and non-DGF groups., Conclusions: Delayed graft function (DGF) development significantly contributes to graft loss in kidney transplants, particularly in grafts with KDRI ≥ 1.

Background: With the emergence of advanced technology, such as robotics, three-dimensional (3D) imaging is necessary to execute preoperative surgical plans accurately. However, 3D imaging adds cost and potential risk to patients. This study determined the measurement accuracy, reliability, and repeatability of a novel artificial intelligence (AI) algorithm which converts two-dimensional (2D) radiographs to 3D bone models., Methods: An AI algorithm was developed to convert 2D radiographs to 3D bone model reconstructions. The accuracy of the AI algorithm was evaluated by comparing mean absolute error in measurements performed on 3D bone reconstructions, 3D computed tomography (CT) scans, and manual measurements on five cadaveric knees. Reliability and repeatability of the AI algorithm were evaluated by assessing the inter-observer and intra-observer agreement between measurements performed on 3D bone reconstructions, respectively., Results: Accuracy of the AI algorithm was considered excellent with mean absolute errors <2mm in 9 of 12 anatomical parameters compared with measurements performed on CTs and manual calipers. All inter-observer and intra-observer correlation coefficients were greater than 0.90 representing a high level of measurement reliability and repeatability by independent observers and the same observers., Conclusion: This particular AI algorithm demonstrated a high degree of accuracy, reliability, and repeatability for converting 2D radiographs to 3D bone reconstructions similar to a CT-scan. Study results suggest this AI algorithm has the potential for use in preoperative surgical planning due to its efficiencies related to cost and time and reduced radiation exposure without the use of 3D imaging., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objectives: Kidney transplant is the optimal treatment for end-stage renal disease; however, due to the imbalance between demand and supply, several strategies have been implemented to increase the donor pool. To increase the number of donors, expanded criteria donors after circulatory death have been explored as an acceptable graft source. In this study, we compared graft survival, estimated glomerular filtration rate at 3 and 5 years, and the incidence of delayed graft function between standard and expanded criteria donors after brain death and between standard and expanded criteria donors after circulatory death., Materials and Methods: A prospective cohort study was conducted between January 1, 2015, and December 31, 2019, at Reina Sofia University Hospital. Variables related to the donor, recipient, and transplant procedure were analyzed, and univariate and multivariate logistic and Cox regression analyses were performed., Results: Our study included 308 deceased donor kidneys. The kidneys from standard criteria brain dead donors had higher estimated glomerular filtration rate than the other groups (P < .03).However, no significant differences in estimated glomerular filtration rate were observed among the suboptimal groups (expanded criteria and standard criteria donors after brain death and expanded criteria donors after circulatory death). The incidence of delayed graft function was significantly higher in expanded criteria donors after circulatory death than in the other groups (odds ratio = 6.9; 95% CI, 2.22-21.71; P < .001). Nevertheless, we found no significant differences in death-censored graft loss among the groups., Conclusions: Kidney transplants from expanded criteria donors and donors after cardiac death are comparable, even when both criteria are combined. The use of expanded criteria donor kidneys after cardiac death is therefore a suitable approach to expand the donor pool, despite the higher risk of delayed graft function, as there were no significant differences in death-censored graft loss.

This technical note presents the single-anteromedial bundle biological augmentation (SAMBBA)-plus technique, which is a combined anterior cruciate ligament (ACL) repair and ACL reconstruction. Preservation of the native ACL fibers improves vascularity by encircling the ACL graft with synovium that is abundant in vascular-derived stem cells. Retaining the proprioceptive fibers of the native ACL can improve the recovery of joint positioning., (© 2022 The Authors.)

Background: Bone-patellar tendon-bone (BPTB) autografts are widely considered the standard for anterior cruciate ligament reconstruction (ACLR)., Purpose/hypothesis: The aims of this study were to compare the clinical outcomes after ACLR with gold standard BPTB autografts versus combined ACLR + anterolateral ligament reconstruction (ALLR) with hamstring tendon (HT) autografts at medium-term follow-up in a large series of propensity-matched patients. The hypothesis was that combined ACLR + ALLR with HT autografts would result in lower graft rupture rates and non-graft rupture-related reoperation rates., Study Design: Cohort study; Level of evidence, 3., Methods: Patients undergoing combined ACLR + ALLR using HT autografts between January 2003 and December 2019 were propensity matched in a 1:1 ratio to patients undergoing isolated ACLR using BPTB autografts. At the end of the study period, graft ruptures, contralateral knee injuries, and any other reoperations or complications after the index procedure were identified by a search of a prospective database and a review of medical records., Results: A total of 1009 matched pairs were included. The mean duration of follow-up was 101.3 ± 59.9 months. Patients in the isolated group were >3-fold more likely to have graft failure than those in the combined group (hazard ratio, 3.554 [95% CI, 1.744-7.243]; P = .0005). Patients aged <20 years were at a particularly high risk of graft ruptures compared with patients aged >30 years (hazard ratio, 5.650 [95% CI, 1.834-17.241]; P = .0002). Additionally, there was a significantly higher reoperation rate after isolated ACLR than after combined ACLR + ALLR (20.5% vs 8.9%, respectively; P < .0001). The overall rate of subsequent contralateral ruptures was 9.1% after index surgery (isolated: 10.2%; combined: 8.0%; P = .0934), indicating that the risk profiles for both groups were similar., Conclusion: Patients who underwent isolated ACLR with BPTB autografts experienced significantly worse graft survivorship and overall reoperation-free survivorship compared with those who underwent combined ACLR + ALLR with HT autografts. The risk of graft ruptures was >3-fold higher in patients who underwent isolated ACLR using BPTB autografts.

Background: Anterior cruciate ligament (ACL) injuries are among the most common knee injuries sustained in elite sport, and athletes generally undergo ACL reconstruction (ACLR) to facilitate their return to sport. ACL graft rupture is a career-threatening event for elite athletes., Purpose/hypothesis: The purpose of this study was to determine the risk factors for graft failure in professional athletes undergoing ACLR. It was hypothesized that athletes who underwent combined ACLR with a lateral extra-articular procedure (LEAP) would experience significantly lower rates of graft rupture in comparison with those who underwent isolated ACLR., Study Design: Cohort study; Level of evidence, 3., Methods: Professional athletes who underwent primary ACLR with a minimum follow-up of 2 years were identified from the Santy database. Patients were excluded if they underwent major concomitant procedures, including multiligament reconstruction surgery or osteotomy. Further ipsilateral knee injury, contralateral knee injury, and any other reoperations or complications after the index procedure were identified by interrogation of the database and review of the medical notes., Results: A total of 342 athletes with a mean follow-up of 100.2 ± 51.9 months (range, 24-215 months) were analyzed. Graft failures totaling 31 (9.1%) were reported, requiring revision surgery because of symptomatic instability. The rate of graft failure was significantly higher when ACLR was not combined with a LEAP (15.5% vs 6.0%; P = .0105) and in athletes aged 21 years or younger (13.8% vs 6.6%; P = .0290). A multivariate analysis was performed using the Cox model and demonstrated that athletes undergoing an isolated ACLR were at >2-fold risk of ACL graft rupture (hazard ratio [HR], 2.678 [1.173; 4.837], P = .0164) when compared with those undergoing a combined ACLR with a LEAP. Additionally, athletes aged ≤21 years were also at >2-fold risk of graft failure (HR, 2.381 [1.313; 5.463]; P = .0068) than those aged >21 years. Sex, sport, and graft type were not found to be significant risk factors for graft failure., Conclusion: Professional athletes undergoing isolated ACLR and aged ≤21 years are at >2-fold greater risk of graft failure. Orthopaedic surgeons treating elite athletes should combine an ACLR with a LEAP to improve ACL graft survivorship.

There has been a significant increase in the number of anterior cruciate ligament (ACL) reconstruction (ACLR) procedures being performed with a lateral extra-articular procedure (LEAP). However, tunnel convergence in combined ACLR and LEAP techniques has been described and can lead to damage to the graft or graft failure. This technical note describes how to avoid knee tunnel convergence when performing a modified Lemaire extra-articular tenodesis using a knotless suture anchor., (© 2022 The Authors.)

The burden of knee osteoarthritis (OA) is increasing worldwide. Advanced tibiofemoral joint OA in young patients is particularly a problem with inferior results seen with total knee arthroplasty in this patient population. Knee joint distraction (KJD) has been evaluated recently as a joint preserving procedure for young patients with advanced tibiofemoral osteoarthritis, to delay the need for a primary total knee arthroplasty (TKA). This will decrease the risk for revision TKA later in life. KJD temporarily unloads the knee joint and keeps the tibia and femur separated over a course of 6 weeks. Outcomes of KJD appear promising. Through this article, the authors hope to share from their collective experience as well as the available literature on the basic science, principles of surgery and outcomes of KJD., (© 2021 Delhi Orthopedic Association. All rights reserved.)

Purpose: The purpose of this study was to perform a scoping review of published literature reporting on surgical management of tibial cysts which developed after ACLR., Methods: A scoping review was conducted following the Arksey and O'Malley framework for scoping studies and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) extension for scoping reviews (PRISMA-ScR) guidelines. A search strategy using the terms ["Tibial Cyst" AND "ACL"], ["Pretibial Cyst" AND "ACL"] was applied to the PUBMED database., Results: Thirty-seven studies published between 1990 and 2019 were a part of this scoping review. Non-absorbable implants for tibial graft fixation were used in 10 studies (comprising a total 21 patients), while bio-absorbable implants were used in 27 studies (comprising a total 115 patients). Incidence of tibial cyst was reported in 3 studies (434 primary ACLRs) from whom 3.9% (n = 17) developed tibial cyst. Tibial cyst development in relation to use of bio-absorbable screws for tibial ACL graft fixation was reported in 16 studies (42.1%). Use of bio-absorbable screws with another factor was found to be related to tibial cyst development in another 1 study (2.6%). Most common symptoms were presence of mass or swelling, pain, tenderness, drainage, instability and effusion., Conclusion: This scoping review demonstrated that tibial cysts is more frequently related to bioabsorbable screws, however it can also occur due to other causes. Current literature on tibial cyst after ACLR is of low-quality evidence. Future research is required to better understand aetiology, risk factors for cyst formation and the best possible mode of management., Level of Evidence: IV.

Cryptococcosis, a potentially fatal mycosis in humans, is acquired via exposure to exogenous environmental sources. This study aimed to investigate the frequency, genetic diversity, and virulence of cryptococcal strains isolated from indoor dust in the Rio Negro micro-region of the Brazilian Amazon. A total of 8.9% of the studied houses were positive, recovering nine Cryptococcus neoformans VNI and 16 C. gattii VGII isolates, revealing an endemic pattern in domestic microenvironments. The International Society for Human and Animal Mycology (ISHAM) consensus multilocus sequence typing (MLST) scheme for the C.&nbsp;neoformans/C. gattii species complexes identified two sequence types (STs), ST93 and ST5, amongst C. neoformans isolates and six STs amongst C. gattii isolates, including the Vancouver Island Outbreak ST7 (VGIIa) and ST20 (VGIIb), the Australian ST5, and ST264, ST268 and ST445, being unique to the studied region. Virulence studies in the Galleria mellonella model showed that five C. gattii strains and one C. neoformans strain showed a similar pathogenic potential to the highly virulent Vancouver Island outbreak strain CDR265 (VGIIa). The findings of this study indicate that humans can be exposed to the agents of cryptococcosis via house dust, forming the basis for future studies to analyze the impact of early and continuous exposure to indoor dust on the development of subclinical or clinical infections., Competing Interests: The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript or in the decision to publish the results.

Objectives: Primary: to assess the use of simulators in prostate digital rectal examination and bladder catheterization on mental workload and the level of confidence in medical students. Secondary: to analyze student satisfaction and skills acquired by students with simulators., Methods: We conducted a prospective, randomized study on medical students. Participants were divided into two groups: Group 1 (G1) (only the explanation) and group 2 (G2) (explanation + simulator workshop). For workload assessment, the validated NASA-TLX questionnaire was completed. The acceptability of the activity, the degree of confidence and the skills acquired were also evaluated., Results: A total of 28 students participated in the practice of prostate examination. All participants reported a higher level of confidence after the theoretical explanation. 34 students participated in the bladder catheterization workshop and all of them increased their confidence after the activity. The G2 showed better scores on the acquired skills exam than the G1. Most students considered positive the incorporation of these models in their learning. According to the NASA-TLX results, less frustration is experienced with the use of simulators in both activities., Conclusions: The implementation of simulators in the training of students may improve their level of confidence, reducing frustration when performing these explorations in the future and improving care quality.

Central nervous system (CNS) involvement in Chagas disease (CD) is an uncommon complication that can result from direct involvement of the parasite or from thromboembolic phenomena. Direct involvement of CNS can occur in both acute and chronic forms of CD, and can also be secondary to reactivation. Reactivation of CD generally occurs in immunosuppressed patients such as those with human immunodeficiency infection or malignancies being rarely described in patients without apparent immunosuppression. We report a case of a patient living for many years in a nonendemic area for CD that presented to the emergency department with sudden onset of neurological symptoms as a result of reactivation of the disease. The microorganism was isolated from cerebrospinal fluid, and despite appropriate use of benznidazole, the patient died of sepsis after 22 days of treatment. Further investigation did not show any apparent cause of immunosuppression. This case report shows the importance of considering the diagnostic possibility of neurological complications from CD reactivation in patients that have ever lived in CD-endemic areas even without apparent underlying immunosuppression., (© The American Society of Tropical Medicine and Hygiene.)

Objectives: To quantify the degree of pain experienced by patients who undergo ultrasound-guided transrectal prostate biopsy in standard clinical practice and assess the clinical factors associated with increased pain., Material and Methods: Analysis of a multicenter series of patients with prostate biopsy according to standard clinical practice. The biopsy was performed transrectally with a protocol of local anesthesia on the posterolateral nerve bundle. The pain was assessed at 20minutes into the procedure using the visual analog scale (0-10). The degree of pain was analyzed, and the association was studied using a univariate/multivariate analysis of selected clinical variables and the degree of pain., Results: A total of 1188 patients with a median age of 64 years were analyzed. Thirty percent of the biopsies were diagnosed with a tumor. The median pain score was 2, with 65% of the patients reporting a pain score ≤2. The multivariate analysis showed that the prostate volume (RR, 1.34; 95% CI 1.01-1.77; P=.04), having a previous biopsy (RR, 2.25; 95% CI 1.44-3.52; P<.01), age (RR, .63; 95% CI .47-.85; P<.01) and feel palpation (RR, 1.95; 95% CI 1.28-2.96; P<.01) were factors independently associated with greater pain during the procedure., Conclusions: Transrectal biopsy with local anesthesia is a relatively painless technique. Factors such as age, a previous biopsy, pain on being touched and prostate volume were associated with the presence of greater pain during the procedure., (Copyright © 2014 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

Chitosan solutions and cellulose nanocrystal suspensions were used to produce highly stable aqueous dispersions of multi-walled carbon nanotubes (MWCNTs). The different MWCNT dispersions, presenting positive and negative charges, were used to prepare multilayered hybrid thin films through electrostatic layer-by-layer (LBL) self-assembly. The MWCNTs are well dispersed and homogeneously distributed on each layer of chitosan and cellulose nanocrystals of the films. The nanotubes are densely packed in each multilayer, forming a random network. The surface of the LBL film exhibited a uniform and relatively smooth surface with a mean roughness value of ∼5.8±0.4nm. Electrochemical characterization revealed a decrease in two orders of magnitude in the film resistance as the number of bilayers increased from 5 to 20, which is a consequence of an increase in the amount of conductive material (MWCNT). The thin films with up to 20 bilayers exhibited transmittance higher than 90% in the visible range. The results presented in this work demonstrate the viability of the LBL technique for the deposition of active materials using the biopolymer pair chitosan/cellulose nanocrystals. The obtained films can be employed for the design of transparent and biocompatible carbon nanostructured based electrodes., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: To determine the efficacy of coenzyme Q10 (CoQ10) in preventing renal injury in patients with lithiasis undergoing extracorporeal shockwave lithotripsy (ESWL)., Patients and Methods: Prospective, randomised, double-blind, placebo-controlled clinical trial of 100 patients with renal lithiasis who were treated with ESWL. The patients were distributed randomly into two groups receiving either placebo or CoQ10 (200 mg/day), a powerful antioxidant with vasoactive properties, orally administered during the week before ESWL and for 1 week after. Renal dysfunction markers, vasoactive hormones, oxidative stress, plasma levels of several interleukins and vascular resistance index (VRI) using Doppler ultrasound were evaluated the week before ESWL, 2 h before ESWL and at 2 h, 24 h and 7 days after ESWL., Results: There was a significant increase in glomerular filtration (P = 0.013), as well as a decrease in the albumin/creatinine ratio and the β2 -microglobulin level (P = 0.02) after 1 week of treatment in the CoQ10 group. These changes were maintained at the follow-up after ESWL. The administration of CoQ10 was associated with improvement in vasoactive hormone parameters, VRI and interleukin levels. These improvements were maintained until the end of the follow-up period. However, the administration of CoQ10 was not associated with significant changes in the oxidative stress parameters., Conclusion: Our results indicate that CoQ10 administration improves renal function and vasoactive and inflammation parameter values, allowing for preconditioning before the tissue insult caused by ESWL., (© 2013 The Authors. BJU International © 2013 BJU International.)

Background: Kidney transplantation is the treatment of choice for patients with end-stage renal disease. In recent years donor criteria have changed to increase the percentage of expanded-criteria donors (ECDs). The aim of this study was to analyze transplants from ECDs obtained at our institution from. 2010 to 2012. We studied the comorbidity of ECD, preimplantation histologic study, renal function, and survival of transplanted grafts., Patients and Methods: Eighty ECDs (160 kidneys) were analyzed. Forty-nine grafts were not implanted owing to macroscopic lesions (37 kidneys) or histologic findings on preimplantation biopsy (12 kidneys). Finally, 60 grafts from ECDs were implanted in our center. We analyzed the characteristics of the grafts (kidney function, creatinine clearance) and compared the data with a control group of allografts from standard-criteria donors (n = 14)., Results: The median age of the ECD group was 72 years (range 65-77). No differences were found in certain characteristics between the ECDs whose kidneys were or were not implanted (hypertension, diabetes, creatinine at the time of the donation or proteinuria). However, there were differences in donor age (75 vs 67; P = .043), increased preimplantation biopsy score (6.8 ± 1.3 vs 4.8 ± 1.1; P = .041), and a higher percentage of cardiovascular disease (62.5% vs 43%; P = .038). Comparison of ECD and non-ECD grafts showed a lower creatinine clearance at 1 year (50 ± 05 mL/min vs 69 ± 96 mL/min, respectively; P < .001) and 2 years (50 ± 07 mL/min vs 67 ± 74 mL/min; P < .001) after transplantation. There were no differences in delayed graft function or graft survival between the 2 groups at 2 years after transplantation (95% vs 100%; P = .38)., Conclusions: We found no differences in graft survival from ECD compared with the control group of standard-criteria donors. The evaluation of grafts from ECD may be a strategy to increase the number of kidney transplants., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: Technical and medical advances over the past few years have produced an important increase in the functionality of renal allografts. The aim of this study was to identify the factors associated with allograft survival 15 years after transplantation in our series., Methods: A retrospective study of kidney transplantations was carried out at Reina Sofia Hospital in Cordoba from February 1979 to December 1997, with follow-up through June 2012. A subanalysis of the series was undertaken, and Kaplan-Meier analysis and Cox proportional hazards model regression used to achieve the main objective of the study., Results: A total of 487 renal allografts with a mean follow-up of 114 months were studied, of which 37% (n = 180) survived for >15 years. Of the 180 patients, the main causes of graft failure were chronic allograft nephropathy in 29 (66%) and patient death in 13 (29.5%). Multivariate analysis identified the number of HLA mismatches (hazard ratio [HR] 1.25, 95% CI 1.01-1.56), panel reactive antibodies (HR 2.61, 95% CI 1.28-5.26), and delayed graft function (HR 11.25, 95% CI 1.33-95.28) as being significantly associated with graft loss after 15 years., Conclusions: The high immunologic risk of the patients was independently associated with graft loss. Delayed graft function was the most important factor in the speed of graft failure beyond 15 years., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Although the association of schizophrenia and winter birth has been replicated many times in the Northern hemisphere, studies in the Southern hemisphere have been less consistent in their findings. A study from NE Brazil indicated the period between May and July, 3 months after the peak in rainfall, as a risk period for schizophrenia birth. We report findings from a random selection of charts (N = 1789) from the only public inpatient psychiatric facility in Ceará, Brazil (2 degrees to 5 degrees S). We compared the seasonality of birth in the schizophrenia group (N = 406) to multiple control groups: (1) psychosis not otherwise specified (N = 868), (2) other psychiatric diagnoses (N = 515), and (3) the average monthly birth rate in the general population. Patients with schizophrenia had a significantly greater risk of being born in the risk period compared with any of the control groups. There is a significant association between rainfall in a month and schizophrenia births 3 (p = 0.03) and 4 months (p = 0.01) later. This study corroborates findings of a significant seasonality in schizophrenia births in northeast Brazil.

Background: Medical care in a hospital under a socialized medicine system should be highly effective at the lowest expense possible. When myocardial perfusion studies are performed in well-selected patients, the costs decrease because of the need for fewer invasive studies. When patients are not selected properly, there is an increase-wasted resource, making it necessary to perform cost-effective studies. The goal of this study is to evaluate the economical impact of the diagnostic process in patients suspected of having coronary artery disease, referred to our service (Nuclear Medicine, Hospital de Cardiología CMN, IMSS) in 2002., Methods: We analyzed 1966 reports of myocardial gammagrams. Patient reports were stratified according to their referring unit. The sum of the unitary fixed cost was converted to the unitary cost for each reason for referral. Kappa was used to evaluate concordance., Results: Patients were 62 +/- 11.39 years old, 52% male. Concordance between the referring diagnosis and the myocardial gammagram was <1% (p <0.001). The cost of cardiac gammagrams varied between $2,613.11 and $3,306.77 (Mexican pesos). Waste was calculated at 30%, which represented $1.8 million (Mexican pesos)., Conclusions: Cost-effective studies are important tools in the administration of resources. In this particular case the results indicate the necessity for systematic registration of financial information, periodic review of operation costs by service, and criteria for use of high-cost services.

Cardiopulmonary bypass (CPB) is one of the methods used in myocardial revascularization and can be associated with adverse events that are uncommon, but CPB induces high morbidity and mortality. Cardiac surgery and CPB activate a systemic inflammatory response characterized by tissular lesions, cells movements and blood flow toward the interstice where the harmful stimulus has begun, under the influence of the mediators. The systemic inflammatory response may be initiated during cardiac surgery by a number of processes, including blood contact with the foreign surface of the CPB apparatus, development of ischemia and reperfusion injury, and presence of endotoxemia. In the course of cardiac surgery using CPB, all three processes are present and contribute concurrently to the systemic inflammatory response. The term "systemic inflammatory response syndrome" (SIRS) has been proposed to describe an entity that continually overlaps with normal postoperative physiology. A frequent complication of SIRS is the development of organ dysfunction, including acute lung injury, shock, renal failure, and multiple organ dysfunction syndrome. Finally, long-term survival in patients developing SIRS may also be adversely affected. The purpose of this review is to examine and understand the pathological mechanisms for inflammatory response that occur following cardiopulmonary bypass.

Objective: We evaluated the precision of the perfusion and ventricular function through cardiac scintigraphy 99mTc-MIBI SPECT synchronized to the electrocardiogram to differentiate the ventricular damage of ischemic origin from the dilated cardiomyopathy., Methods: Thirty patients with myocardial damage with ejection fraction =30% were included. We analyzed the prognostic value of clinical, angiographic, and 99mTc-MIBI SPECT variables., Results: We studied 30 patients with myocardial damage, 26 men (86.7%) and 4 women (13.3%), with an average age of 45.7 +/- 9.3 years. The diagnosis established by cardiac catheterization was dilated cardiomyopathy in 17 patients (56.6%) and 13 with ischemic cardiomyopathy (43.4%). The study by cardiac scintigraphy 99mTc-MIBI SPECT synchronized to the electrocardiogram established the diagnosis of dilated cardiomyopathy in 18 patients, with a sensitivity of 100% and specificity of 92%. The predictive positive value was 100% and the predictive negative value 94.4%., Conclusions: Cardiac scintigraphy 99mTc-MIBI SPECT synchronized to the electrocardiogram differs in the etiology of the myocardial damage produced by dilated cardiomyopathy from that of ischemic origin in a noninvasive way and with high sensitivity and specificity.

Objective: The study deals theoretical aspects of evaluation and the importance of consider one as part of a research process. The diverse theoretical trends in the field of education are synthesized in two main tendencies: the participating and passive education perspectives. The influences of these two tendencies in selection the subjects for evaluation are also discussed in order to explore the gammagraphic interpretation aptitude in residents of nuclear medicine., Material and Methods: An evaluation instrument developed by us to explore aptitudes result of a long validation process. It consists of 90 questions was applied to the whole sample (19 residents in two IMSS courses) in one single session. We also applied other instrument of multiple choice (90 questions too) within the passive tendency of education (control instrument)., Results: Scores obtained by three groups of residents in nuclear medicine in the aptitudes instrument, showed difference in accordance with the respective time of experience: first year obtained the lowest scores (31.5) second year showed intermediate scores (36) 3rd the highest (43) (p = 0.03 between 1st and 3rd). The scores obtained by the control instrument, was not clear difference: the 2nd year of residents was found better (score of 56) than 3rd year residents (score 52.5) The aptitude instrument is better than the control instrument in order to explored, discriminated and estratificated by time of formative experience in medical courses., Conclusions: We believe that the aptitude instrument is capable of detecting learning dependent on the time of clinical experience. Some considerations on the advantages and scope of this instrument, as compared to other current instruments, which are also intended to measure clinical aptitudes, are done. The theoretical superiority of the clinical aptitudes instrument in relation the others are discussed.