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OBJECTIVE To analyze the clinical and radiologic results, the survival and complications obtained in 70 year or older patients who underwent cementless total knee arthroplasty (TKA). MATERIAL AND METHOD An observational study of patients operated between January 2014 and December 2016 was carried out according to the Natural Knee model (Zimmer®, USA). The main variables were the Oxford Knee Score, the visual analog scale, the presence of radiolucencies, complications, survival and reasons for revision. RESULTS Of 104 TKA, 86 were available for revision. The median age was 76 years. The mean follow-up was 5.4 years (range 3.7-6.9). The Oxford Knee Score punctuation showed a median of 17 presurgical (range 0-40) and 37 post surgical (range 5-48), P

Resumen: Introducción: Una de las patologías más frecuentemente atendida en nuestro medio son las lesiones tendinosas que afectan al manguito rotador del hombro. Existen diferentes modalidades de tratamiento para las roturas masivas o irreparables. Desde hace unos años, se introdujo en el mercado una técnica poco invasiva basada en la colocación de un espaciador subacromial biodegradable. El objetivo del trabajo es analizar los resultados de nuestra experiencia con el uso de este dispositivo (InSpace®). Material y método: En el estudio se recogen los resultados obtenidos en 25 pacientes con roturas irreparables del manguito rotador definidas mediante resonancia magnética (RM), en los que se les implantó un balón subacromial en nuestro centro en el periodo comprendido entre enero de 2015 hasta diciembre de 2017. Todos los pacientes fueron evaluados preoperatoriamente y un año después de la cirugía incluyendo la escala visual analógica (EVA), el test de Constant (CS) y el QuickDASH (QD). Resultados: De los 25 pacientes, cinco pacientes (20%) fueron intervenidos mediante artroscopia y 20 (80%) mediante abordaje abierto (mini-open). Un total de 22 pacientes completaron el año de seguimiento. A los 12 meses, el 64% (14/22) de los pacientes obtuvo una mejoría de al menos 10 puntos en el CS. Los pacientes partían de un CS promedio inicial de 32 puntos que mejoró hasta los 54,9 puntos de media en la evaluación postoperatoria a los 12 meses (Promedio de mejoría 22,9 puntos; p < 0,05). En cuanto a la evaluación del dolor, en nuestro estudio, el 87% (19/22) de los pacientes obtuvo una mejoría de al menos 2 puntos en la EVA a los 12 meses de seguimiento (p < 0,05). Los pacientes partían de una EVA media inicial de 8,7 que mejoró hasta los 3,7 puntos de media a los 12 meses. Un 73% de los pacientes contestaron estar satisfechos con la intervención y volverían a someterse a la cirugía. Conclusión: Los resultados obtenidos en nuestra serie a un año de seguimiento hablan en favor de la utilización del balón subacromial de tipo InSpace®, como opción terapéutica disponible para pacientes con roturas irreparables del manguito rotador. Puede ser utilizado como procedimiento provisional, retrasando la necesidad de una cirugía más invasiva, o definitivo en los pacientes médicamente no candidatos a una artroplastia inversa. Es importante tener claras las indicaciones de este procedimiento para no cometer errores. Abstract: Introduction: One of the most frequently treated pathologies in our department are tendon lesions that affect the rotator cuff of the shoulder. There are different types of treatment for massive or irreparable tears. For a few years, a low-invasive technique was introduced based on the placement of a biodegradable subacromial spacer. The objective of the work is to analyse the results of our experience with the use of this device (InSpaceTM). Material and method: The study collects the results obtained in 25 patients with irreparable ruptures of rotator cuff defined by RM, in which they were implanted a balloon subacromial in our centre in the period from January 2015 – until December 2017. All patients were evaluated preoperatively and one year after surgery including the visual analogue scale (VAS), the Constant test (CS) and the QuickDASH (QD). Results: Of the 25 patients, 5 patients (20%) were operated by arthroscopy and 20 (80%) By open approach (mini-open). A total of 22 patients completed the follow-up year. At 12 months, 64% of the patients obtained an improvement of at least 10 points in the CS. Patients departed from an initial average CS of 32 points that improved to 54.9 points of average in the postoperative evaluation at 12 months (average improvement 22.9 points; Value-p < 0.05). In terms of pain assessment, in our study, 87% of patients obtained an improvement of at least 2 points in the EVA at 12 months of follow-up (P-value < 0.05). Patients departed from an initial average EVA of 8.7 that improved to 3.7 points average at 12 months. 73% of the patients responded to be satisfied with the intervention and would return to the surgery. Conclusión: The results obtained in our series to one year of follow-up speak in favour of the use of the Subacromial Balloon (InSpaceTM), as a therapeutic option available for patients with irreparable ruptures of the rotator cuff. It can be used as an interim procedure, delaying the need for more invasive surgery, or as a definitive procedure in patients medically non-candidates for reverse arthroplasty. It is important to have clear indications of this procedure in order not to make mistakes.

Introduction: One of the most frequently treated pathologies in our department are tendon lesions that affect the rotator cuff of the shoulder. There are different types of treatment for massive or irreparable tears. For a few years, a low-invasive technique was introduced based on the placement of a biodegradable subacromial spacer. The objective of the work is to analyse the results of our experience with the use of this device (InSpace™). Material and method: The study collects the results obtained in 25 patients with irreparable ruptures of rotator cuff defined by RM, in which they were implanted a balloon subacromial in our centre in the period from January 2015 — until December 2017. All patients were evaluated preoperatively and one year after surgery including the visual analogue scale (VAS), the Constant test (CS) and the QuickDASH (QD). Results: Of the 25 patients, 5 patients (20%) were operated by arthroscopy and 20 (80%) By open approach (mini-open). A total of 22 patients completed the follow-up year. At 12 months, 64% of the patients obtained an improvement of at least 10 points in the CS. Patients departed from an initial average CS of 32 points that improved to 54.9 points of average in the postoperative evaluation at 12 months (average improvement 22.9 points; value-p

Introduction In the Spanish population, previous studies related to mortality after hip fracture are based on patients aged 60–102 years and did not stratify patients according to the type of fracture. The objective of this study was to identify the factors with influence on mortality at one postoperative year in patients aged 80 years or older after a femoral neck fracture. Material and method Retrospective study of cases and controls. Consecutive patients operated between 2015 and 2016 were included. Baseline characteristics, medical history and previous medication, analytical parameters, Charlson index, ASA scale, Barthel index and Pfeiffer questionnaire were studied. Surgical data and complications were recorded during follow-up. Survival was assessed by the Kaplan–Meier method and the variables that affected it by Cox regression. Results Mortality one year postoperatively was 21.1% and mean survival 10.3 months (95% CI: 9.7–10.9). The Cox regression showed that age >87 years, Barthel score ≤ 85 and the combination of anticoagulants with INR ≥ 1.5 were significant predictors of mortality during the first year of follow-up. Conclusion The predictors of mortality during the first postoperative year after femoral neck fracture in octogenarian or older patients were: age >87 years, physical dependence measured by a Barthel index score ≤ 85, and the use of anticoagulants with a INR ≥ 1.5 at admission.

Resumen Introduccion En la poblacion espanola los estudios previos relacionados con la mortalidad tras fractura de cadera estan basados en pacientes con edades entre 60 a 102 anos y no estratificaban los pacientes de acuerdo con el tipo de fractura. El objetivo de este estudio fue identificar los factores con influencia sobre la mortalidad al ano postoperatorio en pacientes de 80 anos o mas que sufrieron una fractura cervical de cadera. Material y metodo Estudio retrospectivo de casos y controles. Fueron incluidos los pacientes consecutivos intervenidos entre 2015 y 2016. Se estudiaron las caracteristicas basales, los antecedentes y la medicacion previa, los parametros analiticos, el indice de Charlson, la escala ASA, el indice de Barthel y el cuestionario Pfeiffer. Se registraron los datos quirurgicos y las complicaciones durante el seguimiento. La supervivencia se evaluo mediante el metodo de Kaplan-Meier y las variables que la afectaban mediante la regresion de Cox. Resultados La mortalidad al ano postoperatorio fue del 21,1% y la supervivencia media de 10,3 meses (IC 95%: 9,7-10,9). La regresion de Cox mostraba que la edad > 87 anos, la puntuacion de Barthel ≤ 85 y la combinacion de anticoagulantes con INR ≥ 1,5 eran predictores significativos de mortalidad durante el primer ano de seguimiento. Conclusion Los factores predictores de mortalidad durante el primer ano postoperatorio por fractura cervical de cadera en pacientes octogenarios o mayores fueron la edad > 87 anos, la dependencia fisica medida a traves de una puntuacion en el indice de Barthel ≤ 85 y el uso de anticoagulantes con un INR ≥ 1,5 al ingreso.

Resumen Introduccion Una complicacion frecuente tras una artroplastia total de cadera es el sangrado, y para reducirlo se utiliza el acido tranexamico (TXA) intravenoso. Recientemente se han publicado los beneficios de su aplicacion topica. Consideramos necesario realizar un estudio que justifique que via de administracion resulta superior. Material y metodo Estudio prospectivo, controlado, aleatorizado en 2 brazos realizado entre febrero de 2017 a febrero de 2018. En el grupo A se administro 15 mg/kg TXA intravenoso y en el B 2 g TXA intraarticular. Se evaluo los valores de hemoglobina y hematocrito a las 24-72 horas, volumen de sangre drenado, volumen de sangre perdida, transfusiones y complicaciones. Resultados Fueron incluidos 78 pacientes, 31 con tratamiento intravenoso y 47 intraarticular. La hemoglobina descendio 3,15 ± 1,64 g/dl en 24 horas y 3,75 ± 1,56 g/dl en 72 horas en el grupo intravenoso, el hematocrito descendio un 10,4% ± 4,17% en 24 horas y 11,85% ± 4,15% en 72 horas. En el intraarticular se observo una caida de hemoglobina de 3,03 ± 1,30 g/dl en 24 horas y de 3,22 ± 1,2 g/dl en 72 horas y el hematocrito descendio 10,66% ± 3,6% y 12,11% ± 3,29% en 24 y 72 horas (p > 0,05). El drenaje medio en 24 horas fue 195,80 ml en el grupo A frente a 253,93 ml en el grupo B (p > 0,05) y a las 48 horas 225,33 ml en el grupo A y de 328,19 ml en el grupo-B (p = 0,009). En el grupo intravenoso perdieron una media de 1.505 ml de sangre frente a 1.280 ml del grupo intraarticular. Fueron necesarias un 5,1% de transfusiones. No tuvimos complicaciones secundarias. Conclusiones Las diferentes vias de administracion del TXA en la artroplastia total de cadera tienen un efecto similar en la reduccion del sangrado postoperatorio sin evidenciar un incremento de complicaciones.

Resumen Objetivo Evaluar los resultados clinicos y la supervivencia de las protesis de cadera primarias con par ceramica-ceramica ( C -C) de cuarta generacion implantadas en nuestro centro con un seguimiento minimo de 5 anos. Material y metodo Se estudiaron 205 artroplastias primarias de cadera realizadas entre 2008 y 2012. Los resultados clinicos, prequirurgicos y a los 5 anos de seguimiento fueron evaluados mediante el Harris Hip Score (HHS), el Short Form-36 (SF-36), el Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) y la escala analogica visual (EVA). Radiologicamente se estudiaron la posicion de los componentes protesicos, la osteolisis periprotesica, el aflojamiento de los componentes protesicos y las roturas de los componentes ceramicos. Se registraron los eventos adversos relacionados con el par segun su diametro, con especial atencion a las luxaciones protesicas y a la presencia de ruidos. La supervivencia con punto final como revision protesica por cualquier causa fue estimada mediante el metodo de Kaplan-Meier. Resultados Se obtuvieron mejorias significativas del HHS (88,7% de resultados buenos o excelentes), SF-36, WOMAC y EVA, p Conclusiones Las protesis primarias de cadera con par de friccion ceramica-ceramica de cuarta generacion han mostrado una buena supervivencia a medio plazo y buenos resultados clinicos.

Resumen Objetivo Valorar el resultado radiologico y funcional de la artrodesis de la articulacion IFP del 4.° o 5.° dedo de la mano mediante el sistema intramedular de tornillos entrelazados a compresion APEX™ (Extremity Medical, Parsippany, NJ) en pacientes afectos de recidiva grave de la enfermedad de Dupuytren. Material y metodo Los resultados clinicos se valoraron mediante el cuestionario DASH y la escala EVA. En las radiografias se evaluo el angulo de artrodesis, el tiempo de fusion osea y la fijacion del implante. Se observo cualquier complicacion encontrada durante la cirugia o en el periodo de seguimiento. Resultados La muestra estuvo representada por 6 pacientes. El seguimiento medio fue de 19,6 meses. Todos presentaron evidencia clinica y radiologica de fusion en 8 semanas, con un angulo de fusion de 30° (3) y 45° (3). No se presentaron complicaciones y no se tuvo que retirar ningun implante. Los resultados funcionales en este tipo de pacientes fueron pobres. Conclusion El sistema proporciona un metodo fiable para la artrodesis de la IFP en un angulo preciso. Promueve una fijacion estable que no requiere inmovilizacion prolongada. Puede usarse junto con otros procedimientos en la mano afecta por recidiva grave de ED. Los resultados funcionales con el uso de este dispositivo en este grupo de pacientes fueron pobres.

Objective To assess the radiological and functional outcome of arthrodesis of the 4th and 5th finger using the APEX™ (Extremity Medical, Parsippany, NJ) intermedullary interlocking screw system in patients with severe recurrence of Dupuytren's disease. Materials and method The DASH questionnaire and the VAS scale were used to assess the clinical outcomes. The angle of arthrodesis, fusion time and implant fixation were evaluated on X-rays. The patients were monitored for complications during surgery and the follow-up period. Results The sample comprised 6 patients. Mean follow up was 19.6 months. All of the patients presented clinical and radiological evidence of fusion at 8 weeks, with fusion angles of 30° (3) and 45° (3). There were no complications and none of the implants had to be removed. The functional outcomes in these patients were poor. Conclusion The system offers a reliable method for IPJ arthrodesis at a precise angle. It promotes stable fixation that does not require prolonged immobilisation. It can be used together with other procedures on the hand with severe recurrence of DD. The functional outcomes for this group of patients using this device were poor.

Objetivo Evaluar los resultados clínicos y radiográficos de una serie de pacientes sometidos a una artroplastia de Scheker. Material y Método Estudio descriptivo de 16 pacientes con artrosis TMC. Se valoró el estado clínico y funcional según el cuestionario DASH, la movilidad del pulgar según la escala de Kapandji y el dolor según la escala visual analógica (EVA). A nivel radiográfico, se cuantificó el colapso del espacio remanente tras la exéresis del trapecio. Resultados La edad promedio de los pacientes fue 64,9 años, 81% fueron mujeres. El tiempo de seguimiento medio fue de 19 meses. La puntuación DASH preoperatoria fue de 67,68 puntos y postoperatoria 34,88 (p Conclusión La artroplastia descrita por Scheker, es una alternativa quirúrgica que elimina el dolor y preserva la movilidad del pulgar. No evita el colapso del espacio dejado tras la exéresis del trapecio. No hubo diferencia en el resultado clínico entre los pacientes en los que se presentó un colapso leve o moderado.

Introduction One of the most frequent complications after a total hip arthroplasty (THA) is bleeding, intravenous tranexamic acid (TXA) is used to reduce it. We considered it necessary to carry out a study to clarify which administration route is superior. Material and method Prospective, controlled and randomized study in 2 arms carried out between February 2017 and February 2018. 15 mg/kg of intravenous TXA were administered in group A and 2 g of intra-articular TXA in group B. The values of haemoglobin and haematocrit were evaluated at 24 h-72 h, blood loss volume, drained blood volume, transfusions and complications. Results 78 patients were included, 31 with intravenous treatment and 47 with intra-articular. The decrease of haemoglobin in the intravenous group was 3.15 ± 1.64 g/dl in 24 h and 3.75 ± 1.56 g/dl in 72 h, the haematocrit decreased by 10.4 ± 4.17% in 24 h and 11.85 ± 4.15% in 72 h. In the intra-articular group there was a haemoglobin fall of 3.03 ± 1.30 g/dl in 24 h and 3.22 ± 1.2 g/dl in 72 h and the haematocrit fell by 10.66 ± 3.6% and 12.11 ± 3.29% in 24 and 72 h (p > .05). The mean drainage in 24 h was 195.80 ml in group A versus 253.93 ml in group B (p > .05) and in 48 h it was 225.33 ml in group A and 328.19 ml in group B (p = .009). The intravenous group lost an average of 1505 ml of blood compared to the 11,280 ml of the intra-articular group. In 5.1% of the cases, transfusions were necessary. We had no secondary complications. Conclusions The different routes of administration of TXA in THA have a similar effect in the reduction of postoperative bleeding. There was no evidence of an increase in complications.

Objective To evaluate the clinical results and survival of primary hip prosthesis with ceramic delta bearings (C-C) with a minimum follow-up of 5 years. Material and method A total of 205 primary hip arthroplasties performed between 2008 and 2012 were studied. The clinical results, pre-surgical and at 5 years of follow-up were evaluated using the Harris Hip Score (HHS), the Short Form-36 (SF-36), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the visual analogue scale (VAS). The position of the prosthetic components, periprosthetic osteolysis, loosening of the prosthetic components and ruptures of the ceramic components were studied radiologically. The adverse events related to bearings were recorded according to their diameter, paying special attention to prosthetic dislocations and the presence of noise. Survival with an endpoint of prosthetic revision for any cause was estimated using the Kaplan–Meier method. Results Significant improvements were obtained in the HHS (88.7% of good/excellent results), SF36, WOMAC and EVA, p Conclusions Primary hip prostheses with fourth-generation ceramic bearings showed good survival in the medium term, and good clinical results.

Objective The purpose of this study is to assess the need to lock the Gamma 3 nail (Stryker, Mahwah, New Jersey, USA) distally for intertrochanteric fractures of femur 31-A1 and 31-A2 of the AO. Materials and methods Details were recorded on a sample of 177 patients with intertrochanteric femoral fractures treated in our hospital by a standard Gamma nail between June 2011 and January 2013. A prospective study was conducted by randomizing patients by year of birth, even numbers with, or odd numbers without, and distal locking, forming two groups of 90 and 87 fractures, respectively. Results The patients treated with a distal locking nail had an increased incidence of medical complications, a lower incidence of biomechanical complications, and an increase in the fracture collapse compared with the control group, with statistical significance ( P P Conclusions Based on the results found in this work, the use of distal locking screw in the Gamma 3 nails should be restricted to unstable trochanteric fractures after reduction where additional stability to the intramedullary nail is required, and may decrease the risk of complications from use.

Objetivo El propósito de este estudio es valorar la necesidad de bloquear distalmente los clavos Gamma 3 (Stryker. Mahwah, New Jersey. USA) en fracturas pertrocantéreas de fémur 31-A1 y 31-A2 de la AO. Material y métodos Desde junio de 2011 hasta enero de 2013 se recoge una muestra formada por 177 pacientes con fractura pertrocantérea de fémur tratados en nuestro centro mediante osteosíntesis con clavo Gamma 3 estándar. Es un estudio prospectivo y aleatorizado según el año de nacimiento de cada paciente, par con bloqueo o impar sin bloqueo distal del clavo, formando dos grupos de 90 y 87 fracturas respectivamente. Resultados En los pacientes intervenidos mediante clavo con bloqueo distal se observó una mayor incidencia de complicaciones médicas, una menor incidencia de complicaciones biomecánicas y un aumento en el colapso del foco de fractura en comparación con el grupo control, siendo estas diferencias estadísticamente significativas (p < 0,05). También se observa en el grupo con bloqueo distal un mayor requerimiento transfusional y una mayor tasa de éxitus presentando diferencias estadísticamente significativas (p < 0,05), sin embargo esta significación desaparece al ajustar los resultados por otras características relacionadas con los pacientes. Conclusiones Basándonos en los resultados hallados en este trabajo, el uso del tornillo de bloqueo distal en los clavos Gamma 3 debe restringirse a fracturas pertrocantéreas inestables tras reducción donde se requiera una estabilidad adicional al clavo intramedular, pudiendo así disminuir el riesgo de complicaciones derivadas de su uso. Objective The purpose of this study is to assess the need to lock the Gamma 3 nail (Stryker, Mahwah New Jersey USA) distally for intertrochanteric fractures of femur 31-A1 and 31-A2 of the AO. Material and methods Details were recorded on a sample of 177 patients with intertrochanteric femoral fractures treated in our hospital by a standard Gamma nail between June 2011 and January 2013. A prospective study was conducted by randomizing patients by year of birth, even numbers with, or odd number without, distal locking, forming two groups of 90 and 87 fractures, respectively. Results The patients treated with a distal locking nail had an increased incidence of medical complications, a lower incidence of biomechanical complications, and an increase in the fracture collapse compared with the control group, with statistical significance (p < 0.05). It is also observed in the group with distal locking increased transfusion requirement and a higher death rate, with statistically significant differences (p < 0.05), but this significance disappears when adjusting for other patient-related characteristics. Conclusions Based on the results found in this work, the use of distal locking screw in the Gamma 3 nails should be restricted to unstable trochanteric fractures after reduction where additional stability to the intramedullary nail is required, and may decrease the risk of complications from use.

Patients with medically stabilized unstable angina and a negative stress echocardiogram have a favourable outcome as a whole. This study sought to identify which subsets of patients are associated with serious events at long-term within this population.We studied and followed-up 128 patients (mean 2.2 +/- 1.3 years) with medically stabilized unstable angina and a negative dipyridamole stress echocardiogram. Cumulative survival rates were 98.2 +/- 1.3%, 96.0 +/- 2.2% and 93.2 +/- 3.2%, at 1, 2 and 4 years, respectively. Freedom from events (death, myocardial infarction, and revascularization) were 98.2 +/- 1.3%, 96.0 +/- 2.2% and 86.3 +/- 6.0%, at 1, 2, and 4 years, respectively. Cumulative mortality rate was higher in men (3.6 +/- 2.5%, 8.5 +/- 4.1%, and 12.2 +/- 5.4% at 1, 2, and 4 years, vs. 0% at the end of the follow-up in women; p = 0.034), and in those with previous myocardial infarction (4.3 +/- 4.3%, 9.1 +/- 6.2%, and 18.2 +/- 2.3% at 1, 2 and 4 years, vs. 1.1 +/- 1.1%, 2.9 +/- 2.1%, and 2.9 +/- 2.1% in those without previous myocardial infarction, respectively; p = 0.047).Among patients with medically stabilized unstable angina and a negative dipyridamole stress echocardiogram, male gender and previous myocardial infarction are associated with a non-favourable outcome.

Background and objectives: In addition to the myocardium, the microvasculature may be also damaged in acute myocardial infarction. The aim was to evaluate the capability of myocardial contrast echocardiography in the detection of microvasculature damage after myocardial infarction. Patients and methods: Twelve patients with recent acute myocardial infarction and five control subjects with normal coronary arteries and without history of myocardial infarction were studied. Myocardial contrast echocardiography with power modulation was performed, and quantitative data were measured off-line. Power modulation uses a combination of low (0.1) and high (1.7) mechanical indexes, allowing a real-time evaluation of myocardial perfusion. Contrast agent was administered as a 3-min bolus. The quantitative analysis was performed off-line by a different blinded investigator. The refilling velocity was calculated as the difference between the peak myocardial refilling value and the value at 1 s after the impulse divided by the time from the first second after the impulse to the peak refilling value. Results: Eighty-one myocardial segments (75%) were analysed qualitatively and quantitatively in AMI patients, and 18 (60%) in control subjects (P=NS). The peak refilling intensity was not significantly different in patients and control subjects (6.62±5.85 vs. 7.53±4.06 dB, respectively). However, time to peak refilling intensity was significantly longer (5.25±1.57 vs. 4.00±0.53, P=0.004) and the velocity of refilling was significantly lower (2.74±5.34 vs. 6.58±8.02, P=0.028) in patients with myocardial infarction. Conclusion: There is microvasculature damage after myocardial infarction that is reflected as a delayed velocity of refilling in myocardial contrast echocardiography.

Aims: The microvasculature damage after myocardial infarction has important implications. The hypothesis of the study was that wall motion abnormalities and microcirculation status do not necessarily match after myocardial infarction, and therefore the study of only myocardial wall motion could offer an incomplete evaluation in these patients. Methods: Wall motion and myocardial perfusion assessed by contrast echocardiography were evaluated by two different blinded investigators in 29 patients with recent (

The lattice thermal expansion of rhombohedral CaZr4(PO4)6 has been determined to be anisotropic with a negative expansion coefficient along the directions in the plane (0001). This behaviour is anomalous if compared to the rest of the compounds in the set MIIMIV4 (PO4)6; MII=Mg, Ca, Sr, Ba; MIV=Ti, Sn, Zr and to the low temperature form of MISn2(PO 4)3 MI=Na, K, Rb. High temperature high resolution neutron diffraction shows that the rotations of ZrO6 and PO4 polyhedra are opposite to those in the other cases.

High temperature high resolution neutron diffraction study of the crystal chemistry of NaSn 2 (PO 4 ) 3 has been completed, at four different temperatures, applying the Rietveld method to the experimental neutron diffraction profile of a synthetic crystalline powder. Below the phase transition (∼860 K) the space group has been determined to be R3 which changes to R3c in the high temperature phase. No chemical bond breaks through the transition. The change in temperature makes the SnO 6 polyhedra rotate around the three fold axis in both structures. The PO 4 polyhedra rotate strictly around the two fold axis in the high temperature phase, but around the [0001] direction in the low temperature form.

NaSn2(PO4)3 presents a fast and reversible second order phase transition about 575°C. Both phases above and below the transition point are rhombohedral. The high temperature phase is isostructural with NaTi2(PO4)3 and NaZr2(PO4)3, NZP structure. The lattice thermal expansion of these three compounds has been determined from x-ray diffraction data at different temperatures ranging from room temperature up to 1000°C. Differences in behaviour are discussed in relation to the structure.

Myocardial contrast echocardiography (MCE) allows the assessment of myocardial perfusion by imaging the coronary microcirculation. The development of new contrast agents and new diagnostic tools far assessing myocardial perfusion by means of MCE has led to a new field of applications far patients suffering from ischemic heart disease. Several studies have shown that MCE is a feasible and accurate method to evaluate patients with: a) acute coronary syndromes: MCE is useful before the epicardial reperfusion to delineate the area at risk and to assess the collateral-derived myocardial blood flow, and after the epicardial reperfusion to detect the non-reflow phenomenon; b) chronic coronary syndromes: MCE allows the detection of significant coronary stenosis by means of stress methods and methods without any stress; c) myocardial viability and hibernating myocardium: MCE helps to predict functional recovery of akinetic segments. In these settings, MCE is not only useful as a diagnostic tool but also provides prognostic information. MCE is a technique in constant development. Among the latest advances we note the development of transesophageal probes with second-harmonic image that allows assessment of myocardial perfusion in a more accurate way. This technique should introduce MCE into new clinical fields, especially the evaluation of myocardial perfusion during cardiac operations. Another recent development is in parametric imaging techniques. These consist in obtaining time curves for all the pixels in the image instead of working only with a few separate regions of interest. A parameter scan is computed far any pixel showing their value as a color overlay in the parametric image. Summarizing, we can say that MCE is crossing from the experimental laboratory to the daily clinical practice far the evaluation of ischemic heart disease. MCE provides an interesting tool that offers the potential of a complete evaluation of patients with chronic coronary artery disease. This includes both diagnostic and prognostic evaluation.

Background: Doppler Tissue Imaging (DTI) has been evaluated in ischaemic heart disease and some cardiomyopathies. In patients with aortic stenosis (AS), left ventricular contraction is slowered. This study aimed to evaluate the possible role of the measurement of isovolumic contraction time (ICT) by DTI in the evaluation of AS severity. Methods: The study population constitutes 30 patients: 15 with AS (nine severe and six non-severe) and 15 control subjects. All of them had normal systolic function, sinus rhythm, and absence of ischaemic heart disease of conduction abnormalities. ICT was defined as the time from the onset of the QRS complex to the beginning of the DTI systolic wave. The correlation between ICT and aortic area obtained by continuity equation, as well as the diagnostic value of ICT in the identification of severe AS were studied. Results: ICT was significantly increased in patients with severe AS (98 � 27 versus 65 � 21 ms, p ¼ 0:024). There was a significant correlation between ICT and aortic area (r ¼� 0:56; p ¼ 0:035). The receiver operator characteristic curve of ICT in the identification of severe AS yielded an area under the curve of 0.852 (95% confidence interval: 0.665–1.0). The two best cut-points were [73 ms (88% sensitivity, 77% specificity) and [85 ms (78% sensitivity, 83% specificity). A value of[41 ms had a 100% sensitivity, but only a 17% specificity, and [91 ms showed a 100% specificity, but only a 44% sensitivity. Conclusions: ICT measured by pulsed-wave DTI is increased in patients with aortic stenosis. (Eur J Echocardiography 2003; 4: 279–285) 2003 Published by Elsevier Ltd on behalf of The European Society of Cardiology.

Background and Objective: The diagnosis of left ventricular pseudoaneurysm after acute myocardial infarction is usually based on echocardiography. However, this technique may have limitations in some patients, especially in cases with suboptimal acoustic window. The objective of this study was to evaluate the usefulness of contrast echocardiography in the diagnosis of left ventricular pseudoaneurysm after myocardial infarction. Methods and Results: The study population comprises six patients in whom a two-dimensional echocardiography showed an image consistent with left ventricular pseudoaneurysm. Levovist® (Schering) 4 gr was administered i.v. to more clearly visualize the blood flow from the left ventricle to the left ventricular pseudoaneurysm cavity in all patients. Infarct location was anterior in five patients, and posterolateral in one. No patient had received thrombolysis or primary angioplasty during the acute phase. The transthoracic echocardiographic study showed an echo-free space adjacent to left ventricle in all patients. In four cases, the diagnosis of left ventricular pseudoaneurysm was made before contrast administration. In the remaining two patients, the definite diagnosis was made only after Levovist® administration. Conclusion: In the diagnosis of postinfarction left ventricular pseudoaneurysm, the administration of contrast agents may be of help in the correct visualization of the blood flow from the left ventricle to the left ventricular pseudoaneurysm cavity, and may allow a definite diagnosis to be obtained in some patients. Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved .

severity of atherosclerotic involvement of the aortic valve and root in familial hypercholesterolaemia. Heart 1998;80:583–590. 7. Boon A, Cheriex E, Lodder J, Dessels F. Cardiac valve calcification: characteristics of patients with calcification of the mitral annulus and aortic valve. Heart 1997;78:472–474. 8. Shively BK, Roldan CA, Gill EA, Najarian T, Barton Loar S. Prevalence and determinants of valvulopathy in patients treated with dexfenfluramine. Circulation 1999;100:2161–2167. 9. Hensrud DD, Connolly HM, Grogan M, Miller FA, Bailey KR, Jensen MD. Echocardiographic improvement over time after cessation of use of fenfluramine and phentermine. Mayo Clin Proc 1999;74:1191–1197.

Purpose: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with a significantly high risk of stroke and systemic embolism. Thromboembolic risk is known to be related to abnormalities in left atrial (LA) flow and endocardium, as well as local and systemic humoral factors. Our objective is to describe the association between LA mechanics measured by 3D Wall motion tracking (3DWMT) technology and the most common thromboembolic risk scales (CHADS2, CHA2DS2VASc). Methods: 101 consecutive patients with AF underwent conventional transthoracic echocardiogram. We studied conventional bidimentional (2D) atrial parameters and mechanics with 3DWMT. Association between 2D and 3DWMT parameters of LA and both risk schemes was evaluated as well as its correlation with every component of the score individually. Results: Mean age of our cohort (n=101) was 78±10 years, and 47 (46.5%) were male. In regards to comorbidities, 28.7% were diabetic and 85.1% hipertensive. Mean CHADS2 was: 2.7±1.3 and mean CHA2DS2VASc was 4.4±1.7. Mean values of 2D and 3DWTM LA parameters were: area 26.4±9.7 cm2; volume index 49.4±10.1 ml/m2, left atrial ejection fraction (LAEF) 15.9±8.4% and global longitudinal strain 9.1±4.5%. Linear regression analysis showed significant correlation between global longitudinal strain and CHADS2 and CHA2DS2VASc. The latter had also association with LAEF. View this table: Table 1. Linear regression analysis (R value) Conclusions: Our results show that LA longitudinal strain and area strain have a correlation with both scales CHADS2 and CHA2DS2VASc, therefore these parameters might be considered as new predictors of also thromboembolic events in adition to the current scales.

Previous disagreement about the thermal expansion of the rhombohedral compound, NZP-type, NaTi 2 (PO 4 ) 3 has been clarified. It is shown that thermal stresses affect the thermal expansion, but they relax after some time of storage. Its anisotropic thermal expansion, has been calculated from high temperature X-ray diffraction, and it is linear in the range from room temperature up to 800°C. Coefficients are α (a)=−4.4×10 −6 °C −1 and α (c)=20×10 −6 °C −1 . The predictability of thermal expansion and the tailoring of the composition of NZP ceramics require to check whether the thermal effect on the rotations and distortions of the atomic polyhedra in this structure is the responsible for the high anisotropy in the thermal expansion. This effect has been determined experimentally by solving the chemical structure at five different temperatures, applying the Rietveld method to deconvolute the powder X-ray diffraction profiles. The Rietveld computer program was modified to include and refine a coefficient relating to the eccentricity of the sample in the X-ray high-temperature camera.

Lattice thermal expansion has been measured on three samples of composition LiZr 2 (PO 4 ) 3 , prepared by (i) a ceramic method, (ii) a gel-route and (iii) a nonstoichiometric ceramic. The first sample is monoclinic (?), with a transition at 50°C to rhombohedral. The second is clearly monoclinic with lattice parameters depending on the calcination temperature (700 to 1200°C. The third kind of synthesis yielded a new PO 4 -deficitary rhombohedral structure. X-ray diffraction measurements in a high temperature camera have been made from room temperature up to 1100°C. Lattice parameters, as well as their dependence on temperature are different for the three samples. While thermal expansion of the ceramic sample shows a regular trend, in the gel-route sample there is a sharp transition between 155 and 200°C.