RESUMEN
INTRODUCTION: total knee arthroplasty is a common procedure in orthopedic surgery for treating grade IV knee osteoarthritis. This procedure reduces pain and improves functionality. However, the results according to the approach are different, it is not clear which surgical approach is clearly superior. The objective of this study is to evaluate the time and post-surgical bleeding, as well as the postoperative pain of the midvasto versus medial parapatellar approach in primary total knee arthroplasty in grade IV gonarthrosis. MATERIAL AND METHODS: an observational, comparative, retrospective study was carried out from June 1, 2020 to December 31, 2020, including beneficiaries of the Mexican Social Security Institute over 18 years of age with a diagnosis of grade IV knee osteoarthritis scheduled for primary total knee arthroplasty in the absence of other inflammatory pathology, previous osteotomies or coagulopathies. RESULTS: of 99 patients who underwent the midvasto approach (group M) and 100 patients to the medial parapatellar approach (group T), there was preoperative hemoglobin 14.7 g/l group M and 15.2 g/l group T, reduction was 5.0 g/l group M and 4.6 g/l group T. Significant pain reduction in both groups without significant difference; from 6.7 to 3.2 group M and from 6.7 to 3.1 group T. The surgical time was significantly longer with the medial parapatellar approach (98.7 versus 89.2 minutes). CONCLUSIONS: both approaches represent an excellent access route to perform primary total knee arthroplasty; however, no significant differences were found in the volume of bleeding or in the reduction of pain, the midvaste approach was associated with shorter surgical time and less involvement of flexion of the knee. Therefore, the midvasto approach is recommended in patients undergoing primary total knee arthroplasty.
INTRODUCCIÓN: la artroplastía total de rodilla es un procedimiento común en la cirugía ortopédica de tratamiento para gonartrosis grado IV. Este procedimiento disminuye el dolor y mejora la funcionalidad. Sin embargo, los resultados según el abordaje son distintos, no existe evidencia sobre qué abordaje quirúrgico sea claramente superior. El objetivo de este estudio es evaluar el tiempo y sangrado transquirúrgico, así como el dolor postquirúrgico del abordaje midvasto versus parapatelar medial en artroplastía total de rodilla primaria en gonartrosis grado IV. MATERIAL Y MÉTODOS: se realizó estudio observacional, comparativo, retrospectivo del 01 de Junio de 2020 al 31 de Diciembre de 2020 incluyendo derechohabientes del Instituto Mexicano del Seguro Social, mayores de 18 años con diagnóstico de gonartrosis grado IV, programados para artroplastía total de rodilla primaria en ausencia de otra patología inflamatoria, osteotomías previas o coagulopatías. RESULTADOS: noventa y nueve pacientes que fueron sometidos a abordaje midvasto (grupo M) y 100 pacientes a abordaje parapatelar medial (grupo T) con hemoglobina preoperatoria 14.7 g/l grupo M y 15.2 g/l grupo T, la reducción fue de 5.0 g/l grupo M y 4.6 g/l grupo T. Dolor en ambos grupos sin diferencia significativa; de 6.7 a 3.2 grupo M y de 6.7 a 3.1 grupo T. Tiempo quirúrgico mayor con el abordaje parapatelar medial (98.7 versus 89.2 minutos). CONCLUSIONES: ambos abordajes representan excelente vía de acceso para realizar artroplastía total primaria de rodilla; sin embargo, no se encontraron diferencias significativas en el volumen de sangrado ni en la reducción del dolor, el abordaje midvasto se asoció con menor tiempo quirúrgico y menor afectación de la flexión de la rodilla, por lo que se recomienda el abordaje midvasto en pacientes sometidos a artroplastía total de rodilla primaria.
Asunto(s)
Artroplastia de Reemplazo de Rodilla , Articulación de la Rodilla , Humanos , Masculino , Femenino , Adolescente , Adulto , Articulación de la Rodilla/cirugía , Osteoartritis de la Rodilla/cirugía , Tempo Operativo , Dolor Postoperatorio , Rango del Movimiento Articular , Resultado del Tratamiento , Estudios RetrospectivosRESUMEN
Directional coronary atherectomy (DCA) is a percutaneous revascularization procedure. The basic indications are complex lesions (excentricity, irregular borders with ulceration and in non-calcified lesions in large coronary vessels or in vein grafts). DCA in recent years has been a useful procedure in several circumstances, in which initial results with conventional coronary angioplasty had failed, specifically in those conditions like acute occlusions, threatened closure or "elastic recoil" phenomenal, focal dissection or residual stenosis > 50% due to hare atherosclerotic plaque. In this report two cases of "rescue" DCA due to residual stenosis > 50% because of "elastic recoil" are presented. One of them had a concentric lesion and the other a marked excentricity. Both cases had primary success. Atheroma was shown by histopathology. Rescue DCA is a useful feasible alternative procedure in selected cases, in which conventional coronary angioplasty had initially not been successful.
Asunto(s)
Aterectomía Coronaria , Enfermedad Coronaria/terapia , Anciano , Angioplastia Coronaria con Balón , Aterectomía Coronaria/métodos , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia del TratamientoRESUMEN
OBJECTIVES: To analyse the hemodynamic and ventricular function effects of oral captopril in severe aortic stenosis. PATIENT POPULATION: inclusion criteria: patients older than 18 years with critical aortic stenosis. EXCLUSION CRITERIA: angiotensin-converting enzyme inhibitor used previously contraindication to right catheterisation aortic insufficiency, valvular prosthesis in aortic position, or other valvulopathy. As well as the need for immediate valvular aortic replacement arrhythmia, A-V conduction alterations, or ventilatory support. PROTOCOL: prospective, no randomized. Swan-Ganz catheter was used. Basal hemodynamic measurements were made on 1, 2, 4, 6 and 8 hours during 48 hours. Captopril was administered 12.5 mg first and then 8 mg tid (6 doses). STATISTICAL ANALYSIS: Neuman-Keuls test was used for multivariate comparisons. Statistical significance was determined with P < 0.05. RESULTS: 22 patients were analyzed. Systemic vascular resistance fell from 1750 Dyn/seg/cm-5 to 1200 (P-0.001), cardiac output increased from 4.1l/min to 5.8 (P-0.001), cardiac index increased from 2.4 l/min/m2 to 2.9 (P-0.009), stroke volume from 47 ml to 64 (P-0.04) and stroke volume index from 27 ml/m2 to 36 (P-0.002). In patients with heart failure (n = 7) the systemic vascular resistance fell from 2050 Dyn/seg/cm-5 to 1463 (P-0.04), cardiac output increased from 2.8l/min to 4.1 (P-0.04), cardiac index from 2.07 l/min/m2 to 2.75 (P-0.04), stroke volume from 46 ml to 64 (P-0.03), pulmonary capillary wedge pressure fell from 19 mmHg to 16 (0.04) and the systolic pulmonary arterial pressure fell from 63 mmHg to 42 (P-0.009). CONCLUSIONS: captopril improves the hemodynamic parameters in patients with critical aortic stenosis, principally in those with heart failure.
Asunto(s)
Inhibidores de la Enzima Convertidora de Angiotensina/farmacología , Estenosis de la Válvula Aórtica/tratamiento farmacológico , Captopril/farmacología , Hemodinámica/efectos de los fármacos , Disfunción Ventricular Izquierda/tratamiento farmacológico , Función Ventricular Izquierda/efectos de los fármacos , Administración Oral , Adulto , Anciano , Anciano de 80 o más Años , Inhibidores de la Enzima Convertidora de Angiotensina/administración & dosificación , Estenosis de la Válvula Aórtica/complicaciones , Estenosis de la Válvula Aórtica/fisiopatología , Captopril/administración & dosificación , Estudios Cruzados , Femenino , Insuficiencia Cardíaca/tratamiento farmacológico , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Disfunción Ventricular Izquierda/etiología , Disfunción Ventricular Izquierda/fisiopatologíaRESUMEN
Cocaine use has been associated with ischemic syndromes, especially angor pectoris, myocardial infarction, cardiac arrhythmias and sudden death. A significant number of persons suffering from myocardial infarction associated with cocaine abuse do not have significant coronary atherosclerosis, and the mechanism for infarction in these patients have remained obscure. This report describes a young man with angiographically normal coronary arteries in whom cocaine abuse probably produced coronary artery spasm leading to coronary thrombosis and infarction.