RESUMEN
10 patients with major instability symptoms due to an acute anterior cruciate ligament injury were operated on with a bone-patellar tendon-bone reconstruction. Tibial condyle bone mineral density (BMD), bone ingrowth and changes in diameter in the tibia bone tunnel were studied with quantified computed tomography (QCT) postoperatively and after 1, 3, 6 and 12 months. We found no sign of bone ingrowth in the form of increased bone mineral density (BMD) in the bone tunnels in any of the patients. The tunnel diameter increased in all patients during the first postoperative months. After 1 year, 5 patients had a smaller diameter than at the first postoperative examination, 2 had the same diameter as immediately after surgery and 2 patients had a larger diameter. A sclerotic zone developed in all patients along the perimeter of the tunnel during the 3-6 months of follow-up. The BMD in the tibial condyle decreased at 3 months; it then increased, but between 6 and 12 months, it levelled out and was slightly lower than postoperatively. In conclusion, we found no growth of bone into the tunnel and tendinous part of the graft during the first postoperative year.
Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirugía , Traumatismos de la Rodilla/cirugía , Tendones/trasplante , Tibia/patología , Adulto , Femenino , Humanos , Inestabilidad de la Articulación/cirugía , Masculino , Estudios Prospectivos , Procedimientos de Cirugía Plástica , Tomografía Computarizada por Rayos X , Trasplante AutólogoRESUMEN
In a prospective randomized study we investigated 40 patients with functional instability due to old anterior cruciate ligament tears by using two different techniques for reconstruction of the ligament. 20 patients were randomized to reconstruction with use of a traditional medial bone-patellar tendon graft and 20 patients to a half-thickness patellar tendon graft augmented with the Kennedy Ligament Augmentation Device (LAD). At follow-up after 4 years, both groups were still improved concerning function scores and arthrometry. The use of the Kennedy LAD method, however, gave no more subjective or objective benefits than did the traditional method.
Asunto(s)
Lesiones del Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirugía , Tendones/trasplante , Adolescente , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Rótula , Estudios Prospectivos , RoturaRESUMEN
We report a case of status asthmaticus that was unresponsive to the usual agents. The use of an inhalational anesthetic agent allowed us to ventilate the patient with lower inspiratory pressures; however, lasting improvement did not occur until she mobilized large quantities of secretions. To our knowledge, this is the first clinical report on the use of isoflurane anesthesia to treat severe asthma. Despite prolonged administration, there were no significant side-effects. This case demonstrates both the benefits and limitations of such therapy.
Asunto(s)
Anestesia por Inhalación , Asma/terapia , Isoflurano , Éteres Metílicos , Estado Asmático/terapia , Adulto , Análisis de los Gases de la Sangre , Femenino , Humanos , Respiración Artificial , Volumen de Ventilación Pulmonar , Factores de TiempoRESUMEN
Sarcoidosis has been characterized by a variety of clinical presentations ranging from complete lack of symptoms to incapacitating multisystem disease. Bilateral thoracic lymph node enlargement with or without pulmonary disease is the most common presentation. An elderly woman with eye pain, visual disturbance, nonproductive cough, and weight loss was found to have unilateral hilar enlargement on roentgenographic examination of the chest. An aggressive search for a neoplastic process disclosed only noncaseating granulomas consistent with sarcoidosis. The patient completely recovered on corticosteroid therapy alone.
Asunto(s)
Enfermedades Pulmonares/diagnóstico , Sarcoidosis/diagnóstico , Corticoesteroides/uso terapéutico , Adulto , Diagnóstico Diferencial , Femenino , Humanos , Enfermedades Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/diagnóstico , Persona de Mediana Edad , Radiografía , Sarcoidosis/diagnóstico por imagen , Sarcoidosis/tratamiento farmacológicoRESUMEN
Patients with neuromuscular disease frequently experience acute respiratory failure. Most require endotracheal intubation or tracheostomy and mechanical ventilation because of paralysis and inability to maintain adequate spontaneous respiration. The prognosis is usually excellent if ventilatory management is successful.