Biomedical subjects

Angel A Martínez

Publications and source records attributed to Angel A Martínez.

6 recordsLinked to original sources

PubMed2005

Role of parenteral iron in the management of anaemia in the elderly patient undergoing displaced subcapital hip fracture repair: preliminary data.

INTRODUCTION: An important percentage of patients affected by hip fracture require the administration of allogenic blood transfusion (ABT) to avoid the risks of perioperative acute anaemia. However, concerns about ABT risks have led to the search for alternatives, especially in elective orthopaedic surgery. MATERIALS AND METHODS: We have prospectively investigated the effect of preoperative intravenous 200-300 mg (group 2; n=20) iron sucrose on ABT requirements and postoperative morbid-mortality in patients undergoing surgery for displaced subcapital hip fracture (DSHF) repair. A previous series of 57 DSHF patients served as the control group (group 1). All patients were older than 65 years, were operated on the 3rd day after admission to the hospital, by the same medical team, and using the same implant. Age, gender, ASA classification, surgical procedure, perioperative haemoglobin, requirements for ABT, postoperative infection, length of hospital stay (LOS) and 30-day mortality rate were examined. RESULTS: No adverse reactions to the iron administration were observed. The iron group had a lower transfusion rate (15% vs 36.8%), lower transfusion index (0.26 vs 0.77 units per patient), lower 30d mortality rate (0 vs 19.3%), shorter LOS (11.9 vs 14.1 days), as well as a trend to a lower postoperative infection rate (15% vs 33%). CONCLUSION: Preoperative parenteral iron administration could be a safe and effective way to reduce the ABT requirements in DSHF patients. This reduction in the ABT requirements is accompanied by a reduction in the morbid-mortality rate and LOS. A large, randomised, controlled trial to confirm these results is warranted.

Aged↗

PubMed2005

Rotator interval closure after arthroscopic capsulolabral repair: a technical variation.

Rotator interval tear is one of the lesions identified in patients with glenohumeral instability. We present our technique for arthroscopic interval capsule repair. After having performed Bankart reconstruction, we pull the anterosuperior cannula back some millimeters and introduce a Penetrator suture retriever forceps (Arthrex, Naples, FL) through the upper interval capsule into the joint. Then we also remove some millimeters of the anterior cannula and introduce a suture passer (Spectrum; Linvatec, Largo, FL) loaded with a monofilament suture through the lower interval capsule. The suture is pushed into the joint and, using the Penetrator suture retriever forceps, we retrieve it out of the joint. This suture is replaced if desired by a permanent braided suture. Next, a suture passer (Arthrex) advances the end of the suture from the anterosuperior portal into the joint. The suture is retrieved out of the joint from the anterior cannula with a crochet hook. We tie the suture down the anterior cannula to close the anterior capsule. Because we use cannulas, we can use a sliding knot. The degree of tightening can be observed directly under arthroscopic view but the knot is outside of the capsule. We believe that this method is easy, effective, and reproducible.

Arthroscopy↗

PubMed2004

Patients with pertrochanteric hip fracture may benefit from preoperative intravenous iron therapy: a pilot study.

BACKGROUND: Patients undergoing pertrochanteric hip fracture (PHF) repair surgery often receive perioperative allogeneic blood transfusions (ABTs) to avoid the deleterious effects of anemia. Nevertheless, concerns about adverse effects of ABTs have prompted the review of transfusion practice and the search for a safer treatment of perioperative anemia. MATERIAL AND METHODS: The effect of preoperative 200 to 300 mg of intravenous (IV; Group 2; n = 55) iron sucrose administration on transfusion requirements and postoperative morbidity-mortality in patients with PHF has been prospectively investigated. A previous series of 102 PHF patients served as the control group (Group 1). All patients were older than 65 years and were operated on at the third day after admission to the hospital, by the same medical team and with the same implant. RESULTS: Iron sucrose was well tolerated and reduced the transfusion rate in patients with admission hemoglobin levels of greater than 120 g per L (p < 0.05) who also received fewer units of red blood cells (p < 0.05). In addition, iron sucrose reduced postoperative infection rate (p < 0.05), but not 30-day mortality rate or mean length of hospital stay. CONCLUSION: The administration of IV iron sucrose seems to reduce ABT requirements in patients with PHF and is associated to lower postoperative morbidity. The possible mechanisms involved in these effects are discussed.

Aged↗

PubMed2003

Treatment of humeral shaft nonunions: nailing versus plating.

INTRODUCTION: The aim of this study was to compare plating and nailing for treating nonunions of the upper two-thirds of the humerus. MATERIALS AND METHODS: Fifty nonunions of the upper two-thirds of the humerus were treated by two different methods: 24 of them by unreamed locked nailing and bone graft (group A), and the other 26 by plate fixation and bone grafting (group B). RESULTS: All fractures healed in both groups. In group A, the time required for healing was 4.2 months (range 4-6 months), whereas in group B it was 4.7 months (range 4-6 months). This difference was statistically significant ( p<0.05). Functional results and the range of motion of the shoulder and elbow were similar with both techniques. In group B there were 3 cases of transient, iatrogenic, radial nerve palsy. CONCLUSIONS: We feel that both plate fixation and the unreamed humeral locked nail are good alternatives for the treatment of humeral shaft nonunions, although nailing achieves union earlier and has fewer complications.

Adolescent↗

PubMed2003

Extraspinal bone hydatidosis.

BACKGROUND: Bone hydatidosis caused by the tapeworm larva, Echinococcus granulosis, is rare. Extraspinal locations are even rarer. We report our experience with the treatment of twenty-six patients with extraspinal osseous hydatidosis. METHODS: Between 1972 and 1998, we treated twenty-six patients with extraspinal hydatidosis. There were sixteen men and ten women, with a mean age of 51.5 years. The mean duration of follow-up was 12.8 years. The infected area was the ilium in four patients, the ilium and sacral ala in two, the ilium and hip in eight, the femoral head and the acetabular roof in five, the femoral shaft in one, the distal part of the femur in one, the femoral head in one, the scapula in two, and the ribs in two. All patients were treated with curettage or wide resection. Chemotherapy was used in all but five patients. RESULTS: Nineteen patients (73%) were free of disease at the time of the last follow-up. Repeated curettage or wide resection was necessary in nine of these patients; it was required in three of the nine because of surgical wound infection and in six because of recurrence. Of the seven patients who were not free of disease at the time of the last follow-up, six had persistent chronic productive sinuses and one had a chronic wound infection. The cases involving both the ilium and the hip were the most difficult to treat. Radical surgery is difficult in this location, and numerous surgical procedures were always required. CONCLUSIONS: The results of treatment of osseous hydatidosis are satisfactory only in locations where complete and wide excision is possible. In the pelvis and hip, where radical surgery is almost impossible, the results are disappointing.

Albendazole↗

PubMed2002

Good results with unreamed nail and bone grafting for humeral nonunion: a retrospective study of 21 patients.

21 patients with humeral shaft nonunions were treated by retrograde nailing with the unreamed humeral nail. In all cases, we reamed the fracture site and performed a bone graft. Union of the fracture occurred in every case. The mean healing time was 4.2 (4-6) months. The range of motion of the shoulder and elbow was excellent in 14 patients, that of the shoulder moderate in 6 and poor in 1, and that of the elbow moderate in 7. The functional results were excellent in 13 patients, good in 5 and fair in 3. Given the good functional results in this series, retr grade locked nailing and bone grafting appears to be a good method for treating humeral shaft nonunions.

Adolescent↗