Impressions ongoing advances in pathology metatarsal "
course "Advances in metatarsal pathology"
With the entity of the speakers, it was assumed that the course would be a success, and has been, both assistance and the quality of exposures.
Ciccinelli
Luke told us about the metatarsal panresección for a longitudinal decompression of the metatarsals and phalanges and preserve the linearity at all levels, and has made this technique (there is a book of orthopedic Louis Barouk (forefoot Reconstruction, it is translated in English, and mediolateral longitudinal decompression of advanced forefoot deformities) have recommended to read, it explains very well this technique) with very good results.
Javier Pascual has done an anatomical review of MTP structures flexor plate and concrete.
has also made a brilliant exposition on the time of scientific crisis we are facing, where already too many people question the paradigm of Root and several theories have emerged that will be the ones in the near future as the next accept all valid theory stable. Among these theories are that of Kirby, Fuller, Stress tissue, Proprioceptive, etc.
The truth is that people have lost a little on this subject, but that person has served me very great help because all the articles I've studied, I have been able to shape thanks to this chat.
If anyone is interested, I named the items that you can get and read:
1 º "Subtalar Joint Axis Location and Rotational Equilibrium Theory of Foot Function" Kevin Kirby, DPM. JAPMA. Volume 91. Number 9. October 2001.
2 º "Center of Pressure and Its Relationship to Theoretical Foot Pathology" Eric Fuller, DPM
JAPMA. Volume 89. Number 6. June 1999.
These two items are a must read. If you have more interest in further deepening on the subject, there are many more studies on this, but for their understanding before we can understand these 2.
Following the course: Anesthesiologists Piqueras clinic, we have illustrated the effects of anesthetics, such as modifying their times, how to treat pain and many other things.
Finally, Raul Ramos, has shown us by MIS treatment of pathologies metatarsal and other uses of the MIS. Also, as a physiotherapist, has shown physical treatment for postoperative or symptoms of disease in MTP.
Finally, they discussed the benefits of plasma rich in growth factor (right now I do not remember the exact name). (See info in last paragraph)
This I read that technique is widely used in U.S. by podiatrists for treatment of plantar fasciosis. The technique involves removing blood from the patient and centrifuged. The centrifuge is an area just above the blood, where there is a greater concentration of growth factors.
This treatment is infiltrated into the lesion and the results seem impressive, not only because we say so, but because there are athletes who have done well because I read about it, because it is a technique used quite podiatrists.
In short, it has been a course that has played a lot of surgery, but has not neglected other aspects foot as physical therapy, biomechanics, anatomy, internal medicine.
congratulate the COPOGA for this great course and the excellent work they are developing.
By the way, I just found this link to a story about a colleague who attended the course in podiatry and news. Read here
3. Magellan Autologous Platelet Separator System (Arteriocyte Medical Systems). Platelet-rich plasma (PRP) is a Developing technology, Which May Have Benefits for a range of lower extremity conditions. One platelet separator That Is Coming Into WIDER use is the Magellan Autologous Platelet Separator System.
With a small blood sample or a mixture of blood and bone marrow, one can use the Magellan system to prepare PRP, according to the manufacturer Arteriocyte Medical Systems. The company notes that one can mix PRP with autograft and/or allograft bone prior to application. Babak Baravarian, DPM, praises the ability of the Magellan PRP and bone marrow aspirate kit to facilitate the harvest of stem cell/ bone marrow.
“These products allow improved soft tissue and bone healing, and have radically changed the outlook for biologics use in the body,” notes Dr. Baravarian, an Assistant Clinical Professor at the UCLA School of Medicine in Los Angeles.
Dr. Baravarian has been using the Magellan system for approximately three years and has had “excellent results.” Arteriocyte Medical Systems cautions that PRP prepared by the Magellan system has not undergone evaluation for clinical indications.
In addition, the product permits one to adjust the concentration of the PRP and bone marrow aspirate, and has a “state of the art” filtration system, according to Dr. Baravarian, the Director of the University Foot and Ankle Institute in Los Angeles.
The company cites the cost effectiveness of the Magellan system, saying one can conduct as many as three cycles with the same patient. This eliminates the cost of additional platelet separation disposables, According To Arteriocyte Medical Systems. The company adds the device's size Makes for easy use in a Variety of settings. Information obtained from
The page of Herodias: - Look at the moon! How strange it seems the moon! It's like a woman who rises from the grave. One would think you are looking for dead things.
"You think you're looking for dead things." Lorca sounds, right? But it is not. Salome is of Oscar Wilde , I just read. At first everything is Lorca, and then turns into a symbol set very decadent times more reminiscent of Darius, but no longer efficient. Salome is a tiny piece, short but extremely condensed also the style of Lorca. There is no real plot, but only an anecdote and magnified cruelly decorated to make you see the horror of madness, love and death.
And I remembered that other biblical work just begun by Lorca, The destruction of Sodom , which was supposed to close the tragic trilogy begun with Blood Wedding and Yerma . I leave you with what little remains of that Sodom :
Street Sodom. Columns and large purple awnings. On one side is a marble fountain while watering.
Women 1 st. Have not back? Woman 2 ª. (you're on the floor covered with a gray veil.) Women No. 3 ª. They have four days drunk. Women 4 ª. They took all the wine in the jars. Women 1 st. And to crown cut all the bunches of grapes. Woman 2 ª. Ay! Women 1 st. 's not used. They brought their parents in a remote village with her dowry and left here not knowing what they did. Women 3 rd. And she loves her husband. Women 4 ª. When you run out of tears stop mourn.
That's it. The tragedy is chewed. Like the other tragedy, that Lorca never cease to end neither he nor many other works.
What makes me jealous every time someone tells me that. Sending a poem any, of those who have discovered as an adult (because it has been my profession has brought me to poetry, and not vice versa, as would have been logical) and I answered that "this I recited it, haha" . And think of all those teachers I had in my childhood (of which I can not complain, if I have done professional has been largely due to the admiration that I always had the majority of them) and that just made me learn poems memory, that I could now drop in class without having to learn it the day before. Because I learned the poems of memory could be an ordeal for a child, but there is nothing more than enjoy it drop in front of the class once they have been learned. What a shame that the memory is devalued, when you offer one of the greatest literary delights there: the recitation.
month and a half times again where the weather and go if you notice when the sun comes out, the feet are most used by the walks, more aggression, by road and weather conditions (heat, more edema, no socks or stockings, less protection, etc). also are emerging plantar warts, and that is ...... A fact that has surprised me is that in one week have turned many people they look up the nail of the hallux, as seen in a television advertisement in which they said could have fungus. I really think we are doing the advertising, even in self-interest. As a result, many cases of affected nails are not caused by fungal infections. Many fingernails are onycholysis due to microtrauma to the footwear, or the biomechanics that produces a rotation in the finger and the lever holding the nail is altered where the equilibrium point is no longer the center but the side therefore begins to peel by the contralateral. A crude example would be a balance, with two equal weights on both sides and the fulcrum in the middle. (Bridging the gap of plantar pressures received)
This case is interesting because the patient comes for consultation 3 months after nailing a crystal in the center of the foot. A month ago it began to bother him and went to consult, but they do not care. In the first consultation thought of a foreign body or a hypertrophic scar. For the first course I took a deep exfoliation, manual hemostasis, comprising scar tissue and loose hair that I was finding was not appreciated until more fibrous tissue. After 2 weeks back to review, and felt no pain on pressure, but if burning and pain around the injury, a tumor that internal hard consistency and palpable. To delaminate a little bleeding occurred in 1 capillary. Cramp-like pain. She said that for 1 month was scratched to make you bleed in times continuous. Thus the clinic coincided with the plantar wart (pain, cramps pathway, tumor, bleeding capillary sheet) and this has been covered so today. For now do not notice anything that felt and only time will tell whether it was that or is that a hypertrophic scar was forming.
Cleaning injury after cantharidin application.
In this case, a girl with another wart treated 1 year of evolution. The same case as above.
This is another case of unusual. Patient with a 5-second head helomas MTT. were enucleated not be more perfectly to hyperkeratosis. The fact is that after 2 weeks still bothering him and has given no trouble at any time, bothered him less but still there. The clinic also tells us to plantar wart: immunosuppressed patient with family history of wart 1 and 2 years ago, walking barefoot at home. Under the helomas revealed a pedunculated fibrous tissue, pinkish at first gave no importance, but when he continued bothering if appreciated that the dermis was not as it should.
In this case, has spent 45 years thinking you have flat feet, a definition that does not like to listen and to classify a flat or cavus foot, it seems too simple, and if you have low arch foot has etiology, either structural (bone), morphological (such as align the bones and joints) or accommodative (the common) In this case the arc was nonexistent in charge, but was in shock. Pronation of the ASA gives the false image of flat feet, as evidenced by photographs of plantar orthoses then showing the natural arch that is.
The problem is excessive muscle tension flexor posterior chain, causing an equine ankle, apart from obesity. The problem gets better with orthotics and stretching, even improving the symptoms of sciatica. Back foot-leg, evolution. Works using boots water all day. is erythrasma diagnosis, treatment and oral antibiotics.
There is a case that brings me head. A middle-aged patient presents with a sore arch in 3 weeks later. In the exploration is not seen nothing, absolutely nothing. He looks with a magnifying lamp, it is pressure is applied, the area is palpable nodules noted, and nothing. He himself noticed when he arrived from the beach, but also looked at the area and saw anything or erythema or swelling. The diagnosis meant it more to be nailed something and have a foreign body reaction with a vesicle in the deep layers of the skin. muscle involvement has been ruled out.
Another case I've seen today, came only to ask for a 2 Opinion about a fingernail problem on a teenager who has been operated 2 times and the injury becomes manifest. a tumor is well vascularized, friable that produces elevation of the nail plate from the middle to the distal bed. Today was difficult to assess because it recently received a trauma to the area. The dermatologist has operated scraping the lesion for 2 times under anesthesia. I do not think you have had a biopsy, so I'm told. It has been recommended to rule out making a Rx subungual exostosis, osteochondroma and if not for bone involvement, a biopsy of the area or directly to a complete surgical excision.
(Speaking of surgeries, I read on the blog of the practicum conducted bases in Alicante, which has been a success. The truth is that was very good looking, and personal problems have not been able to attend, but the next I will not lose because they think it is important to know how to perform everyday basic things such as nail surgery, tumors, exostoses)
A case also "likely" occurred with a relative, a 9 year old girl without previous trauma has been made limp edema in the posterior and proximal leg, forcing her to march in dorsiflexion of the foot for walking. The mild tenderness in the area produced a lot of pain. After the scan relevant is the pain in the posterior tibial muscle, and that performing passive hyperextension of this is when most apparent pain, also because the analgesic dorsiflexed position reduces muscle solicitation. features a forefoot varus and made a lot of sport every day of the week. oral NSAIDs Kinesio Taping 1 month and the problem was resolved, but showed edema and ankle pain in the medial and anterior as well as subungual hematoma. Rx clean. Inquiring pain occurs at the ankle but not affect the joint, rather the hallux Extendor tendon. then commented that he has fallen skateboard and is bent around the foot in plantar flexion as has occurred in the extensor stretch. Kinesio Taping and contrast baths 2 weeks. And see if it's the latter because the 2 conditions did not match but come together to tell us about that incident.
Finally remark that this weekend we have underway in Santiago de Compostela with Dr. Luke Ciccinelli and Javier Pascual, where they board the metatarsal pathology from the biomechanics and surgery. Here we will again, and in 2 weeks to Madrid to another.
PD Looking for information about MBT shoes, I found an article made 2 years ago on the use of MBT and its effectiveness in osteoarthritis of the knee. The results showed no significant improvement after 12 weeks. (Unstable Shoe Construction and Reduction of Pain in Osteoarthritis Patients BENNO M. NIGGA 1, CAROLYN EMERY 2, and Laurie A. Hiemstra 2)
Also in a recent article, trying to open new avenues of exploration in diabetic neuropathy which decreased the sensitivity related to a nerve entrapment due to fibrosis that occur in the anatomical narrow channels. The improvement in nerve decompression made us wonder whether apart from nerve entrapment neuropathy may coexist to aggravate or accelerate the problem. In the study succeeded in reducing the recurrence of ulcers in almost all cases.
"evidence That Were These encouraging results reproducible Ongoing Would Also inform the debate about using Nerve Decompression for neuropathic pain of diabetic origin"
Low recurrence rate of diabetic foot ulcer after nerve Decompression D. Scott Nickerson JAPMA Volume 100. Numer 2.
The thing is less, but the original version remains in Spain a sort of haven for intense and intellectual. And of course, VO cinemas focus on that audience as specialized and only scheduled European and independent films, the more judicious better. But if you want to see Spiderman Transformers or in VO, you have crappy (in Madrid, for example, in the movies can only Ideal). It is as if the blockbusters like to see them given equal bent. Ten years I've been watching film VO only because ten years ago there was a point of no return in which the dubbing began to creak and get me out of the history of film. But that does not mean that I only like European cinema or indie films American. I film in VO, but all films in VO.
Sometimes the original version you discover new perspectives. New perspectives also can give you more mainstream products . It's like Laura Pausini. His first hits in English ( Loneliness and It was) I look horrible, but years later, I got to listen in Italian and things change, go do change. And when I hear it I reaffirm that I have always thought that no other language like Italian, you can blow my very bland sometimes. I'll stick with these two in English baladones sound of a cheesy Italian gruesome and leave me aniquiladito cuore. And I put them in concert, that you may see that the aunt has a voice over live fucking.
This mass culture I love. Let me explain. Sometime in this blog I have been accused of mixing high culture the crap as if it were blasphemous. I remember I was talking about the future of English, when I joined Garcia Marquez and Ugly Betty in the same paragraph. But I know there's more. If I talk about music the same post will loose a Beethoven you analyze a disk-song of Tarkan or Bisbal (and still has not given me to talk about Bustamante, haha). In movies, I like both the One, two, three of Billy Wilder One, two, three, Splash, Ron Howard . Touching literature, as you analyze the series of Twilight that The Regent . I can enjoy the same talking about Nietzsche that Save me. Eclectic is one, might say. And sometimes I even feel too bipolar, as if not knowing what kind of people should move. And until I get bored if those people are just one type. But I think I'm not eclectic, but the moment we are living in history is for better and for worse as well. And if not, keep reading.
To start, you hear the All by myself Celine Dion of . Do not be lazy and give the play, which no one is looking ...
A tacky, right? But when it rings at the end of Out wave in Jewel version is total:
However, searching on the net is the germ Rachmaninov is so tacky! Remember them spoke of his piano concerto number 2 ? Then I go and I find that the second movement is All by myself as an orchestra. Years and years listening to the two pieces and I've never set! I do not know which of the two hear before, if the song or the show. Probably the concert, I was given the geek in my teens, but maybe it was the opposite and that's why I've always liked this show so much from the beginning (just because it sounded!). Listen, listen, and check.
someone told me the other day. That the Emperor was too monumental. Preferred his first piano concertos. No, I said, those are too Mozart! Sure, I replied. And I, as we are with Mozart ...
For six years, from 12 to 18, I heard nothing but Beethoven , locked in my room (and yes, frikazo often was). Of rebound heard any Bach cantata, the Requiem of Mozart, Schubert Incomplete or Mendelssohn The Hebrides, but little else. Beethoven's obsession left little hole. This also coincided with the bicentenary of Mozart and the premiere of Amadeus . Mozart everywhere, and I scratching of anger that was not recognized that Beethoven was a thousand times better.
Now, years later, with the spotify on my computer, I'm back at it again. And I returned to the Emperor , for me, the best of Beethoven. The first movement is sublime, and I like even more than any of the symphonies. I would even say that is what I like about all the music I've heard in my life.
But today, exploring the spotify , I remembered Rachmaninov. In this concert n.2 for piano that once was the only thing that came to overshadow my obsession for the deaf in Bonn. Right now as I write this, I hear the third movement changed and am unleashed. And I think what Beethoven would have said if he had heard this? And I think that is one of the few things written after his death make him worth listening to. Of the few things that, without exceeding it, fall short of the great monuments of Emperor insult to others my astonished eyes. Because let's see, who may prefer to Mozart and beautiful chords handle this?:
Sometimes a masterpiece can sink the career of an author, at least as far as prestige is concerned. For example, after The House of the Spirits , "Isabel Allende has written something at the height of the great influence he had his first novel? The Allende has remained funny and sometimes clever, but never anything I had written the emotional depth of his early work, even this Paula with which readers cried half the world (including me).
García Márquez is too big. Nothing is further from my intention to compare with Allende, whether The House of the Spirits me come to me in a more intimate setting. Chronicle of a Death Foretold and Love in the Time of Cholera Gabo would be worth it to be considered the greatest living writer in English, but they are NOT Hundred Years of Solitude , This novel despite being a tad sexist can literally everything that is written in the twentieth century.
Let the music. Remember the Jagged Little Pill Alanis Morrissette of ? What a bombshell, right? And now tell me the name of any of the other discs that Canada has taken. No? Then come, at least one song. Nor, right?
But do not fall into the topic. Not always. And one must be careful because even though I absolutely love, sometimes are those topical which condemn any artist's work after you have done your masterpiece . And it is still unfair. Namely:
Madonna: Music
Let us frivolous, which is Madonna. The elastic amazing grandmother has always been an expert in excel after his great records, but will not always be recognized. Today I was listening to my ipod the Music, which released in 2000, two years after the boom of Ray of Light, and the way things are, even in its day Rolling Stone said it was "a just and improvised version of his previous work", Music is a piece of disc. Perhaps more irregular, perhaps rarer or less appealing at first sight, but also revolutionary, because there is only one electronic disk and go. There are songs like I Deserve It or Gone, which at first seem poison country and little else, with Madonna singing more listless than ever, but have a brutal synth arrangements that make you put the creeps. We have to wait half the songs, but it's worth:
Almodóvar: Átame
Critics have said all of this movie, especially his biggest problem is the lack of clarity within a genre. Come on, Almodóvar does not know whether to laugh or mourn. I actually think this movie is a gem, and his only problem is that Almodóvar made just after the boom of Women on the Verge of a Nervous Breakdown , which was a perfect comedy. Átame is no better movie, but not necessarily worse. The comedic tone is not as accomplished, but that was needless, because it was not that.
Anne Rice: The Vampire Lestat
After Interview with the Vampire , Anne Rice took the opportunity to make a long story and box. And ended up prolonging the delirium, with a vampire chronicles the end there was no one to swallow. But it did just after the first, the vampire Lestat , is by far the most fun of all, much more so than the first part (also because the first part was fine, but it was not a work teacher to say).
Sam Mendes, Revolutionary Road
Well what can I say, American Beauty was good, but I never seemed to much. Moreover, it seems to me that I had a whiff of opportunism that has made him become outdated over time. The story is ultimately much of the nineties. The soundtrack, taken as the ultimate moment, sounds and trilladísima. And the scene of the plastic bag in the wind and ends up being cheaper postmodernoide transcendentalism. To me, failing to pass the years so that it can judge in righteousness, Revolutionary Road seems a movie much more perfect and heartbreaking. Ironically, it was not given much hype level Oscars and other awards, but I think that ultimately that it will do a favor to the future of the tape.
Fernando Meirelles, The Constant Gardener
At the time, when I saw City of God not upset me. But I found that the overwhelming aesthetic proposal kept the story a tad diluted. Years later, The Constant Gardener, freaked. There was still a beauty, but here what Meirelles proved its worth as a storyteller was driving a story that actually are three: the love story, the best-seller political and social criticism. Difficult difficult, but Meirelles goes out more than winning, so I think it's much better film than the first.
*** More. From childhood I have always liked more Indiana Jones and the Temple of Doom that Raiders of the Lost Ark . Back to the Future Part II is a Despiporre great, that challenges and laughs even the shadow of the first part (the third is not, the third is horrible). The Empire Strikes is infinitely better than Wars The , much as the freaks they think this is blasphemy. And so on and so forth. And do not talk about The Godfather because it is a topic endlessly released (and because, oops, I have not seen ...).
Today, with such TV series as well done, I think the topic is shattered forever. Lots of series have been made in recent years whose first season just had bellows, but then picked up strength and have been turned into second or third seasons geniales. Buffy , por ejemplo, que tiene una primera temporada bastante aburrida, (y que por eso cuesta tanto trabajo a la hora de convencer a neófitos). O miren los famosos spins-off , como Fraisier , que salió de la genial Cheers , pero que era igualmente genial. En España, lo poco que he visto de Aída me ha parecido siempre bastante mejor que lo poco que vi de Siete vidas . Y sí, no pasa lo mismo con Aquí no hay quien viva , que después de las dos primeras temporadas, alucinantes, no supo mantener el tipo: I've seen something What coming, and it's funny, but not the same.
I'm just saying be careful to crucify those who are lucky or the merit of making a masterpiece, because sometimes, the same devotion to the masterpiece can blind us to judge what comes next.
Green, I love green. Green wind. Green branches. The ship on the sea and the horse on the mountain. With the shadow at the waist she dreams on her balcony, green flesh, green hair, with eyes of cold silver.
Close you
my eyes the shadow season I'll take the white day, and my soul can unleash this time its longing sighs; but not in these other hand, on the bank, will memory, where burned: swim knows my name cold water, and waste severe a law. Soul a god confined, veins blazing fire have given marrow to gloriously burned, your body will not care; be ash, but will make sense; dust will be, but love dust.
That wreath! Soon! I'm dying! Weave fast! Sing! Groans! Sing! the shadow clouds my throat and over a thousand light coming January.
Far hides eternity! What is this Shadow, this mystery? The most sacred book!
Great men have come from dire times, with its dark agonies, pleading, questioning, uncertain. The inexpressible ferocity of dumb spirit clings to you.
By day solitary and silent night, you spend , eternal shadow, with a finger on his lips.
In all, you yourself, shadow enigmatic
and have dreams about a foot of water is life.
Oh dark night. I'm not expecting anything. Loneliness lies your way. Queen mere shadow quiet.
Curious
the shadow and cowed by the threat of dawn relived the terrible guess of Schopenhauer and Berkeley stating that the world is an activity of mind, a dream of souls, without foundation or purpose or volume.
already formidable and frightening sounds, within the heart, the last day and last hour , black and cold approaches, fear and shadows full.
Blind, asked that he saw the light. then was serene, the clean glass to your mouth cold, pure shadow - oh, pure shadow ! - Full.
From shadow come and shade return, the shadow is our home.
You wanted to die entirely, meat and great soul. You wanted into the other shadow without the sad timid prayer and suffering.
enjoys neck, hair, lip and forehead, before it was in your golden years golden , lily, carnation, glittering crystal, silver not only truncated or violates becomes, the more you and this together ground, smoke, dust, shadow , nothing.
Green, I love green. Under the gypsy moon, all things are
looking and she can not see them. Green I want you green. frosted stars, come with the fish of shadow that opens the road of dawn.
