Microbial Ecology

Fungal Community Composition and Potential Depth-Related Driving Factors Impacting Distribution Pattern and Trophic Modes from Epi- to Abyssopelagic Zones of the Western Pacific Ocean Abstract Fungi play an important role in cycling organic matter and nutrients in marine ecosystems. However, the distribution of fungal communities in the ocean, especially the vertical distribution along depth in the water column, remained poorly understood. Here, we assess the depth-related distribution pattern of fungal communities along the water column from epi- to abyssopelagic zones of the Western Pacific Ocean using internal transcribed spacer 2 (ITS2) metabarcoding. Majority of the assigned OTUs were affiliated to Ascomycota, followed by three other minor phyla (Basidiomycota, Chytridiomycota, and Mucoromycota). The epipelagic zone harbored a higher OTU richness with distinct fungal communities as compared with meso-, bathy-, and abyssopelagic zones. Across the whole water column, depth appears as a key parameter for both fungal α- and β-diversity. However, when the dataset was split into the upper (5–500 m) and deeper (below 500 m) layers, no significant correlation was observed between depth and community compositions. In the upper layer, temperature and dissolved oxygen were recognized as the primary environmental factors shaping fungal α- and β- diversity. By parsing fungal OTUs into ecological categories, multi-trophic mode of nutrition was found to be more prevalent with increasing depth, suggesting a potential adaptation to the extreme conditions of the deep sea. This study provides new and meaningful information on the depth-stratified fungal diversity, community structure, and putative ecological roles in the open sea.

Bacterial Community Composition and Diversity Respond to Nutrient Amendment but Not Warming in a Maritime Antarctic Soil Abstract A resumption of climate warming in maritime Antarctica, arising from continued greenhouse gas emissions to the atmosphere, is predicted to lead to further expansions of plant populations across the region, with consequent increases in nutrient inputs to soils. Here, we test the main and interactive effects of warming, applied with open top chambers (OTCs), and nutrient amendment with tryptic soy broth (TSB), an artificial growth substrate, on bacterial community composition and diversity using Illumina sequencing of 16S rRNA genes in soil from a field experiment in the southern maritime Antarctic. Substantial effects of TSB application on bacterial communities were identified after 49 months, including reduced diversity, altered phylogenetic community assembly processes, increased Proteobacteria-to-Acidobacteria ratios and significant divergence in community composition, notably increases in the relative abundances of the gram-positive genera Arthrobacter, Paeniglutamicibacter and Planococcus. Contrary to previous observations from other maritime Antarctic field warming experiments, we recorded no effects of warming with OTCs, or interactive effects of OTCs and TSB application, on bacterial community composition or diversity. Based on these findings, we conclude that further warming of the maritime Antarctic is unlikely to influence soil bacterial community composition or diversity directly, but that increased nutrient inputs arising from enhanced plant growth across the region may affect the composition of soil bacterial communities, with possible effects on ecosystem productivity.

Characterization of Bacterial Communities in Breeding Waters of Anopheles darlingi in Manaus in the Amazon Basin Malaria-Endemic Area Abstract The microbiota in mosquito breeding waters can affect ovipositing mosquitoes, have effects on larval development, and can modify adult mosquito-gut bacterial composition. This, in turn, can affect transmission of human pathogens such as malaria parasites. Here, we explore the microbiota of four breeding sites for Anopheles darlingi, the most important malaria vector in Latin America. The sites are located in Manaus in the Amazon basin in Brazil, an area of active malaria transmission. Using 16S rRNA gene sequencing by MiSeq, we found that all sites were dominated by Proteobacteria and Firmicutes and that 94% of the total number of reads belonged to 36 operational taxonomic units (OTUs) identified in all sites. Of these, the most common OTUs belonged to Escherichia/Shigella, Staphylococcus, and Pseudomonas. Of the remaining 6% of the reads, the OTUs found to differentiate between the four sites belonged to the orders Burkholderiales, Actinomycetales, and Clostridiales. We conclude that An. darlingi can develop in breeding waters with different surface-water bacteria, but that the common microbiota found in all breeding sites might indicate or contribute to a suitable habitat for this important malaria vector.

Community Ecology of Deinococcus in Irradiated Soil Abstract Deinococcus is a genus of soil bacteria known for radiation resistance. However, the effects of radiation exposure on its community structure are unknown. We exposed soil to three levels of gamma radiation, 0.1 kGy/h (low), 1 kGy/h (medium), and 3 kGy/h (high), once a week for 6 weeks and then extracted soil DNA for 16S rRNA amplicon sequencing. We found the following: (1) Increasing radiation dose produced a major increase in relative abundance of Deinococcus, reaching ~ 80% of reads at the highest doses. Differing abundances of the various Deinococcus species in relation to exposure levels indicate distinct "radiation niches." At 3 kGy/h, a single OTU identified as D. ficus overwhelmingly dominated the mesocosms. (2) Corresponding published genome data show that the dominant species at 3 kGy/h, D. ficus, has a larger and more complex genome than other Deinococcus species with a greater proportion of genes related to DNA and nucleotide metabolism, cell wall, membrane, and envelope biogenesis as well as more cell cycle control, cell division, and chromosome partitioning-related genes. Deinococcus ficus also has a higher guanine–cytosine ratio than most other Deinococcus. These features may be linked to genome stability and may explain its greater abundance in this apparently competitive system, under high-radiation exposures. (3) Genomic analysis suggests that Deinococcus, including D. ficus, are capable of utilizing diverse carbon sources derived from both microbial cells killed by the radiation (including C5–C12-containing compounds, like arabinose, lactose, N-acetyl-d-glucosamine) and plant-derived organic matter in the soil (e.g., cellulose and hemicellulose). (4) Overall, based on its metagenome, even the most highly irradiated (3 kGy/h) soil possesses a wide range of the activities necessary for a functional soil system. Future studies may consider the resilience and sustainability of such soils in a high-radiation environment.

Functional Response of MBR Microbial Consortia to Substrate Stress as Revealed by Metaproteomics Abstract Bacterial consortia have a primary role in the biological degradations occurring in activated sludge for wastewater treatment, for their capacities to metabolize the polluting matter. Therefore, the knowledge of the main metabolic pathways for the degradation of pollutants becomes critical for a correct design and operation of wastewater treatment plants. The metabolic activity of the different bacterial groups in activated sludge is commonly investigated through respirometry. Furthermore, in the last years, the development of "omic" approaches has offered more opportunities to integrate or substitute the conventional microbiological assays and to deeply understand the taxonomy and dynamics of complex microbial consortia. In the present work, an experimental membrane bioreactor (MBR) was set up and operated for the treatment of municipal wastewater, and the effects of a sudden decrease of the organic supply on the activated sludge were investigated. Both respirometric and metaproteomic approaches revealed a resistance of autotrophic bacteria to the substrate stress, and particularly of nitrifying bacteria. Furthermore, metaproteomics allowed the identification of the taxonomy of the microbial consortium based on its protein expression, unveiling the prevalence of Sorangium and Nitrosomonas genera both before and after the organic load decrease. Moreover, it confirmed the results obtained through respirometry and revealed a general expression of proteins involved in metabolism and transport of nitrogen, or belonging to nitrifying species like Nitrosomonas europeae, Nitrosomonas sp. AL212, or Nitrospira defluvii.

Edaphic Factors Influence the Distribution of Arbuscular Mycorrhizal Fungi Along an Altitudinal Gradient of a Tropical Mountain Abstract Changes in relief in montane areas, with increasing altitude, provide different biotic and abiotic conditions, acting on the species of arbuscular mycorrhizal fungi (AMF). The objective of this work was to determine the influence of altitude, edaphic factors, and vegetation on the AMF species in a mountainous area. The list of AMF species was obtained from morphological identification of the spores, with 72 species recovered from field samples and trap cultures. Lower levels of Shannon's diversity occurred only at lower altitude; however, there was no difference in AMF richness. The structure of the AMF assembly between the two highest altitudes was similar and differed in relation to the lower altitude. There was variation in the distribution of AMF species, which was related to soil texture and chemical factors along the altitude gradient. Some species, genera, and families were indicative of a certain altitude, showing the preference of fungi for certain environmental conditions, which may aid in decisions to conserve montane ecosystems.

A Physiological and Genomic Comparison of Nitrosomonas Cluster 6a and 7 Ammonia-Oxidizing Bacteria Abstract Ammonia-oxidizing bacteria (AOB) within the genus Nitrosomonas perform the first step in nitrification, ammonia oxidation, and are found in diverse aquatic and terrestrial environments. Nitrosomonas AOB were grouped into six defined clusters, which correlate with physiological characteristics that contribute to adaptations to a variety of abiotic environmental factors. A fundamental physiological trait differentiating Nitrosomonas AOB is the adaptation to either low (cluster 6a) or high (cluster 7) ammonium concentrations. Here, we present physiological growth studies and genome analysis of Nitrosomonas cluster 6a and 7 AOB. Cluster 6a AOB displayed maximum growth rates at ≤ 1 mM ammonium, while cluster 7 AOB had maximum growth rates at ≥ 5 mM ammonium. In addition, cluster 7 AOB were more tolerant of high initial ammonium and nitrite concentrations than cluster 6a AOB. Cluster 6a AOB were completely inhibited by an initial nitrite concentration of 5 mM. Genomic comparisons were used to link genomic traits to observed physiological adaptations. Cluster 7 AOB encode a suite of genes related to nitrogen oxide detoxification and multiple terminal oxidases, which are absent in cluster 6a AOB. Cluster 6a AOB possess two distinct forms of ribulose-1,5-bisphosphate carboxylase/oxygenase (RuBisCO) and select species encode genes for hydrogen or urea utilization. Several, but not all, cluster 6a AOB can utilize urea as a source of ammonium. Hence, although Nitrosomonas cluster 6a and 7 AOB have the capacity to fulfill the same functional role in microbial communities, i.e., ammonia oxidation, differentiating species-specific and cluster-conserved adaptations is crucial in understanding how AOB community succession can affect overall ecosystem function.

Impacts of Freshwater and Seawater Mixing on the Production and Decay of Virioplankton in a Subtropical Estuary Abstract Virioplankton is an important component of the aquatic ecosystem and plays multiple ecological and biogeochemical roles. Although the spatial and temporal distributions and dynamics of virioplankton have been well investigated in riverine and marine environments, little is known about the dynamics and environmental controlling mechanisms of virioplankton in estuaries. In this study, viral abundance, production and decay were examined in the Pearl River Estuary (PRE), one of the largest estuaries in China. The influences of freshwater and seawater mixing on viral ecological dynamics were evaluated with several cross-transplant experiments. In PRE, viral abundance, production and decay rates varied from 2.72 ± 0.09 to 27.5 ± 1.07 × 106 viruses ml−1, 7.98 ± 2.33 to 16.27 ± 2.85% h−1 and 0.80 ± 0.23 to 3.74 ± 0.98% h−1, respectively. When the riverine and marine microbial community were transferred into simulated brackish water, viral production rates were markedly inhibited by 83.8% and 47.3%, respectively. The decay of riverine and marine virioplankton was inhibited by 21.1% and 34.2%, respectively, in simulated brackish water. These results indicate change of estuarine environmental factors significantly alters the dynamics of riverine and marine virioplankton. In addition, the effects of mixing on viral production and decay differed between high- and low-fluorescence viruses. High-fluorescence viruses seemed more resistant to decay than low-fluorescence viruses, whereas the production of marine low-fluorescence viruses seemed more resistant to inhibition than that of marine high-fluorescence viruses. Together, these results provide new insights into the ecological dynamics of virioplankton in estuarine environments.

Time-Dependent Hormetic Response of Soil Alkaline Phosphatase Induced by Cd and the Association with Bacterial Community Composition Abstract Hormetic dose-response that involved Cd in soils is increasingly paid attentions for risk assessment of Cd toxicity, but insufficient studies were conducted to define the temporary modification of soil enzyme and the potential microbial responses. The present study chooses soil alkaline phosphatase (ALP) as endpoint to uncover the time-dependent hormetic responses to low doses of Cd and its association with bacterial community composition. The results showed that addition of 0.01–3.0 mg kg−1 Cd significantly increased ALP's activities with maximum stimulatory magnitude of 11.4–27.2%, indicating a typical hormesis. The response started at 12 h after Cd addition and maintained about 24 h. This demonstrated that the hormetic response is time-dependent and transient. Changes of soil bacterial community composition showed that, at 6 h, relative abundances (RAs) of Proteobacteria and Firmicutes at phylum and Pontibacter, Bacillaceae-Bacillus, Bacillaceae1-Bacillus, and Paenisporosarcina at genus significantly correlated with ALP's activities at 12–36 h (P < 0.05). This suggests that soil bacteria likely showed an earlier response to Cd and potentially contributes to the subsequent soil enzyme's hormesis. In addition, it was found that Gram-negative bacteria other than Gram-positive bacteria are prone to exhibiting a hormetic response under Cd stress. Our findings provide much insight into ecotoxicological risk assessment for soil Cd pollution.

A Polyphasic Approach for Assessing Eco-System Connectivity Demonstrates that Perturbation Remodels Network Architecture in Soil Microcosms Abstract Network analysis was used to show changes in network attributes by analyzing the relations among the main soil microbial groups in a potted tomato soil inoculated with arbuscular mycorrhizal fungus, treated with low doses of Mentha spicata essential oil, or both, and then exposed to tenfold higher oil addition (stress pulse). Pretreatments were chosen since they can induce changes in the composition of the microbial community. Cellular phospholipid fatty acids (PLFAs) and the activity of six soil enzymes, mainly involved in the N-cycle were measured. Networks were constructed based on correlated changes in PLFA abundances. The values of all parameters were significantly different from those of random networks indicating modular architecture. Networks ranked from the lowest to highest modularity: control, non-pretreated and stressed, inoculated and stressed, oil treated and stressed, inoculated and treated with oil and stressed. The high values of network density and 1st/2nd eigenvalue ratio are related to arylamidase activity while N-acetyl-glucosaminidase, acid phosphomoesterase, and asparaginase activities related to high values of the clustering coefficient index. We concluded that modularity may be an efficient indicator of changes in the network of interactions among the members of the soil microbial community and the modular structure of the network may be related to the activity of specific enzymes. Communities that were stressed without a pretreatment were relatively resistant but prone to sudden transition towards instability, while oil or inoculation pretreatments gave networks which could be considered adaptable and susceptible to gradual change.

Otolaryngology

American Journal of Otolaryngology

Research articleAbstract only

Improving efficiency in epistaxis transfers in a large health system: Analyzing emergency department treatment variability as pretext for a clinical care pathway

Clare Richardson, Anish Abrol, Chelsea S. Hamill, Nicole Maronian, ... Brian D'Anza

In Press, Accepted Manuscript, Available online 16 April 2019

Purchase PDFArticle preview

Abstract

Abstract

Introduction

Epistaxis is a common condition with an estimated $100 million in health care costs annually. A significant portion of this stems from Emergency Department (ED) management and hospital transfers. Currently there is no data in the literature clearly depicting the differences in treatment of epistaxis between Emergency Medicine (EM) physicians and Otolaryngologists. Clinical care pathways (CCP) are a way to standardize care and increase efficiency. Our goal was to evaluate the variability in epistaxis management between EM and Otolaryngology physicians in order to determine the potential impact of a system wide clinical care pathway.

Materials and methods

A retrospective case study was conducted of all patients transferred between emergency departments for epistaxis over an 18-month period. Exclusion criteria comprised patients under 18 years old, recent sinonasal surgery, bleeding disorders, and recent facial trauma.

Results

73 patients met inclusion criteria. EM physicians used nasal cautery in 8%, absorbable packing in 1% and non-absorbable packing in 92% (with 33% being bilateral). In comparison, Otolaryngologists used nasal cautery in 37%, absorbable packing in 34%, and non-absorbable packing in 23%. Eighty percent of patients treated by an Otolaryngology physician required less invasive intervention than previously performed by EM physicians prior to transfer.

Conclusions

Epistaxis management varied significantly between Emergency Medicine and Otolaryngology physicians. Numerous patients were treated immediately with non-absorbable packing. On post-transfer Otolaryngology evaluation, many of these patients required less invasive interventions. This study highlights the variability of epistaxis treatment within our hospital system and warrants the need for a standardized care pathway.

select article Predicting transient hypocalcemia in patients with unplanned parathyroidectomy after thyroidectomy

Research articleAbstract only

Predicting transient hypocalcemia in patients with unplanned parathyroidectomy after thyroidectomy

Ramez Philips, Phillip Nulty, Nolan Seim, Yubo Tan, ... Garth Essig

In Press, Accepted Manuscript, Available online 16 April 2019

Purchase PDFArticle preview

Abstract

Abstract

Objective

To assess the utility of rapid parathyroid hormone (PTH) values in predicting transient post-operative hypocalcemia in patients with unplanned parathyroidectomy during total or completion thyroidectomy.

Methods

All patients who underwent total or completion thyroidectomy between January 2010 and January 2015 were reviewed. Incidences of post-operative hypocalcemia were compared in patients with and without unplanned parathyroidectomy. Unplanned parathyroidectomy was defined as intra-operative incidental or intentional parathyroidectomy. Logistic regression assessed for predictors of hypocalcemia and optimum amount of calcium supplementation.

Results

Thirty-eight (13.6%) patients had evidence of incidental parathyroidectomy and 39/280 (13.9%) patients had parathyroid autotransplantation intra-operatively. Central neck dissection and malignancy were identified as risk factors for unplanned parathyroidectomy (p = 0.001, p = 0.060). Patients with unplanned parathyroidectomy were more likely to have hypocalcemia (p = 0.002) and hypoparathyroidism (p < 0.0005). PTH value was the only significant predictor of hypocalcemia in these patients. In patients with a post-operative PTH of ≤15, initial calcium supplementation ≥ 1000 mg decreased the risk of hypocalcemia (p < 0.05).

Conclusion

Post-operative PTH value predicts hypocalcemia in patients undergoing total and completion thyroidectomy with unplanned parathyroidectomy. In patients with a post-operative PTH < 15, initial calcium supplementation with ≥1000 mg of elemental calcium is recommended.

select article Clinical practice patterns in laryngeal cancer and introduction of CT lung screening

Research articleAbstract only

Clinical practice patterns in laryngeal cancer and introduction of CT lung screening

Krzysztof Piersiala, Lee M. Akst, Alexander T. Hillel, Simon R. Best

In Press, Accepted Manuscript, Available online 12 April 2019

Purchase PDFArticle preview

Abstract

Abstract

Objectives

After the publication of large clinical trials, in January 2014 The U.S. Preventive Services Task Force (USPSTF) recommended annual lung cancer screening with low-dose CT in a well-defined group of high-risk smokers. A significant proportion of patients with laryngeal cancer (LC) meet the introduced criteria, and we hypothesized that clinical practice would change as a result of these evidence-based guidelines.

Methods

Retrospective chart review of patients diagnosed with LC and treated at Johns Hopkins Hospital who met USPSTF criteria for annual chest screening and were followed for at least 3 consecutive years in the years surrounding the introduction of screening guidelines (January 2010 to December 2017) was performed to identify those who had recommended screening CT chest.

Results

A total of 151 patients met the inclusion criteria of the study and were followed for a total of 746 patient-years. 184/332 (55%) patient-years in the pre-guidelines period and 246/414 (59%) in the post-guidelines period included at least one recommended chest imaging (CT or PET-CT; p = 0.27). 248/332 (75%) patient-years in the pre-guidelines period and 314/414 (76%) in the post-guidelines period included any radiological chest imaging (X-ray, CT or PET-CT; p = 0.72). Screening scans were ordered by OHNS (45%), Medical Oncology (31%), Radiation Oncology (8%), and primary care (14%) with 70% of patients missing at least one year of indicated screening.

Conclusions

The implementation of new lung cancer screening guidelines did not change clinical practice in the management of patients with LC and many patients do not receive recommended screening. Further study concerning potential barriers to effective evidence-based screening and coordination of care is warranted.

select article Wideband timpanometry results of bone cement ossiculoplasty

Research articleAbstract only

Wideband timpanometry results of bone cement ossiculoplasty

O. Yigit, S. Tokgoz-Yilmaz, E. Tahir, M.D. Bajin, ... L. Sennaroglu

In Press, Accepted Manuscript, Available online 12 April 2019

Purchase PDFArticle preview

Abstract

Abstract

Objective

We aim to investigate hearing sensitivity and wideband tympanometry results in bone cement ossiculoplasty cases in present study.

Study design

A prospective study.

Setting

Ossiculoplasty patients were grouped according to the anatomical location of bone cement application by surgery note. Ossiculoplasty and tympanoplasty patients were retrospectively invited to the clinic and evaluated. 30 bone cement ossiculoplasty cases as well as 30 Type I tympanoplasty cases (intact ossicular chain) and 30 healthy controls were included in the study and Wideband Tympanometry was performed. Tympanometric peak pressure, equivalent middle ear volume, static admittance, tympanogram width, resonance frequency, average wideband tympanometry and absorbance measurements were analyzed.

Results

A statistically significant improvement was observed in the hearing levels of all ossiculoplasty and type I tympanoplasty patients (p < 0.05). Bone cement ossiculoplasty groups demonstrated the remarkable differences than the type I tympanoplasty and control group in Wideband Tympanometry test parameters. In some parameters, malleus-stapes and manubriostapedioplasty groups demonstrated similarities to Type I tympanoplasty and control groups.

Conclusion

Bone cement is an effective application for ossiculoplasty. Wideband tympanometry is a promising method for the evaluation of the middle ear dynamics.

select article Intracapsular hemorrhage rates in non-fixated nylon sheet orbital implants for orbital fracture management

Research articleAbstract only

Intracapsular hemorrhage rates in non-fixated nylon sheet orbital implants for orbital fracture management

Mark A. Prendes, Brett Gudgel, Enoch B. Kassa, Amelia M. Todd, ... H.B. Harold Lee

In Press, Corrected Proof, Available online 9 April 2019

Purchase PDFArticle preview

Abstract

Abstract

Purpose

To examine the incidence of intracapsular hemorrhage in orbital fracture repair with non-fixated nylon sheet implants.

Methods

A retrospective chart review of 227 patients presenting from January 2013 to December 2016 for orbital fracture repair with nylon sheet implants.

Results

Of the 331 orbital fractures repaired over 4 years, a total of 227 met inclusion criteria. The average implant thickness was 0.38 mm and no implants were fixated. Four total implants (1.8%) were removed due to complications; one each secondary to exploration for ongoing postoperative diplopia, immediate post-operative orbital hemorrhage, a cystic mass anterior to the implant, and pain. There were no cases of intracapsular hemorrhage nor infection for any of the 227 patients over 4 years.

Conclusions

To the authors knowledge, this represents the largest case series to date to assess the rate of intracapsular hemorrhage in non-fixated nylon sheet orbital implants. In the 227 cases reviewed over a 4-year period, there were no cases of intracapsular hemorrhage. This suggests a much lower complication rate than previously reported.

Précis

A case series of 227 patients who underwent orbital fracture repair with non-fixated nylon sheet implants.

select article Atypical thyroglossal duct cyst with intra-laryngeal and para-glottic extension

Case reportAbstract only

Atypical thyroglossal duct cyst with intra-laryngeal and para-glottic extension

Adele Chin Wei Ng, Heng Wai Yuen, Xin Yong Huang

In Press, Accepted Manuscript, Available online 8 April 2019

Purchase PDFArticle preview

select article The etiology, pathogeneses, and treatment of objective tinnitus: Unique case series and literature review

Case reportAbstract only

The etiology, pathogeneses, and treatment of objective tinnitus: Unique case series and literature review

Parsa P. Salehi, David Kasle, Sina J. Torabi, Elias Michaelides, Douglas M. Hildrew

In Press, Corrected Proof, Available online 5 April 2019

Purchase PDFArticle preview

Abstract

Abstract

We present two unique cases of myoclonus-induced objective tinnitus (OT), along with a comprehensive literature review on the topic. Primary goals include: explore the relationship between palatal myoclonus (PM) and middle ear myoclonus (MEM), highlight the embryologic, neurologic, and anatomical relationship between the involved peri-tubular muscles, exemplify the first case of OT which documents video evidence demonstrating the link between objective tinnitus and eustachian tube movement. Also, we discuss available treatment interventions and why they often do not fully resolve patients' symptoms. Finally we introduce a novel way to objectively quantify the severity of OT. Ultimately, our series hopes to inform future diagnostic and treatment guidelines.

select article Expression of vimentin (VIM) and metastasis-associated 1 (MTA1) protein in laryngeal squamous cell carcinoma are associated with prognostic outcome of patients

Research articleAbstract only

Expression of vimentin (VIM) and metastasis-associated 1 (MTA1) protein in laryngeal squamous cell carcinoma are associated with prognostic outcome of patients

Sotirios Karamagkiolas, Ioannis Giotakis, Efthimios Kyrodimos, Evangelos I. Giotakis, ... Andreas M. Lazaris

In Press, Corrected Proof, Available online 3 April 2019

Purchase PDFArticle preview

Abstract

Abstract

Purpose

Laryngeal squamous cell carcinoma (LSCC), a common type of head and neck cancer, is associated with high rates of metastasis and recurrence. In this study, we investigated the potential combinatorial prognostic value of NOTCH1, Vimentin (VIM), and Metastasis-associated 1 (MTA1) protein in LSCC, using immunohistochemistry.

Materials and methods

Tissue specimens from 69 patients with LSCC were immunohistochemically evaluated for the protein expression of NOTCH1, VIM, and MTA1. Then, biostatistical analysis was performed, in order to assess the prognostic value of the expression of each one of these proteins.

Results

NOTCH1 expression status was not a significant prognosticator in LSCC, as shown in Kaplan-Meier survival analysis. On the contrary, both VIM and MTA1 seem to have an important prognostic potential, independently of TNM staging and histological grade of the tumor. In fact, positive VIM expression was shown to predict patients' relapse and poor outcome regarding patients' overall survival, in contrast with MTA1, the positive expression of which predicts higher disease-free survival (DFS) and overall survival (OS) rates in LSCC.

Conclusions

VIM and MTA1 constitute potential tumor biomarkers in LSCC and could be integrated into a multiparametric prognostic model. Undoubtedly, their prognostic value needs further validation in larger cohorts of LSCC patients.

select article Spontaneous cervical chyle fistula: A case report

Case reportAbstract only

Spontaneous cervical chyle fistula: A case report

Swathi Appachi, Joseph B. Meleca, Paul C. Bryson

In Press, Corrected Proof, Available online 2 April 2019

Purchase PDFArticle preview

Abstract

Abstract

Background

Cervical chylous fistulae are rare complications usually occurring from iatrogenic injury to the thoracic duct. There have been no reported cases of spontaneous chyle leaks in surgical naïve necks.

Methods

Case report.

Results

A 50 year-old female presented with progressive left neck swelling without fever, dyspnea, or dysphagia. Imaging demonstrated extensive infiltrative changes of the left neck with retropharyngeal fluid extending into strap musculature and the mediastinum. Flexible laryngoscopy revealed posterior pharyngeal wall edema. Differential diagnosis included abscess versus necrotizing fasciitis. Broad-spectrum antibiotics were initiated and she was taken to the OR for neck exploration. Intra-operatively, milky fluid was present around the carotid sheath and in the retropharyngeal space. Fluid analysis demonstrated chylomicrons and triglycerides >2400 mg/dL. Repeat imaging of the neck, chest, and abdomen did not reveal malignancy or obstructive masses. A lymphangiogram showed dilated lymphatic vessels near the cervical thoracic duct. On post-operative day four, the patient was taken back to the OR for thoracic duct ligation and biopsy of nearby tissue. Pathology demonstrated benign lymph nodes with dilated sinusoids. A low-fat diet was started and she was discharged home on hospital day nine. She has followed up regularly with no signs of recurrence.

Conclusion

A cervical chylous fistula usually results from iatrogenic injury to the thoracic duct. To our knowledge, this is the first reported case of a spontaneous cervical chyle leak.

select article Does cervical range of motion affect the outcomes of canalith repositioning procedures for posterior canal benign positional paroxysmal vertigo?

Research articleAbstract only

Does cervical range of motion affect the outcomes of canalith repositioning procedures for posterior canal benign positional paroxysmal vertigo?

Salvatore Martellucci, Giuseppe Attanasio, Massimo Ralli, Vincenzo Marcelli, ... Andrea Gallo

In Press, Corrected Proof, Available online 2 April 2019

Purchase PDFArticle preview

Abstract

Abstract

Purpose

Canalith repositioning procedure (CRP) for posterior canal benign positional paroxysmal vertigo (BPPV), also known as Epley maneuver, is a common procedure for the treatment of BPPV. This maneuver entails flexion, extension and rotation of the patient's neck. This study aims to investigate the impact of cervical range of motion (C-ROM) on CRP efficacy.

Materials and methods

The study included 47 patients with posterior canal BPPV treated by CRP. The procedure was considered successful if vertigo and nystagmus disappeared at the post-treatment evaluation. If CRP resulted ineffective, it was repeated up to three times per session. C-ROM was measured at BPPV diagnosis before treatment. Patients were followed up for 30 days.

Results

The first CRP was successful in 29 patients (61.7%), while it was ineffective in 18 patients (38.3%) requiring multiple repositioning maneuvers. Patients who needed two or more CRP showed lower C-ROM in extension (p = .003) and flexion (p = .042), and earlier recurrences (p = .006). Univariate regression analysis showed that lower cervical extension was significantly associated with the failure of the first CRP (OR: 0.899, 95% CI 0.831–0.973, p = .008).

Conclusions

Our data suggest that a reduced C-ROM can require multiple CRPs to successfully treat BPPV and increase the risk of early recurrences.

select article Total vs hemithyroidectomy for intermediate risk papillary thyroid cancer: A 23 year retrospective study in a tertiary center

Research articleAbstract only

Total vs hemithyroidectomy for intermediate risk papillary thyroid cancer: A 23 year retrospective study in a tertiary center

Kwan Pok Tsui, Wai Yin Kwan, Tam Lin Chow

In Press, Corrected Proof, Available online 2 April 2019

Purchase PDFArticle preview

Abstract

Abstract

Background

There is much debate in the literature over the extent of surgery for patients with intermediate risk papillary thyroid cancer. We herein report our results in a local tertiary hospital.

Method

We identify from our database patients with papillary thyroid cancer who underwent surgery in our hospital and were stratified to be of intermediate risk from the GAMES stratification system. Patients' demographic data, surgical and pathological details were recorded. Primary end points were disease specific survival (DSS) and recurrence free survival (RFS).

Results

From January 1993 to December 2016, 231 patients with papillary thyroid cancer underwent surgery of which 137 (59%) were of intermediate risk. 45 (33%) patients had hemithyroidectomy and 92 (67%) patients had total thyroidectomy. In the total thyroidectomy group, patients had a higher tumor (T) (p value = 0.009) and nodal (N) staging (p value = 0.001). They were also predicted to have a higher risk of recurrence according to the American Thyroid Association (ATA) classification (p value = 0.005). The 5 year DSS in both groups were 100%. The 5 year RFS in the total thyroidectomy and hemithyroidectomy groups were 92% and 100% respectively and were significantly different by the log rank test (p value = 0.02). The median follow up time was 54 months (range 4–276 months).

Conclusion

The 5 year survival in intermediate risk papillary thyroid cancer is favorable. Hemithyroidectomy is an acceptable choice of operation in intermediate risk patients with a better risk profile.

select article Translation and validation of the Parotidectomy Outcome Inventory 8 (POI-8) to Spanish

Research articleAbstract only

Translation and validation of the Parotidectomy Outcome Inventory 8 (POI-8) to Spanish

Carlos Miguel Chiesa-Estomba, Elizabeth Ninchritz, Teresa Rivera-Schmitz, Jose Angel González-García, ... Xabier Altuna-Mariezcurrena

In Press, Corrected Proof, Available online 2 April 2019

Purchase PDFArticle preview

Abstract

Abstract

Introduction

There are >400 million of native Spanish speakers around the world, being the second most spoken language in regard to the number of native speakers. For this reason, a valid questionnaire to access the quality of our patients after parotidectomy is necessary.

Material and methods

Validation and cross-cultural adaptation of the POI-8 questionnaire to the Spanish language. Internal consistency of Sp-POI 8 measured with Cronbach α.

Results

35 patients met the inclusion criteria during the mentioned period. Mean age was 59 ± 15,37 (Min: 18/Max: 87). 20 patients (57,1%) were male and 15 (42,9%) were female. Internal consistency with Cronbach α was 0.868. The intraclass correlation coefficient was 0.830 [CI] (95%: 0,791–925). Hypoesthesia was the most severely weighted problem (0,91) and xerostomia was the second (0,89). However, the high score was for fear of revision surgery (1,26).

Conclusion

The Spanish Language is the second most spoken language with regard to the number of native speakers and the Sp-POI 8 translation represents a valid option for the Spanish-speaking medical community, from which a large number of patients can benefit.

select article Sex-specific enlarged vestibular aqueduct morphology and audiometry

Research articleAbstract only

Sex-specific enlarged vestibular aqueduct morphology and audiometry

Jeremy Ruthberg, Mustafa S. Ascha, Armine Kocharyan, Amit Gupta, ... Todd D. Otteson

In Press, Accepted Manuscript, Available online 29 March 2019

Purchase PDFArticle preview

Abstract

Abstract

Objective

Enlargement of the vestibular aqueduct (EVA) is one of the most common congenital malformations in pediatric patients presenting with sensorineural or mixed hearing loss. The relationship between vestibular aqueduct (VA) morphology and hearing loss across sex is not well characterized. This study assesses VA morphology and frequency-specific hearing thresholds with sex as the primary predictor of interest.

Materials and methods

A retrospective, longitudinal, and repeated-measures study was used. 47 patients at an academic tertiary care center with hearing loss and a record of CT scan of the internal auditory canal were candidates, and included upon meeting EVA criteria after confirmatory measurements of vestibular aqueduct midpoint and operculum widths. Audiometric measures included pure-tone average and frequency-specific thresholds.

Results

Of the 47 patients (23 female and 24 male), 79 total ears were affected by EVA; the median age at diagnosis was 6.60 years. After comparing morphological measurements between sexes, ears from female patients were observed to have a greater average operculum width (3.25 vs. 2.70 mm for males, p = 0.006) and a greater average VA midpoint width (2.80 vs. 1.90 mm for males, p = 0.004). After adjusting for morphology, male patients' ears had pure-tone average thresholds 17.6 dB greater than female patients' ears (95% CI, 3.8 to 31.3 dB).

Conclusions

Though females seem to have greater enlargement of the vestibular aqueduct, this difference does not extend to hearing loss. Therefore, our results indicate that criteria for EVA diagnoses may benefit from re-evaluation. Further exploration into morphological and audiometric discrepancies across sex may help inform both clinician and patient expectations.

select article Clinical and audiometric outcomes of palisade cartilage myringoplasty under local anesthetic in an office setting

Research articleAbstract only

Clinical and audiometric outcomes of palisade cartilage myringoplasty under local anesthetic in an office setting

Nael M. Shoman

In Press, Accepted Manuscript, Available online 29 March 2019

Purchase PDFArticle preview

Abstract

Abstract

Objective

Assess clinical and functional outcomes of a modified palisade cartilage-perichondrium graft myringoplasty under local in an office setting.

Study design

Retrospective case series.

Setting

Tertiary care facility.

Patients

Patients with a tympanic membrane perforation presenting between March 2013 and October 2017. Inclusion criteria included age ≥ 7 years, entire perforation margin visualized through a transcanal view, and the ability to lie supine for up to 45 min. Exclusion criteria included a conductive hearing loss larger than expected, and presence of active infection.

Intervention

In-office modified myringoplasty technique under local anesthesia without sedation.

Main outcome measures

Complete perforation closure rate and audiometric outcomes.

Results

250 patients underwent the procedure, of whom 13 had bilateral sequential procedures (total 263 ears). Of those, 197 were primary and 66 revision. Average age was 46.3 years. Perforation sizes were categorized as small (32), moderate (109), large (78), and subtotal (44). Complete perforation closure was evident in 219 of the 250 cases (88%). Preoperative mean air pure tone average (PTA) was 56.7 dB and mean bone PTA was 27.5 dB (pre-operative ABG 29.2 dB). AC-PTA significantly improved to 35.0 dB (p < 0.0001), and ABG to 9.6 dB (p < 0.0001). Only subtotal perforations showed a statistically significant negative relationship with outcome (p = 0.04).

Conclusion

The modified palisade cartilage-perichondrium graft myringoplasty under local anesthetic is a highly successful procedure well tolerated by adult and pediatric patients with variable perforation sizes. This may have significant potential patient benefits, as well as cost savings to the health care system.

select article Cricoarytenoid joint abscess associated with rheumatoid arthritis

Case reportAbstract only

Cricoarytenoid joint abscess associated with rheumatoid arthritis

Megan J. Foggia, Henry T. Hoffman

In Press, Corrected Proof, Available online 28 March 2019

Purchase PDFArticle preview

Abstract

Abstract

Cricoarytenoid joint arthritis is an uncommon manifestation of rheumatoid arthritis. We encountered a 68-year-old woman with rheumatoid arthritis who presented with odynophagia, dysphagia, and progressive shortness of breath. Examination findings showed diminished mobility of the left vocal cord and right arytenoid swelling associated with an immobile right vocal cord. Computed tomography (CT) imaging identified a ring-enhancing lesion of the right lateral cricoarytenoid joint. Microdirect laryngoscopy with drainage of the cricoarytenoid abscess and tracheotomy were performed. Development of a laterally based cricoarytenoid joint abscess is identified as a complication of chronic rheumatoid arthritis with successful management described.

select article Delayed laryngeal implant infection and laryngocutaneous fistula after medialization laryngoplasty

Case reportAbstract only

Delayed laryngeal implant infection and laryngocutaneous fistula after medialization laryngoplasty

Joseph B. Meleca, Paul C. Bryson

In Press, Corrected Proof, Available online 27 March 2019

Purchase PDFArticle preview

Abstract

Abstract

Background

Medialization laryngoplasty is a common procedure for voice rehabilitation in patients with unilateral vocal fold paralysis. Complications are uncommon and delayed infections involving implants are rare. We report a delayed infectious complication following an animal scratch resulting in a laryngocutaneous fistula.

Methods

Case report.

Results

A 73-year-old female underwent a successful and uneventful medialization laryngoplasty for idiopathic unilateral vocal fold paralysis using a silastic implant. More than one year after surgery, she presented with an anterior neck infection following an animal scratch with CT neck findings of a left strap muscle abscess. After incision and drainage, cultures grew methicillin-resistant Staphylococcus aureus. Despite culture-directed antibiotic therapy, the neck continued to drain persistently. Laryngoscopy with stroboscopy revealed a medialized vocal fold with no obvious granulation tissue and normal mucosal pliability.

The patient underwent neck exploration revealing a laryngocutaneous fistula. Thus, both the fistulous tract and implant were removed. The wound was closed with a strap muscle advancement into the laryngoplasty window. One month after surgery and antibiotics, the patient had no signs of recurrent neck infection, with a well-healing wound and stroboscopic findings of complete glottic closure, symmetric vocal fold oscillation and acceptable phonation with mild supraglottic compression.

Conclusions

Delayed complications of medialization laryngoplasty are rarely reported. This case demonstrates a delayed infection of a laryngeal implant after an animal scratch requiring implant removal, local tissue reconstruction, and culture-directed antibiotic therapy.

select article Conservative thyroidectomy for papillary thyroid microcarcinoma

Research articleAbstract only

Conservative thyroidectomy for papillary thyroid microcarcinoma

Hyun Joo Nahm, Sung Jun Choi, Young Chang Lim

In Press, Corrected Proof, Available online 21 March 2019

Purchase PDFArticle preview

Abstract

Abstract

Objective

According to American Thyroid Association (ATA) guideline, thyroid lobectomy is recommended for the management of papillary thyroid microcarcinomas (PTMC) with a diameter lesser than 1 cm. However, this procedure is associated with a risk of potential complications such as vocal cord palsy. Thus, we considered the applicability of conservative thyroidectomy, involving partial removal of the thyroid cancer lesion, not the entire ipsilateral thyroid lobe.

Methods

A retrospective analysis of all PTMC patients who underwent conservative thyroidectomy at Konkuk University Hospital between August 2008 and February 2014 was performed. Oncologic results of these patients along with the incidence of postoperative complications were evaluated. Seventy-nine patients who underwent conservative thyroidectomy for the treatment of PTMC were enrolled in the present study.

Results

Four of the 79 patients (5.0%) showed recurrence, 2 local (2.5%) and 2 regional (2.5%), respectively. All of these patients consequently underwent surgery alone and were salvaged. Temporary postoperative complications such as vocal cord palsy and hypocalcemia developed in 1 and 1 case, respectively, but completely recovered over time.

Conclusions

Conservative thyroidectomy is an oncologically and functionally safe procedure for surgical treatment of PTMC and can be considered as an alternative to thyroid lobectomy for the surgical management of PTMC.

select article Histopathologic analysis in chronic rhinosinusitis: Impact on quality of life outcomes

Research articleAbstract only

Histopathologic analysis in chronic rhinosinusitis: Impact on quality of life outcomes

Feng Wang, Yang Yang, Qihan Wu, Haihong Chen

In Press, Corrected Proof, Available online 21 March 2019

Purchase PDFArticle preview

Abstract

Abstract

Objective

This study investigates the impact of histopathologic parameters on quality of life outcomes in patients with chronic rhinosinusitis.

Setting

Hospital of Zhejiang University.

Study design

Retrospective analysis of collected data.

Subjects and methods

One hundred and twenty patients with chronic rhinosinusitis (CRS) who underwent endoscopic sinus surgery were recruited. Clinical features, CT evaluation, pre and postoperative SNOT-22 scores and histopathologic findings were collected. Tissue eosinophils and mucosal remodeling were analyzed relative to clinical features and outcomes 12 months postoperatively.

Results

Symptom improvement was seen for the entire population. Eosinophilic CRS had significantly worse preoperative and postoperative SNOT-22 scores than non- eosinophilic CRS. Symptom improvement in eosinophilic CRS after surgery was less than that of non-eosinophilic CRS. There was no significant association between preoperative and postoperative SNOT-22 scores and remodeling markers. However, patients with basement membrane thickening showed less reductions of SNOT-22 score postoperatively.

Conclusions

Presence of mucosal eosinophilia and basal membrane thickening appear to be the main factors adversely affect the symptom control of surgical intervention. Routine histopathology analysis can provide meaningful information for prognostication of surgical outcome.

select article Vestibulotoxicity in a patient without renal failure after inhaled tobramycin

Case reportAbstract only

Vestibulotoxicity in a patient without renal failure after inhaled tobramycin

Adam C. Kaufman, Steven J. Eliades

In Press, Corrected Proof, Available online 19 March 2019

Purchase PDFArticle preview

Abstract

Abstract

Aminoglycoside antibiotics have a long history of use in the control of gram-negative bacterial infections, but their systemic use has been complicated by known ototoxicity and nephrotoxicity. Because of the utility of these medications in patients with frequent pulmonary infections, there has been a move towards the use of inhaled agents, in particular tobramycin, due to a lower rate of systemic complications. Inhaled tobramycin is generally consider to be safe from otologic complications, with only two previous reports of ototoxicity, both in patients who had underlying chronic renal disease. Here we present the first case of a patient developing isolated vestibular toxicity, without associated hearing loss or evidence of renal insufficiency, in a patient receiving inhaled tobramycin. This is an extremely rare complication of an inhaled aminoglycoside and underscores the importance of careful monitoring despite perceived safety.

select article Transdermal lidocaine as treatment for chronic subjective tinnitus: A pilot study

Research articleAbstract only

Transdermal lidocaine as treatment for chronic subjective tinnitus: A pilot study

Daniel C. O'Brien, Aaron D. Robinson, Nancy Wang, Rodney Diaz

In Press, Corrected Proof, Available online 18 March 2019

Purchase PDFArticle preview

Abstract

Abstract

Objective

To assess the efficacy of transdermal lidocaine as a treatment for chronic subjective tinnitus as measured by the Tinnitus Functional Index (TFI).

Study design

Pilot, prospective efficacy trial.

Setting

Tertiary care hospital.

Patients

Men and women, over the age of 18 with chronic subjective tinnitus for >6 months.

Intervention

Daily application of commercially available transdermal lidocaine patch.

Outcome measure

Change in the TFI.

Results

The average pre-treatment TFI score was 56.2. After 1 month the average TFI decreased to 41 (p < 0.05). The scores dropped to 34 and 35 after 2 and 3 months of treatment respectively. Despite improvement in symptoms of tinnitus, most patients did not continue the study after the first month, dropping out due to the size, discomfort, and appearance of the lidocaine patch, failure to follow-up and lack of perceived benefit from treatment.

Conclusions

In this preliminary study, 5% transdermal lidocaine appears to be a potential treatment for chronic subjective tinnitus. The majority of subjects who completed 1 month of treatment had clinically significantly improved tinnitus. These findings are confounded however by the small sample size and significant drop out rate.

Cirugía Ortopédica y Traumatología

Exploración ecográfica de las caderas del bebé en mochilas de porteo Publication date: Available online 28 March 2019 Source: Revista Española de Cirugía Ortopédica y Traumatología Author(s): C.G. Fontecha, A. Coma Muñoz, A. Catala Muñoz Resumen Antecedentes y objetivo La displasia de cadera se ha asociado con factores de riesgo como la presentación de nalgas, el sexo femenino o los antecedentes familiares. Sin embargo, factores externos, como los sistemas de porteo, parecen influir en el desarrollo de la cadera en los primeros meses de vida. El objetivo del presente trabajo es valorar por imagen ecográfica la posición de las caderas en bebés colocados en diferentes tipos de mochilas portabebés. Método Se ha realizado un estudio ecográfico de las caderas de bebés sanos entre 1,5 y 3,5 meses de edad, cuando el niño es porteado en tres diferentes mochilas portabebés que proporcionan diferentes grados de sujeción de los muslos del bebé. Todas las caderas eran tipo I de Graf. Se han valorado tres parámetros ecográficos: el ángulo alfa de Graf, la cobertura acetabular y la distancia a pubis en situación basal (mesa de exploración) y en las tres diferentes mochilas de porteo. Resultados En todos los casos los bebés mostraron valores de normalidad en los tres parámetros estudiados, sin diferencias estadísticamente significativas entre ninguna de las situaciones. Tampoco se encontraron diferencias en los parámetros ecográficos relacionadas con el sexo, la edad o el peso del bebé. Conclusiones La cadera derecha del bebé mantiene unos parámetros ecográficos de normalidad cuando es colocada en cualquiera de los modelos de mochila estudiados. Abstract Background and objective Hip dysplasia has been associated with risk factors such as breech presentation, female gender or family history. However, external factors, such as the use of baby carriers, seem to influence the development of the hip in the first months of life. The aim of this study is to evaluate the position of the hips of babies placed in different types of baby carriers by ultrasound image. Method An ultrasound study of the hips of healthy babies between 1.5 and 3.5 months of age was carried out, when the children were carried in three different baby backpacks, which provide different degrees of support for the babies' thighs. All hips were type I according to the Graf classification. Graf's alpha angle, acetabular coverage and distance to the pubis were assessed at baseline (examination table) and when the children were carried in the three different backpacks. Results In all cases, the babies showed normal values in the three studied parameters, without statistically significant differences between any of the situations. There were also no differences in the ultrasound parameters related to the sex, age or weight of the baby. Conclusions The right hip of the babies shows normal ultrasound parameters when placed in any of the baby carriers studied.

Resección de la primera fila del carpo en pacientes mayores de 50 años: 3 a 16 años de seguimiento Publication date: Available online 27 March 2019 Source: Revista Española de Cirugía Ortopédica y Traumatología Author(s): V. Montiel, J. Payo-Ollero, S. Amillo Resumen Objetivo Conocer los resultados a largo plazo y el pronóstico de los pacientes que han sido intervenidos de resección de la primera fila del carpo (RPFC) en nuestro centro. Material y método Realizamos un estudio retrospectivo de 14 pacientes intervenidos de RPFC con un seguimiento de 3 a 16 años. Se evaluaron la movilidad, la capacidad funcional mediante el cuestionario Patient-Rated Wrist Evaluation (PRWE) y la capacidad para realizar las actividades de la vida diaria tras la intervención. Resultados El balance articular fue satisfactorio. La puntuación media en la escala PRWE fue de 20,9 ± 17,2 para la subescala de dolor y de 39 ± 35,5 para la subescala de funcionalidad. Ningún paciente había precisado reintervención ni han desarrollado complicaciones. El 80% de los pacientes estuvieron satisfechos o muy satisfechos. El 90% de los pacientes volvería a operarse. Discusión El rango de movimiento de la muñeca es similar con las diferentes técnicas de preservación de la movilidad. Los cambios artrósicos en la articulación radio-hueso grande secundarios a esta intervención no producen necesariamente dolor. Algunos autores han descrito que el grado de satisfacción de la RPFC es comparable con el de otros procedimientos, como la artrodesis en 4 esquinas con placa circular o artrodesis mediocarpiana con agujas. Conclusión La RPFC tiene alta tasa de satisfacción entre los pacientes con alivio del dolor, buena movilidad y funcionalidad postoperatoria de la muñeca. Además, presenta escasas complicaciones. Abstract Objective To analyze the long-term results and the prognosis of patients who have undergone proximal row carpectomy (PRC) in our hospital. Material and method This is a retrospective study of 14 patients undergoing PRC with a follow-up of 3 to 16 years. The ability to perform daily activities, mobility and functional capacity after the surgery were assessed using the Patient-Rated Wrist Evaluation questionnaire (PRWE). Results The range of movement was satisfactory. The mean score on the PRWE scale was 20.9 ± 17.2 for the pain subscale and 39 ± 35.5 for the functional capacity subscale. None of the patients required revision surgery or developed complications. Eighty percent of the patients were satisfied or very satisfied. Ninety percent of the patients would undergo surgery again. Discussion The wrist's range of movement achieved with this technique is similar to that obtained with other mobility preservation techniques. Secondary arthritic changes in the radio-capitate joint do not necessarily produce pain. Some authors have described that the degree of satisfaction after PRC is equivalent to that of other procedures such as arthrodesis in 4 corners with circular plate arthrodesis or middle-carpal arthrodesis. Conclusion PRC achieved high satisfaction rates among the patients providing pain relief, good mobility and post-operative functionality of the wrist. In addition, it presented few complications.

Diagnóstico y tratamiento de los osteomas osteoides del retropié: un método terapéutico para cada caso Publication date: Available online 25 March 2019 Source: Revista Española de Cirugía Ortopédica y Traumatología Author(s): M.A. Mellado-Romero, J. Vilá-Rico, C. Gallego-Herrero, S. Sánchez-Herraéz, P. Casas-Ramos, J.A. Santos-Sánchez, L.R. Ramos-Pascua Resumen Objetivos 1) Recordar el diagnóstico de los osteomas osteoides (OO) del pie; y 2)definir las indicaciones de su tratamiento en el retropié. Material y método Se han revisado un total de 5 osteomas osteoides (3 localizados en el astrágalo y 2 en el calcáneo). El diagnóstico se estableció por datos clínicos y de imagen. En todos los casos se identificó un nidus calcificado en la TC, edema óseo perilesional en la RM y captación focal gammagráfica. Se realizaron 2 termoablaciones con ondas de radiofrecuencia y 3 resecciones: 2 abiertas y una artroscópica. Se evaluaron los resultados clínicos y oncológicos al final del seguimiento. Resultados No se registró ninguna complicación. El resultado clínico fue excelente en todos los casos. Un paciente fue tratado inicialmente con cirugía abierta y, después, por fracaso del procedimiento, mediante termoablación. No hubo recidivas después de un tiempo medio de seguimiento de 4 años y 6 meses (rango: 1-12 años). Discusión Los OO del retropié son poco frecuentes y su diagnóstico se basa en la conjunción de datos clínicos con los característicos hallazgos de imagen. El tratamiento depende del asiento del nidus y de las relaciones de este con estructuras anatómicas próximas. Conclusiones El diagnóstico de un OO del retropié puede asegurarse cuando los datos epidemiológicos, clínicos y de imagen son compatibles con la enfermedad. La termoablación está indicada en casos intracorticales o esponjosos en los que el nidus dista más de 1 cm de la piel y de estructuras neurovasculares mayores. En el resto de casos una resección abierta o artroscópica sería de elección. Abstract Objectives 1) to set a reminder of the diagnostic approach to osteoid osteomas (OOs) of the foot; 2) to define the indications of treatment for hindfoot OOs. Material and method 5 OOs were checked (3 cases located in the talus and two cases in calcaneus). The diagnosis was established by clinical and imaging data. In all cases, a calcified nidus was identified on CT, perilesional bone oedema on MRI and focal scintigraphic uptake. Two cases were treated with radiofrequency ablation (RFA) and 3 cases with surgical resections: two open surgeries and one arthroscopic surgery. Clinical and oncological outcomes were evaluated at the end of the follow-up. Results No complications were reported. The clinical outcome was excellent in all cases. One patient was initially treated with open surgery and then subsequently with RFA due to failure of the procedure. There were no recurrences after an average follow-up time of 4 years and 8 months (range, 1-12 years). Discussion Hindfoot OOs are uncommon and their diagnosis is based on clinical data in conjunction with characteristic imaging findings. Their treatment choices depend on the location of the nidus and relationships with nearby anatomical structures. Conclusions The diagnosis of an OO of the hindfoot can be ensured when the epidemiological, clinical and imaging data are compatible with this pathological entity. RFA is indicated for intracortical or cancellous cases in which the nidus is more than 1 cm off the skin and significant neurovascular structures. For all other cases an open surgical resection or arthroscopic resection would be the first choice.

Reconstrucción con prótesis modulares posterior a una resección oncológica. Evaluación de los fracasos y análisis de la supervivencia Publication date: Available online 25 March 2019 Source: Revista Española de Cirugía Ortopédica y Traumatología Author(s): A.E. Cabas-Geat, M.G. Bruchmann, J.I. Albergo, M.A. Ayerza, G. Farfalli, L.A. Aponte-Tinao, L.D. Muscolo Resumen Objetivo Analizar una serie de pacientes oncológicos tratados con prótesis modulares y evaluar: 1) Supervivencia del implante. 2) Causas de fracaso. 3) Tasa de reintervención. 4) Supervivencia del miembro. 5) Resultados funcionales y tiempo hasta la carga completa. Materiales y métodos Se realizó una búsqueda retrospectiva en una base de datos oncológica entre marzo de 2001 y agosto de 2015 de pacientes con tumores óseos y pacientes con cirugía de revisión de trasplantes óseos reconstruidos con endoprótesis. Se incluyó a 106 pacientes con seguimiento mínimo de 2 años. Se dividió la población en 3 grupos: grupo 1, tumores óseos primarios; grupo 2, metástasis ósea; grupo 3, revisiones de trasplantes óseos masivos. Las causas de fracasos fueron clasificadas según Henderson et al. (2014) y la funcionalidad se evaluó según el la escala de la Musculoskeletal Tumor Society (MSTS). Se realizó análisis demográfico, estimación de la supervivencia y se compararon las diferencias entre grupos. Resultados El seguimiento medio de los pacientes fue de 68 meses. La edad promedio fue de 43 años. La supervivencia global del implante fue del 86% a 2 años (IC 95%: 79-94) y del 73% a 5 años (IC 95%: 60-80). Diecinueve pacientes (18%) presentaron fracaso protésico, con revisión. La conservación del miembro en nuestra serie fue del 96% a 5 años(IC 95%: 91-99). Los resultados funcionales promedio según la escala de la MSTS fueron de 24 y el tiempo medio para carga completa de 2, 3 semanas. Conclusión La cirugía de conservación de miembro representa el tratamiento de elección en pacientes con tumores óseos y la reconstrucción con endoprótesis resulta una alternativa válida, con índices de fracaso similares a otras reconstrucciones. Abstract Objective To analyze a series of patients with bone tumours reconstructed with modular prostheses and to evaluate: 1) Survival of the implant. 2) Causes of failure. 3) Complication rates. 4) Limb salvage overall survival. 5) Functional results and full weight bearing. Materials and methods A retrospective study from longitudinally maintained oncology databases was undertaken. All patients with bone tumours reconstructed with endoprosthesis were analysed. A toal of 106 patients matched the inclusion criteria. They were divided into groups: group 1, primary bone tumours; group 2, bone metastasis; group 3, osteoarticular allograft reconstruction revisions. The type of failures were classified according to Henderson et al. (2014) and functional results assessed by the Musculoskeletal Tumor Society (MSTS). Demographic analysis, survival and the differences between groups were recorded. Result The mean follow-up of the patients was 68 months. Mean age was 43 years. Overall implant survival was 86.4% at 2 years (95% CI: 79-94) and 73% at 5 years (95% CI: 60-80). Nineteen patients (18%) developed a prosthetic failure. The limb salvage overall survival was 96% at 5 years (95% CI: 91-99). The mean functional results according to the MSTS was 24 and mean time to full weight bearing was 2.3 weeks. Conclusions Limb conservation surgery and endosprosthetic reconstruction is a valid option for patients with bone tumours with failure rates similar to other reconstruction methods.

Condrosarcoma de húmero proximal. Resultados clínicos y oncológicos a largo plazo Publication date: Available online 23 March 2019 Source: Revista Española de Cirugía Ortopédica y Traumatología Author(s): J.I. Albergo, G.L. Farfalli Luis, M.A. Ayerza, D.L. Muscolo, L.A. Aponte-Tinao Resumen Introducción El húmero proximal es una localización frecuente de los sarcomas óseos y el condrosarcoma representa el 15%. Existen pocos trabajos sobre este grupo seleccionado de tumores. El objetivo del estudio fue analizar a un grupo de pacientes con condrosarcoma del húmero proximal tratados con cirugía y evaluar los resultados quirúrgicos y oncológicos a largo plazo. Material y métodos Se realizó una búsqueda retrospectiva y se incluyeron en el estudio todos los pacientes con condrosarcoma de húmero proximal tratados quirúrgicamente en una única institución. Se analizaron la supervivencia global y la tasa de recurrencia local. Las complicaciones postoperatorias fueron registradas y los fracasos de la cirugía de conservación de miembros se clasificaron de acuerdo a la clasificación de Henderson. Resultados Treinta y siete pacientes fueron incluidos en el estudio. La mediana de edad fue de 46 años (DE: 15,6; rango: 17-24), 24 (65%) eran mujeres y la media de seguimiento fue de 8,5 años (DE: 6,4; rango: 2-26). Diez y ocho fueron clasificados como grado 1 (49%), 15 como grado 2 (40%), 2 como grado 3 (5%) y 2 condrosarcomas desdiferenciados (5%). La supervivencia global a 10 años fue del 94,5% y la supervivencia libre de eventos a 10 años del 84,5%. Cinco pacientes desarrollaron recurrencias locales (13%) y ninguno de ellos fue grado 1. Las tasas de fracaso en la reconstrucción fue del 27% a los 5 años y del 34% a los 10 años. No se registraron complicaciones ni recurrencia local en los pacientes tratados con raspado. Conclusión El condrosarcoma de húmero proximal presento altas tasas de supervivencia. El raspado y relleno con injerto óseo es un procedimiento seguro, con bajo riesgo de complicaciones y recurrencia local para los condrosarcomas de grado 1 y debe ser la primera indicación para el húmero proximal. La reconstrucción del húmero proximal después de una resección en bloque tiene una tasa de fracaso del 27% a 5 años y del 34% a 10 años. Abstract Introduction The proximal humerus is a common site for primary bone sarcomas, of which chondrosarcoma represents 15%. There are few reports about this select group of tumours. We set out to analyse a group of patients with proximal humerus chondrosarcoma treated with surgery and to assess their long term surgical and oncological outcomes. Material and methods A retrospective review was performed and all patients with a proximal humerus chondrosarcoma treated with surgery were included in the study. Overall survival and local recurrence rates were analyzed. Post-operative complications were recorded and limb salvage surgery failures classified according to the Henderson classification. Results 37 patients were included in the study. The median age was 46 years (SD: 15.6, range: 17-24), 24 (65%) were female and the mean follow-up was 8.5 years (SD: 6.4, range: 2 -26). Eighteen patients were classified as grade 1 (49%), 15 as grade 2 (40%), 2 as grade 3 (5%) and 2 dedifferentiated chondrosarcomas (5%). The 10-year overall survival was 94.5% and the 10-year event-free survival was 84.5%. Five patients developed local recurrences (13%) and none of them was grade 1. The reconstruction failure rate was 27% at 5 years and 34% at 10 years. There were no complications or local recurrence in patients treated with curettage. Conclusion Proximal humerus chondrosarcoma presented high survival rates. Curettage and bone grafting is a safe procedure, with low risk of complications and local recurrence for grade 1 chondrosarcomas and should be the first indication for the proximal humerus. Reconstruction of the proximal humerus after a wide resection has a 5-year failure rate of 27% and 10-year failure rate of 34%.

Resultados a largo plazo de artroplastia de cadera en pacientes en diálisis por insuficiencia renal crónica. Mortalidad y supervivencia del implante en el Registro Nacional de Uruguay desde el año 2000 Publication date: Available online 23 March 2019 Source: Revista Española de Cirugía Ortopédica y Traumatología Author(s): S. Ibarra Melogno, L. Chifflet, R. Rey, G. Leiva, N. Morales, H. Albornoz Resumen Objetivo Evaluar la incidencia de mortalidad, revisión y valoración funcional en la artroplastia de cadera en pacientes dializados en Uruguay. Métodos Se realizó un estudio observacional analítico de una cohorte histórica de artroplastias de cadera en pacientes con enfermedad renal crónica tratados con hemodiálisis o diálisis peritoneal entre el 1/1/2000 y el 31/12/2013; análisis de supervivencia mediante el método de Kaplan-Meier. Se realizó además, la evaluación funcional y radiológica de los pacientes vivos. Ciento cuarenta y una artroplastias de cadera, 42 por artrosis (29,8%) y 99 por fracturas (70,2%), edad 72,3 (DE: 12,1) años (18,9-93,1), 72 mujeres (51,1%) y 69 varones (48,9%), 75 artroplastias izquierdas (53,2%) y 66 derechas (46,8%). Predominó el abordaje anterolateral (115, 81,6%) respecto al posterolateral (26, 18,4%). Resultados La mortalidad a los 30, 180 días, uno y 5 años en pacientes diagnosticados por artrosis fue del 2,4, 7,1, 9,5 y 47,6%, respectivamente, y en pacientes con fractura del 7,1, 18,2, 29,3 y 82,6%, respectivamente. Se realizaron 5 revisiones protésicas, 3 por luxación recidivante, una por aflojamiento aséptico y una artroplastia resección por infección. Doce pacientes estaban vivos al último control, la puntuación media según la escala de Merle D́Aubigne-Postel fue 6,4 en el preoperatorio y 11 al final del seguimiento. El índice de Barthel promedio en el seguimiento fue 72,8. Discusión La mortalidad a mediano y largo plazo de estos pacientes fue muy alta, mucho mayor que la observada en los pacientes sometidos al mismo procedimiento que no están en diálisis. La revisión es excepcional, y la evaluación funcional de los pocos pacientes vivos muestra malos resultados clínico-radiológicos. Abstract Objective To evaluate the incidence of mortality, revision and functional assessment after hip arthroplasty in dialysis patients in Uruguay. Methods An observational analytical study of a historical cohort of hip arthroplasties was performed on patients with chronic kidney disease treated with haemodialysis or peritoneal dialysis between 1/1/2000-31/12/2013; survival analysis using the Kaplan-Meier method. Functional and radiological evaluation of the live patients was also carried out. One hundred and forty-one hip arthroplasties, 42 for osteoarthritis (29.8%) and 99 for fractures (70.2%), age 72.3 (SD: 12.1) years (18.9-93.1), 72 women (51.1%) and 69 men (48.9%), 75 left arthroplasties (53.2%) and 66 right (46.8%). The anterolateral approach (115, 81.6%) predominated over the posterolateral approach (26, 18.4%). Results Mortality at 30, 180 days, 1 and 5 years of patients diagnosed with osteoarthritis was 2.4, 7.1, 9.5 and 47.6%, respectively, and of patients with fracture it was 7.1, 18.2, 29.3 and 82.6%. Five prosthetic revisions were performed, 3 due to recurrent dislocation, one due to aseptic loosening, and one resection arthroplasty due to infection. Twelve patients were alive at the last control, the average score according to the scale of Merle D'Aubigne-Postel was 6.4 preoperatively, and 11 at the end of the follow-up. The average Barthel index at follow-up was 72.8. Discussion The mortality in the medium and long term of these patients was very high, much higher than that observed in patients undergoing the same procedure not on dialysis. The review is exceptional, and the functional evaluation of the few living patients shows poor clinical-radiological results.

Neoplasia de células epiteloides perivasculares (PEComa) tibial. Reporte de un caso y revisión de la literatura Publication date: Available online 21 March 2019 Source: Revista Española de Cirugía Ortopédica y Traumatología Author(s): R. Técualt-Gómez, A. Atencio-Chan, R.A. Amaya-Zepeda, A.G. Cario-Méndez, R. González-Valladares, J.H. Rodríguez-Franco Resumen Introducción La célula perivascular epiteloide (PEC) es un tipo celular constante presente en un grupo de tumores que incluyen el angiomiolipoma, tumores «de azúcar» de células claras pulmonares y de sitios extrapulmonares, linfangioleiomiomatosis, entre otros. Las características de la PEC incluyen: apariencia epiteloide con citoplasma claro agranular, un núcleo central redondo a oval y un nucléolo discreto además de expresar marcadores inmunohistoquímicos únicos. Únicamente han sido descritos 11 casos de presentación ósea primaria desde su primer reporte en 2002. Objetivo Presentar el caso de un tumor de células perivasculares epiteloides óseo primario. Reporte de caso Varón de 24 años de edad con dolor de un año de evolución y lesión lítica de tibia proximal derecha y extensión a partes blandas. Diagnóstico histológico de tumor de células perivasculares epiteloides óseo e inmunohistoquímica negativa. Resultados Seguimiento de 2 años después del tratamiento con quimioterapia adyuvante (epirrubicina/cisplatino) y de la resección en bloque; el paciente se encuentra libre de enfermedad. Conclusiones Este es el primer caso de tumor de células perivasculares epiteloides óseo primario reportado en Latinoamérica. No encontramos los marcadores inmunohistoquímicos y creemos que esto puede deberse a variaciones étnicas no descritas. Abstract Introduction Perivascular epithelioid cell (PEC) is a cell type constantly present in a group of tumours including angiomyolipoma (AML), clear-cell «sugar» tumour (CCST) of the lung and extrapulmonary sites, lymphangioleiomyomatosis (LAM), and clear-cell tumours of other anatomical sites. It has morphologic distinctive features: epithelioid appearance with a clear to granular cytoplasm, a round to oval, centrally located nucleus and an inconspicuous nucleolus. Immunohistochemically, PEC expresses myogenic and melanocytic markers. Eleven cases of primary bone PEComa presentation have been described since 2002. Objective To report a case of primary bone perivascular epithelioid cell tumour. Case report 24 year-old male presented with pain. X-ray revealed an osteolytic lesion at right proximal tibia with soft tissue extension. Evaluation of slides identified a bony perivascular epithelioid cell tumour without immunohistochemical study confirmation. Results Patient was treated by surgical excision and adjuvant chemotherapy (epirubicin/cysplatin). After two years of follow-up the patient remains disease free. Conclusions This is the first-case report in Latin America. Immunohistochemical stains were negative and we believe it may be due to non-described ethnic variations.

Análisis de las causas de demora quirúrgica y su influencia en la morbimortalidad de los pacientes con fractura de cadera Publication date: Available online 21 March 2019 Source: Revista Española de Cirugía Ortopédica y Traumatología Author(s): S. Correoso Castellanos, F. Lajara Marco, M.M. Díez Galán, E. Blay Dominguez, P.F. Bernáldez Silvetti, M.A. Palazón Banegas, J.A. Lozano Requena Resumen Introducción El tratamiento quirúrgico demorado en fracturas de cadera (> 48 h) se ha asociado con una mayor frecuencia de eventos clínicos adversos. Sin embargo, no está clara la influencia de los motivos de demora en estos resultados. El objetivo de este estudio es el análisis de las causas de demora quirúrgica y su influencia en la morbimortalidad en pacientes con fractura de cadera con indicación de tratamiento quirúrgico. Material y método Se revisó retrospectivamente una cohorte de 376 fracturas de cadera intervenidas en nuestro centro entre enero de 2012 y diciembre de 2016. Se excluyó a pacientes menores de 65 años y fracturas patológicas. De ellos, 280 pacientes fueron intervenidos con una demora quirúrgica de > 48 h. Las causas de la demora fueron: antiagregación (AG), anticoagulación (AC), motivos médicos (MM), test cardíacos preoperatorios o motivos administrativos/organizativos. Se compararon las complicaciones de la herida quirúrgica, las complicaciones generales y la mortalidad. Resultados Hubo una mayor proporción de complicaciones de la herida quirúrgica en los AC (p = 0,063). Los pacientes de los grupos AG, AC y MM se asociaron a mayores tasas de complicaciones generales (p = 0,3). El 7,51% de los pacientes incluidos falleció al año de la cirugía. La tasa de mortalidad al año fue mayor en el grupo MM (p = 0,005). Conclusión La tasa de mortalidad fue mayor de forma estadísticamente significativa en el grupo MM. Al comparar resultados, los pacientes de los grupos AG, AC y MM presentaron mayores tasas de complicaciones generales. Abstract Introduction Surgical delay for hip fractures (> 48 h) has been associated with greater adverse clinical events. However, the influence of the reasons for delay is unclear. The objective of this study was to analyse the causes of surgical delay and its influence on morbidity and mortality, in patients with hip fracture with indication for surgical treatment. Material and method A cohort of 376 hip fractures operated at our centre between January 2012 and December 2016 was retrospectively reviewed. Patients younger than 65 years and pathological fractures were excluded. Of these, 280 patients were operated with a surgical delay > 48 h. The causes of the delay were: antiaggregation (AG), anticoagulation (AC), medical reasons (MM), preoperative cardiac tests or administrative/organizational reasons. Surgical wound complications, general complications and mortality were compared. Results There was a greater proportion of surgical wound complications in the AC group (P = .063). Patients in the AG, AC, and MM groups had higher rates of general associated complications (P = .3). Seven point fifty-one percent of the patients included died one year after surgery. The mortality rate at one year was highest in the MM group (P = .005). Conclusion The mortality rate was statistically significantly higher in the MM group. When comparing results, patients in the AG, AC, and MM groups presented higher rates of general complications.

Trombosis venosa profunda en extremidad superior como complicación tras luxación de la articulación acromioclavicular Publication date: Available online 18 March 2019 Source: Revista Española de Cirugía Ortopédica y Traumatología Author(s): M. Osca Guadalajara, A. Urgel Granados, M. Royo Agustín Resumen Un 5-10% de las trombosis venosas profundas ocurren en el miembro superior. Su causa más frecuente suele ser secundaria a cáncer, catéter venoso central, tratamiento con radio-quimioterapia u hormonal. Con menor frecuencia, los traumatismos en la región del hombro también pueden ser causantes de una trombosis venosa profunda. Su diagnóstico probablemente sea más complejo que en la extremidad inferior debido a su baja frecuencia, así como por la clínica que presenta, siendo un 50% de los casos asintomáticos o presentando tan solo una cervicalgia u omalgia leves. Debido a su infrecuencia, las recomendaciones terapéuticas se basan en la evidencia indirecta de estudios de la trombosis venosa profunda de la extremidad inferior, siendo la anticoagulación oral el mejor tratamiento. Presentamos un caso clínico de trombosis venosa profunda en miembro superior tras sufrir traumatismo directo en el hombro por una caída con bicicleta de montaña, causando una luxación acromioclavicular grado III de Rockwood. Abstract Around 5%-10% of deep vein thrombosis occurs in the upper limb. Its most frequent cause is usually cancer, central venous catheter, radio-chemotherapy or hormonal treatment. Less commonly, trauma around the shoulder region can also be a cause of deep vein thrombosis. Its diagnosis is probably more complex than in the lower limb due to its low frequency and clinical suspicion, as well as the clinical presentation, 50% of the cases being asymptomatic or presenting only with mild neck pain or omalgia. Because of their infrequency, therapeutic recommendations are based on indirect evidence from studies of deep vein thrombosis of the lower limb, considering oral anticoagulation the best treatment. We report a case of deep vein thrombosis in the upper limb after trauma to the shoulder causing grade III Rockwood acromioclavicular dislocation.

Validación experimental de un modelo de análisis de elementos finitos en fractura de cadera y su aplicabilidad clínica Publication date: March–April 2019 Source: Revista Española de Cirugía Ortopédica y Traumatología, Volume 63, Issue 2 Author(s): R. Larrainzar-Garijo, J.R. Caeiro, M. Marco, E. Giner, M.H. Miguélez Resumen La fractura de la extremidad proximal de fémur es objeto de interés en investigación. La complejidad del entramado óseo y la ineficiencia estructural asociada al envejecimiento hacen que existan muchas variables todavía por comprender desde el punto de vista experimental, pero no existe un modelo de investigación estructural y biomecánico de la fractura de cadera claramente definido. La hipótesis de este trabajo es que es posible desarrollar un modelo de experimentación computacional que caracterice el hueso de la extremidad proximal del fémur como un material heterogéneo a partir de la traslación directa de los parámetros mecánicos obtenidos de piezas anatómicas de experimentación. Material y método Trabajo experimental que compara la experimentación real en cadáver y un modelo numérico basado en análisis de elementos finitos (AEF). Las variables que se han empleado son: punto de inicio de la fractura, su propagación, carga progresiva y la carga máxima hasta fractura. Al modelo computacional se trasladaron los parámetros mecánicos reales obtenidos de las piezas anatómicas basándose en la relación entre las unidades Hounsfield de la TAC de alta resolución y la densidad mineral ósea de cada elemento virtual, mientras que la propagación de la fractura se modeló mediante desarrollo computacional propio del equipo investigador, con disminución de las propiedades mecánicas de los elementos dañados conforme avanza la línea fractuaria. Resultados El modelo computacional fue capaz de determinar el punto de inicio de la fractura, con una discreta tendencia a la medialización anatómica de dicho punto respecto a lo ocurrido de manera experimental. El grado de correlación fue muy alto al comparar el valor real de deformación progresiva de las muestras frente al obtenido por el modelo computacional. Sobre 32 puntos analizados, se obtuvo una pendiente de 1,03 en regresión lineal, con un error relativo entre las deformaciones del 6% y un coeficiente de Pearson de R2=0,99. El modelo computacional infraestimó discretamente la carga máxima de fractura, con un error relativo aproximado al 10%. Conclusión El modelo computacional de AEF desarrollado por este equipo investigador multidisciplinar se puede considerar, en conjunto, un modelo completo de AEF de la extremidad proximal del fémur con aplicabilidad clínica futura al ser capaz de simular e imitar el comportamiento biomecánico de fémures humanos contrastado con un modelo experimental clásico realizado en piezas anatómicas. Sobre esta base podrán evaluarse interacciones cualitativas y cuantitativas que lo consoliden como un potente banco de ensayos de experimentación computacional sobre el fémur proximal humano. Abstract Fracture of the proximal extremity of the femur is the subject of research interest. The complexity of the bone framework and the structural inefficiency associated with ageing leave many variables yet to be understood from an experimental perspective. However, there is no clearly defined structural and biomechanical research model for hip fracture. The hypothesis of this paper is that it is possible to create a computational experimentation model that characterises the bone of the proximal extremity of the femur as a heterogeneous material from directly translating the mechanical parameters obtained from anatomical experimentation specimens. Material and method An experimental paper comparing real experimentation on cadavers and a numerical model based on finite element analysis (FEA). The variables uses were: the start point of the fracture, propagation of the fracture, progressive load and maximum load until fracture. The real mechanical parameters obtained from the anatomical specimens were translated to the computational model based on the relationship between the Hounsfield units of the high resolution CAT scan and the bone mineral density of each virtual element, whereas the propagation of the fracture was modelled by the research team's own computational design, reducing the mechanical properties of the damaged elements as the fracture line advanced. Results The computational model was able to determine the start point of the fracture, with a slight tendency towards anatomical medialisation of this point compared to what happened experimentally. The degree of correlation was very high on comparing the real value of progressive deformation of the samples compared to that obtained by the computational model. Over 32 points analysed, a slope of 1.03 in lineal regression was obtained, with a relative error between the deformations of 16% and a Pearson's coefficient of R2=.99. The computational model slightly underestimated the maximum fracture load, with a relative error of approximately 10%. Conclusion The FEA computational model developed by this multi-disciplinary research team could be considered, as a whole, a complete FEA model of the proximal extremity of the femur with future clinical applicability since it was able to simulate and imitate the biomechanical behaviour of human femurs contrasted with a traditional experimental model made from anatomical specimens. On this basis, qualitative and quantitative interactions can be assessed which consolidate it as a powerful computational experimentation test bench for the human proximal femur.