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Abstract Objective The purpose of this study was to evaluate the clinical and functional results of simultaneous reconstruction of the ACL and PCL with bilateral hamstring autografts. We hypothesized that this reconstruction technique results in less morbidity and has similar results to the ones published in the previous literature. Methods Eighteen patients with bicruciate lesions were selected and treated by arthroscopic surgery with autologous hamstring tendons in a single-stage procedure. The thicker semitendinosus tendon (ST) and the two gracilis tendons (G) were used for a 6-strand PCL reconstruction. The thinner ST was used for a 3-strand ACL reconstruction. The average patient age at surgery was 31 years, and the minimum follow-up was 2 years. Function of the operated knee was evaluated according to the Lysholm scale. Anterior knee laxity was examined with a KT-1000 arthrometer. Posterior laxity was evaluated using stress radiographies. Results Statistically significant improvements were found for all three measurements (p < 0.001). Knee function by the Lysholm score increased from 43.8 ± 4.1 to 89.9 ± 3.8 post-surgery. The average anterior knee laxity improved from 5.2 + −0.8 mm initially to 2.4 + - 0.5 mm post-surgery. The posterior translation of the tibia relative to the femur decreased from 10 ± 3.4 mm to 3 ± 1.6 mm post-surgery. No patient showed loss of motion in extension or knee flexion. Conclusion The simultaneous bicruciate reconstruction with bilateral hamstring autograft is a valuable option to achieve good functional outcomes and ligamentous stability.
Resumo Objetivo O objetivo deste estudo foi avaliar os resultados clínicos e funcionais da reconstrução simultânea do ligamento cruzado anterior (LCA) e ligamento cruzado posterior (LCP) com autoenxertos bilaterais de isquiotibiais. Nossa hipótese é que esta técnica de reconstrução gera menor morbidade e tem resultados semelhantes aos publicados na literatura anterior. Métodos Dezoito pacientes com lesões em LCA e LCP foram selecionados e tratados por cirurgia artroscópica com tendões isquiotibiais autólogos em procedimento único. O tendão semitendinoso (ST) mais espesso e os dois tendões do músculo grácil (G) foram usados para a reconstrução do LCP com seis fios. O ST mais fino foi usado para reconstrução do LCA com três fios. A média de idade dos pacientes à cirurgia foi de 31 anos e o acompanhamento mínimo foi de 2 anos. A função do joelho operado foi avaliada de acordo com a escala de Lysholm. A lassidão anterior do joelho foi examinada com um artrômetro KT-1000. A lassidão posterior foi determinada por meio de radiografias de estresse. Resultados Melhoras estatisticamente significativas foram observadas nas três medidas (p < 0,001). A função do joelho pelo escore de Lysholm aumentou de 43,8 ± 4,1 para 89,9 ± 3,8 após a cirurgia. A lassidão anterior média do joelho melhorou de 5,2 ± 0,8 mm para 2,4 ± 0,5 mm após a cirurgia. A translação posterior da tíbia em relação ao fêmur diminuiu de 10 ± 3,4 mm para 3 ± 1,6 mm no período pós-operatório. Nenhum paciente apresentou perda de movimento em extensão ou flexão do joelho. Conclusão A reconstrução simultânea do LCA e do LCP com autoenxerto bilateral dos isquiotibiais é uma opção valiosa para obtenção de bons resultados funcionais e estabilidade ligamentar.
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ABSTRACT Introduction: Patients with rheumatoid arthritis (RA) are 30-60% more likely to develop cardiovascular disease (CV) than the general population. Metabolic syndrome (MS), defined by a number of cardiovascular risk factors, confers a greater risk of CVdisease and diabetes. The association of MS with RA is not yet fully understood and its prevalence varies from 19-63% across studies. Objectives: To assess the prevalence of MS in a population of RA patients followed in a hospital in Northeastern Brazil and analyze associations of demographic and clinical factors with MS. Methods: Outpatients with RA were evaluated in a cross-sectional study regarding demographic, clinical, laboratory and anthropometric data. The criteria for defining MS were those adopted by NCEPIII (2005) and IDF (2006). Results: 110 patients with RA were studied; 97.3% were female, with a mean age of 55.5 years (SD = 12.9) and duration of illness of 11.2 years (SD = 7.3). The MS prevalence from NCEPIII (2005) and IDF (2005) were, respectively, 50% and 53.4%. Advanced age (57.9 ± 11.9 versus 52.9 ± 13.5; p = 0.04) and smoking load> 20 packs/year (29% versus 9%, p = 0.008) were associated with MS. The major components of the metabolic syndrome were abdominal obesity (98.1%), hypertension (80%) and low HDL cholesterol (72.2%). Conclusions: RA patients in a tertiary center in Northeastern Brazil showed high prevalence of MS. It is worth noting that almost all patients had MS and abdominal obesity, which has important practical implications. In addition to the components of MS, age and smoking were associated with this syndrome.
RESUMO Introdução: Pacientes com artrite reumatoide (AR) têm 30 a 60% mais chances de desenvolver doenças cardiovasculares (DCV) do que a população geral. A síndrome metabólica (SM), definida por um conjunto de fatores de risco cardiovasculares, confere maior risco de DCV e diabete. A associação da SM com AR ainda não está totalmente esclarecida e sua prevalência varia de 19 a 63% entre os estudos. Objetivos: Avaliar a prevalência de SM numa população de pacientes com AR acompanhada num hospital do Nordeste brasileiro e analisar associações de fatores demográficos e clínicos com SM. Pacientes ambulatoriais com AR foram transversalmente avaliados com relação a dados demográficos, clínicos, laboratoriais e antropométricos. Os critérios para definir SM foram os adotados pelo NCEPIII (2005) e IDF (2006). Resultados: Foram estudados 110 pacientes com AR, 97,3% mulheres com média de 55,5 anos (DP = 12,9) e duração da doença de 11,2 anos (DP = 7,3). As prevalências de SM do NCEPIII (2005) e IDF (2005) foram, respectivamente, 50% e 53,4%. Idade avançada (57,9 ± 11,9 versus 52,9 ± 13,5; p = 0,04) e carga tabágica > 20 maços ano (29% versus 9%; p = 0,008) estiveram associadas com SM. Os principais componentes da SM foram obesidade abdominal (98,1%), hipertensão arterial (80%) e HDL baixo (72,2%). Conclusões: Pacientes com AR de um serviço terciário do Nordeste brasileiro apresentaram alta prevalência de SM. Chama atenção a quase totalidade dos pacientes com SM e obesidade abdominal, o que traz implicações práticas importantes. Além dos componentes de SM, idade e tabagismo se mostrarem associados com SM.
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Humanos , Masculino , Feminino , Artrite Reumatoide/epidemiologia , Síndrome Metabólica/epidemiologia , Brasil , Fumar/epidemiologia , Estudos Transversais , Fatores Etários , Obesidade Abdominal/epidemiologia , Hospitais Universitários , Pessoa de Meia-IdadeRESUMO
Resumo Introdução: O Disease Activity Score 28 (DAS28) e versões têm sido usados para medir atividade da artrite reumatoide (AR), mas não existe consenso sobre qual é o melhor. Objetivos: Determinar a correlação entre os índices (DAS28 VHS, DAS28 PCR, SDAI e CDAI) e avaliar a concordância dos estratos de atividade com o uso de diferentes pontos de corte. Métodos: Pacientes com artrite reumatoide foram avaliados transversalmente com coleta de dados para cálculo do DAS28 (VHS e PCR), SDAI e CDAI, com o uso de pontos de cortes diferentes para definição de remissão, atividade leve, moderada e alta. Correlações de Pearson foram calculadas para medidas contínuas e concordância (teste de kappa) para os estratos (remissão, atividade leve, moderada e alta). Resultados: De 111 pacientes incluídos, 108 foram mulheres, média de 55,6 anos, tempo de doença de 11 anos. DAS28 (VHS) foi significantemente maior do que DAS28 (PCR) (4 vs. 3,5; p < 0,001) e os valores permaneceram maiores após estratificação por idade, sexo, tempo doença, fator reumatoide e HAQ. Correlações entre índices variaram de 0,84 a 0,99, com melhor correlação entre SDAI e CDAI. Concordâncias entre estratos de atividade variaram de 46,8% a 95,8%. DAS28 (PCR) com ponto de corte para remissão de 2,3 subestimou atividade da doença em 45,8% quando comparado com DAS28 (VHS). SDAI e CDAI apresentaram concordância de 95,8%. Os quatro índices mostraram associação com tempo de doença e HAQ. Conclusões: Embora os índices de atividade apresentem boa correlação, mostram discrepâncias nos estratos de atividade. Tornam-se necessários mais estudos para definir melhor índice e melhores pontos de corte.
Abstract Introduction: The Disease Activity Score 28 (DAS28) and its versions have been used to measure rheumatoid arthritis activity, but there is no consensus about which one is the best. Objectives: Determine the correlation among indexes (DAS28 ESR, DAS28 CRP, SDAI and CDAI) and evaluate agreement of activity strata using different cut-off points. Methods: Rheumatoid arthritis patients were cross-sectionally evaluated with data collection to calculate the DAS28 (ESR and CRP), SDAI and CDAI, using different cut-offs for defining remission, mild, moderate and high activity. Pearson correlations were calculated for continuous measures and agreement (kappa test) for the strata (remission, mild, moderate and high activity). Results: Of 111 patients included, 108 were women, age 55.6 years, 11-year disease duration. DAS28 (ESR) was significantly higher than DAS28 (CRP) (4.0 vs. 3.5; p < 0.001) and the values remained higher after stratification by age, gender, disease duration, rheumatoid factor and HAQ. Correlations among indexes ranged from 0.84 to 0.99, with better correlation between SDAI and CDAI. Agreements among activity strata ranged from 46.8% to 95.8%. DAS28 (CRP) with cut-off point for the remission of 2.3 underestimated disease activity by 45.8% compared with DAS28 (ESR). SDAI and CDAI showed agreement of 95.8%. The four indexes were associated with disease duration and HAQ. Conclusions: Although the activity indexes show good correlation, they show discrepancies in activity strata, thus requiring more researches to define a better index and better cut-off points.
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Humanos , Masculino , Feminino , Artrite Reumatoide/fisiopatologia , Índice de Gravidade de Doença , Brasil , Estudos Transversais , Pessoa de Meia-IdadeRESUMO
PURPOSE: The aim of this study was to evaluate the relaxation in vitro of cavernous smooth muscle induced by a new NO donor of the complex nitrosil-ruthenium, named trans-[Ru(NH3)4(caffeine)(NO)]C13 (Rut-Caf) and sodium nitroprusside (SNP). MATERIALS AND METHODS: The tissues, immersed in isolated bath systems, were pre-contracted with phenilephrine (PE) (1 µM) and then concentration-response curves (10 (-12) - 10(-4) M) were obtained. To clarify the mechanism of action involved, it was added to the baths ODQ (10 µM, 30 µM), oxyhemoglobin (10 µM), L-cysteine (100 µM), hydroxicobalamine (100 µM), glibenclamide, iberotoxin and apamine. Tissue samples were frozen in liquid nitrogen to measure the amount of cGMP and cAMP produced. RESULTS: The substances provoked significant relaxation of the cavernous smooth muscle. Both Rut-Caf and SNP determined dose-dependent relaxation with similar potency (pEC50) and maximum effect (E(max)). The substances showed activity through activation of the soluble guanylyl cyclase (sGC), because the relaxations were inhibited by ODQ. Oxyhemoglobin significantly diminished the relaxation effect of the substances. L-cysteine failed to modify the relaxations caused by the agents. Hydroxicobalamine significantly diminished the relaxation effect of Rut-Caf. Glibenclamide significantly increased the efficacy of Rut-Caf (pEC50 4.09 x 7.09). There were no alterations of potency or maximum effect of the substances with the addition of the other ion channel blockers. Rut-Caf induced production of significant amounts of cGMP and cAMP during the relaxation process. CONCLUSIONS: In conclusion, Rut-Caf causes relaxation of smooth muscle of corpus cavernosum by means of activation of sGC with intracellular production of cGMP and cAMP; and also by release of NO in the intracellular environment. Rut-Caf releases the NO free radical and it does not act directly on the potassium ion channels.
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Relaxamento Muscular/fisiologia , Músculo Liso/efeitos dos fármacos , Doadores de Óxido Nítrico/farmacologia , Nitroprussiato/farmacologia , Compostos de Rutênio/farmacologia , Animais , GMP Cíclico/biossíntese , GMP Cíclico/química , Cisteína/farmacologia , Guanosina Monofosfato/biossíntese , Guanosina Monofosfato/química , Masculino , Músculo Liso/fisiologia , Doadores de Óxido Nítrico/química , Nitroprussiato/química , Canais de Potássio/química , Coelhos , Compostos de Rutênio/química , Fatores de TempoRESUMO
PURPOSE: The aim of this study was to evaluate the relaxation in vitro of cavernous smooth muscle induced by a new NO donor of the complex nitrosil-ruthenium, named trans-[Ru(NH3)4(caffeine)(NO)]C13 (Rut-Caf) and sodium nitroprusside (SNP). MATERIALS AND METHODS: The tissues, immersed in isolated bath systems, were pre-contracted with phenilephrine (PE) (1 µM) and then concentration-response curves (10-12 - 10-4 M) were obtained. To clarify the mechanism of action involved, it was added to the baths ODQ (10 µM, 30 µM), oxyhemoglobin (10 µM), L-cysteine (100 µM), hydroxicobalamine (100 µM), glibenclamide, iberotoxin and apamine. Tissue samples were frozen in liquid nitrogen to measure the amount of cGMP and cAMP produced. RESULTS: The substances provoked significant relaxation of the cavernous smooth muscle. Both Rut-Caf and SNP determined dose-dependent relaxation with similar potency (pEC50) and maximum effect (Emax). The substances showed activity through activation of the soluble guanylyl cyclase (sGC), because the relaxations were inhibited by ODQ. Oxyhemoglobin significantly diminished the relaxation effect of the substances. L-cysteine failed to modify the relaxations caused by the agents. Hydroxicobalamine significantly diminished the relaxation effect of Rut-Caf. Glibenclamide significantly increased the efficacy of Rut-Caf (pEC50 4.09 x 7.09). There were no alterations of potency or maximum effect of the substances with the addition of the other ion channel blockers. Rut-Caf induced production of significant amounts of cGMP and cAMP during the relaxation process. CONCLUSIONS: In conclusion, Rut-Caf causes relaxation of smooth muscle of corpus cavernosum by means of activation of sGC with intracellular production of cGMP and cAMP; and also by release of NO in the intracellular environment. Rut-Caf releases the NO free radical and it does not act directly on the potassium ion channels.