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Madrid, Spain

Cuellar A.,Galdakao Usansolo Hospital | Ruiz-Iban M.T.,Ramon and Cajal Hospital | Cuellar R.,San Sebastian University
Arthroscopy Techniques | Year: 2016

Autologous matrix-induced chondrogenesis (AMIC) is often used for treating chondral defects in different joints. We describe an all-arthroscopic approach for the treatment of glenoid and humeral chondral lesions with this technique. AMIC starts with the use of microfractures of the damaged cartilage, followed by coverage of the defect with a type I/III collagen matrix (Chondro-Gide; Geistlich Pharma, Wolhusen, Switzerland) that is fixed with fibrin glue (Tissucol; Baxter, Warsaw, Poland). In a 1-step approach, the unstable cartilage is debrided, microfractures that penetrate up to the subchondral bone are performed, and the membranes are pasted to the lesion. Our technique reduces morbidity rates compared with traditional open surgery. The arthroscopic AMIC procedure is a viable, cost-effective treatment for the repair of chondral lesions of the shoulder. © 2016 Arthroscopy Association of North America. Source


Fontana R.J.,University of Michigan | Brown R.S.,Columbia University | Moreno-Zamora A.,Ramon and Cajal Hospital | Prieto M.,Polytechnic University of Valencia | And 26 more authors.
Liver Transplantation | Year: 2016

Daclatasvir (DCV) is a potent, pangenotypic nonstructural protein 5A inhibitor with demonstrated antiviral efficacy when combined with sofosbuvir (SOF) or simeprevir (SMV) with or without ribavirin (RBV) in patients with chronic hepatitis C virus (HCV) infection. Herein, we report efficacy and safety data for DCV-based all-oral antiviral therapy in liver transplantation (LT) recipients with severe recurrent HCV. DCV at 60 mg/day was administered for up to 24 weeks as part of a compassionate use protocol. The study included 97 LT recipients with a mean age of 59.3 ± 8.2 years; 93% had genotype 1 HCV and 31% had biopsy-proven cirrhosis between the time of LT and the initiation of DCV. The mean Model for End-Stage Liver Disease (MELD) score was 13.0 ± 6.0, and the proportion with Child-Turcotte-Pugh (CTP) A/B/C was 51%/31%/12%, respectively. Mean HCV RNA at DCV initiation was 14.3 × 6 log10 IU/mL, and 37% had severe cholestatic HCV infection. Antiviral regimens were selected by the local investigator and included DCV+SOF (n = 77), DCV+SMV (n = 18), and DCV+SMV+SOF (n = 2); 35% overall received RBV. At the end of treatment (EOT) and 12 weeks after EOT, 88 (91%) and 84 (87%) patients, respectively, were HCV RNA negative or had levels <43 IU/mL. CTP and MELD scores significantly improved between DCV-based treatment initiation and last contact. Three virological breakthroughs and 2 relapses occurred in patients treated with DCV+SMV with or without RBV. None of the 8 patient deaths (6 during and 2 after therapy) were attributed to therapy. In conclusion, DCV-based all-oral antiviral therapy was well tolerated and resulted in a high sustained virological response in LT recipients with severe recurrent HCV infection. Most treated patients experienced stabilization or improvement in their clinical status. Liver Transplantation 22 446-458 2016 AASLD. © 2016 American Association for the Study of Liver Diseases. Source


Cuellar A.,University of the Basque Country | Cuellar R.,University of the Basque Country | Garcia-Alonso I.,University of the Basque Country | Ruiz-Iban M.A.,Ramon and Cajal Hospital
Arthroscopy - Journal of Arthroscopic and Related Surgery | Year: 2015

Purpose To evaluate if different knee flexion angles can modify the neurovascular injury risk during lateral meniscus repair. Methods Twenty cadaveric knees were studied. An all-inside suture device (FasT-Fix; Smith & Nephew, Andover, MA) was placed at the posterior horn and at the medial and lateral limits of the popliteal hiatus. The minimal distances between the device and the popliteal artery and peroneal nerve were measured with the knee at 90°, 45°, and 0° of flexion through a limited posterolateral arthrotomy. Results The distance between the device when inserted at the lateral edge of the popliteal hiatus and the peroneal nerve decreased from a median of 26 mm (interquartile range [IQR], 3.5 mm; range, 19 to 29 mm) at 90° to 21.5 mm (IQR, 4.5 mm; range, 14 to 25 mm) at 45° and 15.5 mm (IQR, 6.5 mm; range, 4 to 20 mm) at 0° (significant differences, P <.001). The distance between the device when inserted at the medial edge of the popliteal hiatus and the peroneal nerve decreased from 16 mm (IQR, 3.3 mm; range, 9 to 21 mm) at 90° to 12 mm (IQR, 4.3 mm; range, 9 to 16 mm) at 45° and 7 mm (IQR, 4.0; range, 4 to 15 mm) at 0° (significant differences, P <.001). The distance between the device when inserted at the medial edge of the popliteal hiatus and the popliteal artery decreased from 21 mm (IQR, 5.0 mm; range, 11 to 27 mm) at 90° to 19 mm (IQR, 5.0 mm; range, 10 to 23 mm) at 45° and 16 mm (IQR, 7.5 mm; range, 10 to 23 mm) at 0° (significant differences, P <.001). The distance between the device when inserted 5 mm lateral to the posterior root of the lateral meniscus and the popliteal artery decreased from 13 mm (IQR, 4.3 mm; range, 7 to 27 mm) at 90° to 10.5 mm (IQR, 4.3 mm; range, 4 to 19 mm) at 45° and 5.5 mm (IQR, 4.0 mm; range, 0 to 14 mm) at 0° (significant differences, P <.001). Conclusions The risk of injury to the popliteal artery or to the peroneal nerve during all-inside repair of the posterior half of the lateral meniscus is lower at 90° of flexion and increases with knee extension to 45° and 0°. Clinical Relevance All-inside meniscal repair of the lateral meniscus is safer with the knee at 90° of flexion. © 2015 Arthroscopy Association of North America. Source


Cuellar A.,University of the Basque Country | Cuellar R.,University of the Basque Country | Heredia J.D.,Ramon and Cajal Hospital | Ruiz-Iban M.A.,Ramon and Cajal Hospital
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2016

Purpose: To evaluate the risk of injuring the axillary nerve during an inferior glenohumeral ligament (IGHL) plication and finding out whether shoulder position (either beach chair position or lateral decubitus position) has any effect in this risk. Methods: The axillary nerve (AN) was identified through a 3-cm posterior incision in 12 cadaveric shoulders. Under arthroscopic visualization, a curved indirect suture-passing device was placed through the posterior and anterior bands of the IGHL. The distances between the device and the AN were measured with the shoulder specimen placed at simulated lateral decubitus position and beach chair position. Results: There were no cases of nerve injury nor the suture-passing device came closer than 10 mm to the nerve. There was an increase in the injury risk to the AN when inserting the device at the posterior band of the IGHL in the beach chair position [median 13 mm (range 10–21 mm)] compared to the risk in the lateral decubitus position [22.5 mm (20–26 mm), significant differences, p < 0.001]. When the device was inserted at the anterior band of the IGHL, there were no significant differences (n.s.) [lateral decubitus position: 18 mm (14–24 mm) vs. 16 mm (13–18 mm)]. When comparing differences between bands, there were no differences in the beach chair position, but the risk was lower for the posterior band in the lateral decubitus position (p < 0.001). Conclusions: During plication of the posterior band of the IGHL, the risk is higher if the procedure is performed in the beach chair position. The posterior plication is safer than the anterior plication in lateral decubitus position. Clinical relevance: This study helps the surgeon to better understand the proximity of the nerve to the IGHL and to highlight that the risk of nerve injury during capsular plication might be reduced in the lateral decubitus position. © 2016 European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) Source

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