RESUMEN
Despite the great amount of research that has been focused on the anterior cruciate ligament in recent years, relatively little is known about the exact mechanisms that cause these injuries. By defining the factors that contribute to these injury mechanisms in soccer players, the authors hope to facilitate appropriate training methods and work at preventing these serious injuries.
Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Traumatismos en Atletas/fisiopatología , Traumatismos de la Rodilla/fisiopatología , Fútbol/lesiones , Fenómenos Biomecánicos , Humanos , Traumatismos de la Rodilla/etiologíaRESUMEN
Healthcare professionals caring for children with cerebral palsy should be aware of an association between it and latex anaphylaxis. Between 1989 and 1992 we had 22 patients with intraoperative anaphylactic reactions to latex at our institutions. Of these, six had cerebral palsy. The case histories of these six children are reported here. Most had had multiple operations and ventriculoperitoneal shunts. Preoperative recognition is key to prevention. If suspected from a patient's history, latex antibody testing is available. If needed, anesthesia for these individuals should be given using a latex-free environment with or without medical prophylaxis.
Asunto(s)
Anafilaxia/inmunología , Parálisis Cerebral/fisiopatología , Hipersensibilidad/inmunología , Látex/efectos adversos , Adolescente , Adulto , Preescolar , Humanos , Complicaciones IntraoperatoriasRESUMEN
Over a 3-year period, in 36,075 general anesthetic anesthesia procedures done at our institution, 21 patients had type I (anaphylactic) intraoperative reactions to latex (phase 1). We subsequently established a system for classification of at-risk patients with a corresponding regimen for prophylaxis used prospectively between January 1992 and July 1994 (phase II). Three groups of patients at risk for type I hypersensitivity reaction were identified, and a regimen for prophylaxis developed (based in part on protocols used in preparing patients who are allergic to radiocontrast media). Since using this protocol, the incidence of intraoperative anaphylaxis has decreased. During phase 2, 34,513 patients received a general anesthetic in the operating room, and there have been three cases of suspected intraoperative latex anaphylaxis; two of these three patients did not meet any of the risk criteria and therefore did not receive preoperative prophylaxis or avoidance of latex. Of these 34,513 patients, 86 at-risk patients received prophylaxis. A prospective study is needed to determine whether the pharmacologic prophylaxis is needed in addition to a latex-free environment.
Asunto(s)
Anafilaxia/prevención & control , Complicaciones Intraoperatorias/prevención & control , Látex/efectos adversos , Adolescente , Adulto , Anafilaxia/inmunología , Niño , Preescolar , Protocolos Clínicos , Femenino , Humanos , Complicaciones Intraoperatorias/inmunología , Látex/inmunología , Masculino , Factores de RiesgoAsunto(s)
Deformidades Adquiridas de la Articulación/cirugía , Articulación de la Rodilla , Prótesis de la Rodilla/métodos , Artritis Reumatoide/complicaciones , Humanos , Deformidades Adquiridas de la Articulación/etiología , Deformidades Adquiridas de la Articulación/patología , Articulación de la Rodilla/anatomía & histología , Articulación de la Rodilla/cirugíaRESUMEN
During the past five years, systemic IgE-mediated anaphylactic reactions to latex have been reported more frequently, and a significant proportion of these anaphylactic reactions have occurred intraoperatively. Anaphylactic reactions under general anesthesia occur without warning, and early signs often are obscured by surgical drapes. Therefore, early recognition of symptoms and prevention are essential to avoid catastrophic results. Orthopaedic surgeons must be aware of the risk, diagnosis, prevention, and treatment of latex anaphylaxis. Patients at risk, testing, and prevention are discussed in this review. Additionally, a classification system and the corresponding regimen for prophylaxis that is currently being used at Children's Hospital of Philadelphia is described.