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BACKGROUND: There are multiple factors in both technique and substrate that lead to recurrence of atrial fibrillation after ablation. We sought to examine whether the degree of heart rate increase (HRI) caused by concurrent high-power-short-duration (HPSD) incidental parasympathetic denervation during AF ablation predicts long term success. Between December 2018 and December 2021, prospectively enrolled 214 patients who presented in sinus rhythm at AF ablation. Used 50 W of power and contact force (CF) of 5-15 g and 10-20 g at a flow rate of 40 mL/min on the anterior and posterior left atrial walls, respectively. RESULTS: Males were 143 (66.8%) and paroxysmal was 124 (57.9%) patients. Mean age 61.1 ± 12.3 years and follow-up time was 32.8 ± 13.2 months. Arrhythmia occurred after 90 days in 39 (18.2%) patients, 19 (48.7%) from the paroxysmal and 20 (51.3%) from the persistent AF patients. Recurrence group showed a lower HRI from a mean of 57 ± 7.7 to 64.4 ± 10.4 bpm (12.3%) while in success group HRI was from 53.8 ± 9.7 to 66.8 ± 11.6 bpm [(24.2%) p = 0.04]. We divided HRI in 3 percentiles of ≤ 8%, > 8 ≤ 37% and > 37%. A predictor of recurrence was identified in those in the first (< 8%, p = 0.006) and a predictor of success in the later (> 37%, p = 0.01) HRI percentile. CONCLUSION: Atrial fibrillation ablation with HPSD incidental cardiac parasympathetic denervation identified that patients with lower heart rate increase are prone to recurrence while those with higher heart rate increase had higher maintenance of sinus rhythm at a long-term follow-up.
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BACKGROUND OR PURPOSE: Different atrial tachyarrhythmias (AT) may be seen during follow-up after atrial fibrillation ablation. Evaluate and analyze characteristics and management of AT following first atrial fibrillation (AF) ablation with high-power short-duration (HPSD) comparing to low-power long-duration (LPLD) and its impact on late outcome. METHODS: Observational, retrospective study, 144 patients submitted to HPSD and LPLD ablation. HPSD with 71 and LPLD with 73 patients and no major clinical differences between the two groups. RESULTS: AT occurred in 60 patients (41.67%) in entire follow-up. HPSD 22 patients had AT: 13 during blanking period (BP) and 9 after that. LPLD: 38 patients with AT, 14 during BP and 24 after that. During BP, HPSD showed high rate of atrial flutter/tachycardia in 9 (69.23) of 13 and LPLD 4 (28.57%) of 14 patients. At 12 months' follow-up, 62 (87.32%) of 71 HPSD patients were in sinus rhythm comparing to 49 (67.12%) of 73 patients in LPLD. CONCLUSIONS: HPSD ablation produced higher rates of early than late recurrence comparing to LPLD. Regular tachyarrhythmias were most common arrhythmia during BP with HPSD ablation and AF in LPLD. HPSD compared to LPLD showed a superiority in maintaining sinus rhythm at 12 months.
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Fibrilación Atrial , Ablación por Catéter , Fibrilación Atrial/diagnóstico por imagen , Fibrilación Atrial/cirugía , Humanos , Recurrencia , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
PURPOSE: To evaluate the influence of preoperative mitomycin C (MMC) on the proliferative behavior of fibroblasts and fibrovascular tissue derived from the primary pterygium using the immunohistochemical method (Ki67 and CD34). DESIGN: Randomized clinical trial. SUBJECTS, PARTICIPANTS AND/OR CONTROLS: Sixty-five patients with primary pterygium were randomly selected and divided into one of three groups. The control group had 29 patients that were only submitted to pterygium removal. The group that received the MMC injection a month before surgery had 16 patients, and the group that received the MMC 2 weeks before surgery had 20 patients. Each patient only had one eye operated on. METHODS: Sixty-five patients were selected to undergo pterygium excision surgery. We randomly placed the patients into three groups: one without MMC (n = 29), one with MMC application 1 month before surgery (n = 16) and another with MMC application 2 weeks before surgery (n = 20). Subconjunctival injection was applied with 0.1 ml of 0.02% MMC in the pterygium body, and patients were followed for 2 years. MAIN OUTCOME MEASURES: Proliferative behavior of fibroblasts and fibrovascular tissue using the immunohistochemical method (Ki67 and CD34) comparing the three groups. RESULTS: Of the total 29 patients (44.6%) in the control group (without MMC application), 11 cases had recurrence (37.9%), of which seven (63.6%) were within 3 months of follow-up and four (36.3%) within 6 months of follow-up. The mean proliferation index of the recurrent cases was 4.5%, and of the cases without recurrence, it was 6.1%. There were 16 patients (24.6%) in the MMC application group 1 month before surgery, in which one case (6.25%) recurred at 6 months. In the group with MMC application 2 weeks before surgery, of the total of 20 patients (30.7%), there was one case of recurrence (5%) at 6 months. The proliferation index of the group that had MMC administered and did not have a recurrence was 7.2%, and in the group with recurrence, it was 6.4%. The CD34-labeled cell count was 5.8% among cases with recurrence and 5.6% in cases without recurrence. No side effects of MMC application were reported during the study follow-up period. CONCLUSION: MMC was efficient to reduce the recurrence index despite the absence of a direct relation with its antimitotic and antiangiogenic effect in the samples that were analyzed.
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Conjuntiva/anomalías , Mitomicina/administración & dosificación , Procedimientos Quirúrgicos Oftalmológicos/métodos , Cuidados Preoperatorios/métodos , Pterigion/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Conjuntiva/cirugía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Inhibidores de la Síntesis del Ácido Nucleico/administración & dosificación , Soluciones Oftálmicas/administración & dosificación , Estudios Prospectivos , Pterigion/cirugía , Recurrencia , Adulto JovenRESUMEN
The aim of this study was to integrate the available data published on odontogenic carcinosarcoma into a comprehensive analysis of their features, treatment and recurrence. An electronic search with no publication date or language restriction was undertaken in March 2018 in the following databases: Medline Ovid, PubMed, Web of Science, Scopus and LILACS. Eligibility criteria included publications having enough clinical, imaginological and histopathological information to confirm a definite diagnosis of the neoplasm. Data were evaluated descriptively and statistically using the MedCalc software. The Kaplan-Meier method was used for survival analysis. The systematic review detected nine articles from eight countries. Six cases with no age predilection occurred in male individuals complaining of painful swelling in the posterior mandible. Radiographically, the lesions were large, with expansive radiolucency and with ill-defined borders and seven cases were associated with preexisting odontogenic lesions. Radical surgery was the treatment of choice in the majority of cases. Recurrences (nâ¯=â¯6), metastasis (nâ¯=â¯4) and death (nâ¯=â¯4) were frequently observed in many cases. Odontogenic carcinosarcoma is a very aggressive neoplasm with a poor prognosis. This study provides knowledge that could help surgeons, oncologists, otorhinolaryngologists and oral maxillofacial pathologists with the diagnosis and management of these lesions.
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Carcinosarcoma , Tumores Odontogénicos , Adulto , Distribución por Edad , Anciano , Carcinosarcoma/epidemiología , Carcinosarcoma/patología , Carcinosarcoma/cirugía , Niño , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Neoplasias Mandibulares/epidemiología , Neoplasias Mandibulares/patología , Neoplasias Mandibulares/cirugía , Persona de Mediana Edad , Metástasis de la Neoplasia , Recurrencia Local de Neoplasia/epidemiología , Tumores Odontogénicos/epidemiología , Tumores Odontogénicos/patología , Tumores Odontogénicos/cirugía , Distribución por Sexo , Adulto JovenRESUMEN
BACKGROUND: The aim of this study was to integrate the available data published on calcifying odontogenic cyst (COC), dentinogenic ghost cell tumor (DGCT), and ghost cell odontogenic carcinomas (GCOCs) into a comprehensive analysis of their clinicoradiological features, treatment, and recurrence. MATERIALS AND METHODS: An electronic search with no publication date restriction was undertaken in October 2017 in the following databases: PubMed, Medline Ovid, Web of Science, and Scopus. Eligibility criteria included publications containing enough clinical, radiological, and histopathological information to confirm a definite diagnosis of these lesions. Data were evaluated descriptively. RESULTS: The literature review indicated a total of 234 publications reporting 367 COCs, 55 DGCTs and 44 GCOCs. These lesions have a predilection for Asian males. COCs mainly affect the mandible and patients in the second decade of life, DGCTs mostly affect the mandible and patients in the fourth decade of life, and GCOCs mostly affect the maxilla and patients in the fifth decade of life. CONCLUSION: Conservative surgery was the most common therapy for COCs and DGCTs, while radical surgery was most common for GCOCs. This study provides important and interesting data that could help clinicians and surgeons as well as oral and maxillofacial pathologists with the diagnosis and management of these lesions.
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Quiste Odontogénico Calcificado , Tumores Odontogénicos , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Niño , Bases de Datos Bibliográficas , Femenino , Humanos , Masculino , Neoplasias Mandibulares/diagnóstico por imagen , Neoplasias Mandibulares/epidemiología , Neoplasias Mandibulares/cirugía , Neoplasias Maxilares/diagnóstico por imagen , Neoplasias Maxilares/epidemiología , Neoplasias Maxilares/cirugía , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Quiste Odontogénico Calcificado/diagnóstico por imagen , Quiste Odontogénico Calcificado/epidemiología , Quiste Odontogénico Calcificado/cirugía , Tumores Odontogénicos/diagnóstico por imagen , Tumores Odontogénicos/epidemiología , Tumores Odontogénicos/cirugía , Procedimientos Quirúrgicos Orales , Adulto JovenRESUMEN
BACKGROUND: Hernia repair represents about 25% of all pediatric surgeries. Repair can be done using an open or laparoscopic technique. The open approach has a reported recurrence rate of 1.2% but requires an additional incision to repair for a contralateral hernia. With the laparoscopic approach, no additional incision is needed but the recurrence rate has been reported to be as high as 4%. The objective of this study was to assess the safety and efficacy of a novel sutureless laparoscopic inguinal hernia repair that has the advantages of both approaches. METHODS: Since April 2014 up to March 2017, 26 children (12 girls and 14 boys) aged 3 months to 13 years underwent sutureless laparoscopic inguinal hernia repair. The peritoneum around the internal inguinal ring was severed and folded into the inguinal canal. Regeneration of the peritoneum around the inguinal ring creates a scar that effectively closes the internal orifice. RESULTS: No recurrences or complications were observed in any of the 26 cases after a follow-up of 1-35 months (median, 14 months). CONCLUSIONS: Sutureless laparoscopic inguinal hernia repair provides a new option for the management of patients with a pediatric inguinal hernia. The procedure does not require advanced laparoscopic skills, is easily reproducible, and is safe. THERAPEUTIC STUDY: Level of Evidence IV.
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Hernia Inguinal/cirugía , Herniorrafia/métodos , Laparoscopía/métodos , Peritoneo/cirugía , Adolescente , Niño , Preescolar , Femenino , Hernia Inguinal/patología , Humanos , Lactante , Masculino , Peritoneo/lesiones , Recurrencia , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Nonlinear analysis of EEG recordings allows detection of characteristics that would probably be neglected by linear methods. This study aimed to determine a suitable epoch length for nonlinear analysis of EEG data based on its recurrence rate in EEG alpha activity (electrodes Fz, Oz, and Pz) from 28 healthy and 64 major depressive disorder subjects. Two nonlinear metrics, Lempel-Ziv complexity and scaling index, were applied in sliding windows of 20 seconds shifted every 1 second and in nonoverlapping windows of 1 minute. In addition, linear spectral analysis was carried out for comparison with the nonlinear results. The analysis with sliding windows showed that the cortical dynamics underlying alpha activity had a recurrence period of around 40 seconds in both groups. In the analysis with nonoverlapping windows, long-term nonstationarities entailed changes over time in the nonlinear dynamics that became significantly different between epochs across time, which was not detected with the linear spectral analysis. Findings suggest that epoch lengths shorter than 40 seconds neglect information in EEG nonlinear studies. In turn, linear analysis did not detect characteristics from long-term nonstationarities in EEG alpha waves of control subjects and patients with major depressive disorder patients. We recommend that application of nonlinear metrics in EEG time series, particularly of alpha activity, should be carried out with epochs around 60 seconds. In addition, this study aimed to demonstrate that long-term nonlinearities are inherent to the cortical brain dynamics regardless of the presence or absence of a mental disorder.
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Encéfalo/fisiopatología , Trastorno Depresivo Mayor/fisiopatología , Electroencefalografía , Adulto , Anciano , Trastorno Depresivo Mayor/diagnóstico , Electroencefalografía/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dinámicas no Lineales , Procesamiento de Señales Asistido por Computador , Tiempo , Adulto JovenRESUMEN
INTRODUCTION: Urethral strictures generate great morbidity. Two procedures have been described for their management - laser and cold knife techniques - which are still widely used. We aim to assess the safety and efficacy of laser versus cold knife urethrotomy. MATERIALS AND METHODS: We conducted a systematic search of the literature using MEDLINE, EMBASE, LILACS and Cochrane databases and gray literature. Primary outcomes were urethral stricture recurrence, time-to-recurrence and complication rate. Secondary outcomes were quality of life and maximum urinary flow rate (Qmax). Data analysis was obtained using Review Manager 5.2. RESULTS: Out of 137 publications, 4 articles were included in the meta-analysis. At 3 months, the recurrence rate was similar in both groups (0.55, 95% CI 0.18-1.66), but at 6 and 12 months, it was significantly lower in the laser urethrotomy group (0.39, 95% CI 0.19-0.81 and 0.44, 95% CI 0.26-0.75). The analysis of Qmax at 6 months post-intervention suggested a greater improvement in the laser urethrotomy group. A qualitative analysis showed that complications in both procedures were minor and infrequent. CONCLUSIONS: Laser urethrotomy has a lower recurrence rate at 6 and 12 months compared to cold knife urethrotomy. Complications in both procedures are minor and infrequent. Results should be interpreted cautiously, since they were evaluated only for a short term.
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Terapia por Láser/mortalidad , Estrechez Uretral/cirugía , Procedimientos Quirúrgicos Urológicos/métodos , Distribución de Chi-Cuadrado , Diseño de Equipo , Humanos , Terapia por Láser/efectos adversos , Terapia por Láser/instrumentación , Rayos Láser/efectos adversos , Oportunidad Relativa , Complicaciones Posoperatorias/etiología , Recurrencia , Factores de Riesgo , Instrumentos Quirúrgicos , Factores de Tiempo , Resultado del Tratamiento , Procedimientos Quirúrgicos Urológicos/efectos adversos , Procedimientos Quirúrgicos Urológicos/instrumentaciónRESUMEN
Pterygium is a benign lesion usually growing from the nasal side of the conjunctiva onto the cornea. Most cases of pterygium does not cause problem or requires specific treatment. The exact cause of pterygium is not clear yet, but some factors are pointed as causes, being the most important the long-term ultraviolet ray exposure. Pterygium surgery is usually considered when there are symptoms that do not respond to conservative treatment. Recurrence is the main complication of the surgery, and much has been done to avoid it. Mitomycin C (MMC) has been used as a fibroblast proliferation inhibitor during the surgery to reduce the chance of recurrence of the pterygium. This review describes the use of MMC as an adjunctive, the optimal dosage, the duration of administration of MMC and possible complications, when used during, after and before the surgery. Most studies suggest that increased exposure (dose or duration) of MMC is associated with a lower recurrence, but with higher risks of complications.
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OBJECTIVE: To assess the recurrence rate of postterm delivery (gestational age at or beyond 42+0 weeks or 294 days) and to describe maternal and perinatal outcomes after previous postterm delivery. STUDY DESIGN: From the longitudinal linked Netherlands Perinatal Registry database, we selected all singleton primiparous women who delivered between 37+0 and 42+6 weeks with a subsequent singleton pregnancy from 1999 to 2007. We excluded congenital abnormalities. We compared the recurrence rate of postterm delivery and risk of antenatal fetal death in women with and without a postterm delivery in their first pregnancy. We compared perinatal outcome (composite of perinatal mortality, Apgar score <7 and birth injury) and adverse maternal outcome (composite of maternal death, abruptio placentae, PPH>1000ml and blood transfusions) between women with a recurrent and a de novo postterm second pregnancy. RESULTS: Our study population consisted of 233,327 women of whom 17,874 (7.7%) delivered postterm in the first pregnancy. In the second pregnancy, 2678 (15%) women had a recurrent postterm delivery compared to 8698 (4%) women with a de novo postterm delivery (odds ratio (OR) 4.2 95% confidence interval (CI) 4.0-4.4). Subgroup analysis in recurrent and de novo postterm delivery showed no differences in composite perinatal and composite maternal outcome (OR 1.0; CI 0.7-1.5, p=0.90 and OR 1.1, CI 0.9-1.4, p=0.16), adjusted for fetal position and mode of delivery). CONCLUSIONS: Women with a postterm delivery in the first pregnancy have a higher risk of recurrent postterm delivery. Our data suggest that there is no difference in the composite adverse perinatal outcome between recurrent and de novo postterm delivery.
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Edad Gestacional , Resultado del Embarazo/epidemiología , Embarazo Prolongado/epidemiología , Desprendimiento Prematuro de la Placenta/epidemiología , Adulto , Puntaje de Apgar , Traumatismos del Nacimiento/epidemiología , Transfusión Sanguínea/estadística & datos numéricos , Estudios de Cohortes , Femenino , Mortalidad Fetal , Humanos , Recién Nacido , Masculino , Mortalidad Materna , Países Bajos/epidemiología , Mortalidad Perinatal , Hemorragia Posparto/epidemiología , Embarazo , Recurrencia , Sistema de Registros , Adulto JovenRESUMEN
La hidatidosis causada por el echinococcus granulosus puede afectar cualquier órgano del cuerpo siendo el pulmón y el hígado los más comúnmente afectados. El compromiso vertebral por el echinococcus granulosus es de escasa prevalencia, comprendiendo con menos de 1% del compromiso óseo. Presentamos el caso de una mujer de 50 años que consultó en Servicio de Traumatología por cuadro de dolor lumbar progresivo, de cinco meses de evolución, irradiado a extremidad inferior derecha y posterior compromiso neurológico de extremidad. El estudio imagenológico reveló espondilodiscitis T12-L1 que posterior a estudio de biopsia confirmó este cuadro. El tratamiento es mixto, tanto ortopédico como quirúrgico. El nivel de recurrencia es alto, reportándose entre 30 y 40%. El objetivo de este caso es proponer diagnóstico diferencial de masa vertebral de origen desconocido y detallar el manejo de esta patología.
Hydatidosis caused by echinococcus granulosus may affect any organ in the body, with the lungs and the liver as the most commonly affected organs. Vertebral compromise resulting from echinococcus granulosus has a low prevalence and accounts for less than 1% of bone compromise. We report the case of a 50 year-old female who presented at the Trauma Service with progressive low back pain with 5 months of duration that irradiated to the right lower limb, and led to neurologic compromise of the limb. Imaging studies showed spondylodiscitis at T12-L1, confirmed by a biopsy. Treatment of this condition is both orthopedic and surgical. The recurrence rate is high, between 30 and 40%. The objective of describing this case is to propose the differential diagnosis of a vertebral mass of unknown origin and provide details as to how to manage this condition.
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Animales , Femenino , Humanos , Persona de Mediana Edad , Discitis/diagnóstico , Equinococosis/diagnóstico , Dolor de la Región Lumbar/parasitología , Enfermedades de la Columna Vertebral/diagnóstico , Diagnóstico Diferencial , Discitis/parasitología , Equinococosis/patología , Echinococcus granulosus/aislamiento & purificación , Enfermedades de la Columna Vertebral/parasitologíaRESUMEN
Oral hairy leukoplakia (OHL) is a disease associated with Epstein-Barr virus and human immunodeficiency virus infections. OHL is usually an asymptomatic lesion, but in some cases treatment is recommended to reestablish the normal characteristics of the tongue, to eliminate pathogenic microorganisms, to improve patient comfort and for cosmetic reasons. Proposed treatments for this condition include surgery, systemic antiviral treatment and topical management. Topical treatment is an inexpensive and safe therapy that is easy to apply, noninvasive, free of systemic adverse effects and effective over a long period of time. The aim of this study was to present a review of the literature for topical therapy for OHL. Gentian violet, retinoids, podophyllin, acyclovir and podophyllin associated with topical antiviral drugs were used to treat OHL. Reports with this focus are limited, and since 2010, no new studies have been published that discuss the efficacy of topical treatments for OHL. Podophyllin with acyclovir cream was found to be effective, causing regression of lesions with no recurrences. Additional searches are necessary to provide clinical evidence of topical management effectiveness.
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Introducción: la inestabilidad es una patología frecuente del hombro, cuyo tratamiento se puede realizar por vía artroscópica o mediante cirugía abierta. Las series iniciales de reconstrucción artroscópica reportaron una mayor tasa de recidiva. Sin embargo, en la actualidad los resultados de ambas técnicas son similares. Objetivo: Evaluar los resultados funcionales e índice de recurrencia de la reconstrucción artroscópica de la inestabilidad antero-inferior de hombro a 2 años de seguimiento. Material y métodos: se analizaron 65 hombros (64 pacientes) con diagnóstico de inestabilidad traumática anterior de hombro. El promedio de edad fue de 27 años (18-45). El seguimiento promedio fue de 23,2 meses (12-50). Tomamos como recidiva aquellos pacientes que habían sufrido luxación de hombro, y también a los pacientes que en la evaluación final de control presentaban test de aprehensión y recolocación positivos. Se evalúo rango de movilidad pre operatorio y al final del seguimiento. Los pacientes fueron evaluados funcionalmente con el Constant score, ASES score y Simple Shoulder Test. Se utilizó el score de Rowe para la evaluación al final del seguimiento. Resultados: Tuvimos 1 caso (1,5 por ciento) que presento luxación de hombro. Pero si considerando recidiva los pacientes que presentaron test de aprehensión y recolocación positivo tuvimos 5 casos más; lo que representa un total del 7,7 por ciento de recidiva pero sin luxación. Se observó una mejoría significativa de los scores funcionales. Conclusión: La reconstrucción artroscópica permite restaurar la estabilidad articular, obteniendo resultados funcionales aceptables, con alto índice de satisfacción de los pacientes y una tasa de recidiva aceptable menor al 10 por ciento en el seguimiento a los 2 años de operado. Tipo de estudio: Serie de Casos. Nivel de evidencia: IV (AU)
Introduction: Shoulder Instability is a frequent pathology and its treatment can be done by arthroscopic or open surgery. Initial series of arthroscopic reconstruction reports high failure rates. However both technique have similar results. Purpose: To evaluate outcomes and recurrence of the arthroscopic reconstruction of the shoulder instability at 2 year follow up. Method: We evaluate 65 shoulder (64 patients) with traumatic anterior-inferior shoulder dislocation. Mean age was 27 years (18-45). Mean follow-up was 23,2 months (12-50). We defined has recurrence patients with shoulder dislocation o patients with positive apprehension or relocation test at the last control test. We evaluate range of motion prior surgery and at the end of follow up. Patients were evaluated functionally with Constant Score, ASES and Simple Shoulder Test. We use the Rowe score to evaluate the last follow up. Results: Recurrence rate was 1,5% (1 cases) with shoulder dislocation and 7,7% (5 cases) with positive apprehension or relocation test. A significant improvement of functional outcomes scores was observed. Conclusion: Arthroscopic reconstruction restores joint stability, with very good clinical outcomes and high rate of patient satisfaction with a recurrence rate below 10% at 2 years follow-up. Study Design: Cases Series. Level of Evidence: IV (AU)
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Humanos , Masculino , Femenino , Adulto Joven , Adulto , Luxación del Hombro/cirugía , Inestabilidad de la Articulación/cirugía , Articulación del Hombro , Artroscopía/métodos , Recurrencia , Rango del Movimiento Articular , Resultado del Tratamiento , Estudios de SeguimientoRESUMEN
Introducción: la inestabilidad es una patología frecuente del hombro, cuyo tratamiento se puede realizar por vía artroscópica o mediante cirugía abierta. Las series iniciales de reconstrucción artroscópica reportaron una mayor tasa de recidiva. Sin embargo, en la actualidad los resultados de ambas técnicas son similares. Objetivo: Evaluar los resultados funcionales e índice de recurrencia de la reconstrucción artroscópica de la inestabilidad antero-inferior de hombro a 2 años de seguimiento. Material y métodos: se analizaron 65 hombros (64 pacientes) con diagnóstico de inestabilidad traumática anterior de hombro. El promedio de edad fue de 27 años (18-45). El seguimiento promedio fue de 23,2 meses (12-50). Tomamos como recidiva aquellos pacientes que habían sufrido luxación de hombro, y también a los pacientes que en la evaluación final de control presentaban test de aprehensión y recolocación positivos. Se evalúo rango de movilidad pre operatorio y al final del seguimiento. Los pacientes fueron evaluados funcionalmente con el Constant score, ASES score y Simple Shoulder Test. Se utilizó el score de Rowe para la evaluación al final del seguimiento. Resultados: Tuvimos 1 caso (1,5 por ciento) que presento luxación de hombro. Pero si considerando recidiva los pacientes que presentaron test de aprehensión y recolocación positivo tuvimos 5 casos más; lo que representa un total del 7,7 por ciento de recidiva pero sin luxación. Se observó una mejoría significativa de los scores funcionales. Conclusión: La reconstrucción artroscópica permite restaurar la estabilidad articular, obteniendo resultados funcionales aceptables, con alto índice de satisfacción de los pacientes y una tasa de recidiva aceptable menor al 10 por ciento en el seguimiento a los 2 años de operado. Tipo de estudio: Serie de Casos. Nivel de evidencia: IV
Introduction: Shoulder Instability is a frequent pathology and its treatment can be done by arthroscopic or open surgery. Initial series of arthroscopic reconstruction reports high failure rates. However both technique have similar results. Purpose: To evaluate outcomes and recurrence of the arthroscopic reconstruction of the shoulder instability at 2 year follow up. Method: We evaluate 65 shoulder (64 patients) with traumatic anterior-inferior shoulder dislocation. Mean age was 27 years (18-45). Mean follow-up was 23,2 months (12-50). We defined has recurrence patients with shoulder dislocation o patients with positive apprehension or relocation test at the last control test. We evaluate range of motion prior surgery and at the end of follow up. Patients were evaluated functionally with Constant Score, ASES and Simple Shoulder Test. We use the Rowe score to evaluate the last follow up. Results: Recurrence rate was 1,5% (1 cases) with shoulder dislocation and 7,7% (5 cases) with positive apprehension or relocation test. A significant improvement of functional outcomes scores was observed. Conclusion: Arthroscopic reconstruction restores joint stability, with very good clinical outcomes and high rate of patient satisfaction with a recurrence rate below 10% at 2 years follow-up. Study Design: Cases Series. Level of Evidence: IV
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Humanos , Masculino , Femenino , Adulto Joven , Articulación del Hombro , Artroscopía/métodos , Inestabilidad de la Articulación/cirugía , Luxación del Hombro/cirugía , Estudios de Seguimiento , Rango del Movimiento Articular , Recurrencia , Resultado del TratamientoRESUMEN
Introdução: os tumores hepáticos malignos são muito mais comuns do que os benignos, sendo os metastáticos ou secundários 20 vezes mais frequentes do que os primários. A hepatectomia permanece como o principal e mais utilizado método de tratamento dos tumores hepáticos. Infelizmente, esse método é aplicável apenas em cerca de 10% dos casos. Analisar a sobrevida dos pacientes portadores de tumor hepático submetidos a ressecções hepáticas no Estado do Amazonas, assim como as principais complicações pós-operatórias e índice de recidiva tumoral. Métodos: estudo retrospectivo, analisando os prontuários e laudos anatomopatológicos dos pacientes submetidos à ressecção hepática na Fundação Centro de Controle de Oncologia do Amazonas (FCECON), entre janeiro de 2006 a dezembro de 2010. Resultados: foram realizadas 34 ressecções hepáticas, sendo 55,9% tumores malignos primários do fígado, 26,5% doença metastática e 17,6% tumores benignos. Houve 17,64% de complicações pós-operatórias, sendo as mais graves o abscesso subfrênico e a hemorragia intra-abdominal. A taxa de reoperação foi de 2,94%. Não houve mortalidade operatória. O índice de recidiva tumoral foi de 23,5%, com óbito ocorrendo em 75% destes casos. A taxa de sobrevida em um, três e cinco anos foi respectivamente 96%, 89% e 68%. Conclusão: a cirurgia hepática tem se tornado cada vez mais factível e as complicações pós-operatórias, sob maior controle clínico, tem diminuído consideravelmente a mortalidade.
Introduction: malignant Hepatic tumors are much more common than the benign ones, being the metastatics 20 times more frequent than the primaries. Hepatectomy remains as the more common and used method in its treatment. Unfortunately this method can be applied in around 10% of cases. To analyze the overall survival of malignant liver tumors patients who underwent a hepatic resection in the state of Amazonas, as well as the post-operative complications and recurrence rate. Methods: retrospective study, analysing the patient records and anatomopathologic reports of patients who underwent liver resection in Fundação Centro de Controle de Oncologia do Amazonas (FCECON), between january 2006 and december 2010. Results: a total amount of 34 liver resections were done, being 55,9% liver primary malignant tumors, 26,5% metastatic disease e 17,6% benign tumors. There were 17,64% of post-operative complications, being the more serious diaphragmatic abscess and intra-abdominal bleeding. Reoperation rate was of 2,94%. There were no preoperative mortality. Tumor recurrence was 23,5%, with death happening in 75% of these cases. Overall survival in one, three and five years were respectively 96%, 89% e 68%. Conclusion: hepatic surgery has been increasingly more appliable and post-operative complications, under strict clinical care, has considerably diminished mortality.