RESUMO
OBJECTIVE: To report our experience in the treatment of 2-3 fragment proximal humeral fractures using a minimally invasive technique that involves an angular-stable locking implant and find out the factors affecting patients outcomes. MATERIAL AND METHODS: Descriptive, prospective study of the case series type. Twenty-two patients, 13 females and 9 males, were operated on between February 2010 and August 2012. Mean age was 50.8 years (24-82 years). Patients were placed in a beach-chair position. A lateral acromial approach was used under fluoroscopic guidance. Minimal follow-up period was 24.3 months (11-32). Follow-up consisted of X-ray review to check for bone healing and avascular necrosis, and functional assessment using the Constant-Murley scale. RESULTS: Bone healing occurred in all cases at 6 months. There were no cases of avascular necrosis. Two patients had varus healing (109º), and two had plate impingement. The functional assessment score according to the Constant-Murley scale was 68.8. There were no associated neurologic lesions. CONCLUSIONS: Fixation of proximal humeral fractures with a minimally invasive technique using locking plates represents a valid surgical approach. The avascular necrosis rate was low and early rehabilitation was possible in patients with poor bone quality.
OBJETIVO: Dar a conocer nuestra experiencia en el tratamiento de las fracturas de húmero proximal de 2 a 3 partes con técnica de mínima invasión mediante el uso de un implante con estabilidad angular bloqueado e investigar los factores que afectan los resultados de los pacientes. MATERIAL Y MÉTODOS: Estudio descriptivo y prospectivo tipo serie de casos. De 22 pacientes fueron intervenidos 13 mujeres y nueve hombres en el período comprendido entre Febrero de 2010 y Agosto de 2012. El rango de edad media fue 50.8 años (24-82 años). Se hizo un abordaje acromial lateral con el paciente en posición de silla de playa bajo visión fluoroscópica. El tiempo de seguimiento mínimo fue de 24.3 meses (11-32). El seguimiento se hizo mediante revisión de radiografías para la consolidación y necrosis avascular y la valoración funcional de la escala de Constant. RESULTADOS: En todos los casos se observó consolidación de la fractura a los seis meses. No se detectaron casos con necrosis avascular. Dos pacientes mostraron consolidación en varo (109o). Dos pacientes presentaron pinzamiento por la placa. El resultado funcional según la escala de valoración de Constant-Murley fue de 68.8 puntos. No hubo lesiones neurológicas asociadas. CONCLUSIONES: La fijación con técnica mínimamente invasiva para las fracturas de húmero proximal con placas bloqueadas es una alternativa válida como tratamiento quirúrgico. La incidencia de necrosis avascular fue baja y se permitió una rehabilitación temprana en pacientes de mala calidad ósea.
Assuntos
Placas Ósseas , Fixação Interna de Fraturas , Fraturas do Úmero , Fraturas do Ombro , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Fraturas do Úmero/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Estudos Prospectivos , Fraturas do Ombro/cirurgia , Resultado do Tratamento , Adulto JovemRESUMO
Resumen: Objetivo: Dar a conocer nuestra experiencia en el tratamiento de las fracturas de húmero proximal de 2 a 3 partes con técnica de mínima invasión mediante el uso de un implante con estabilidad angular bloqueado e investigar los factores que afectan los resultados de los pacientes. Material y métodos: Estudio descriptivo y prospectivo tipo serie de casos. De 22 pacientes fueron intervenidos 13 mujeres y nueve hombres en el período comprendido entre Febrero de 2010 y Agosto de 2012. El rango de edad media fue 50.8 años (24-82 años). Se hizo un abordaje acromial lateral con el paciente en posición de silla de playa bajo visión fluoroscópica. El tiempo de seguimiento mínimo fue de 24.3 meses (11-32). El seguimiento se hizo mediante revisión de radiografías para la consolidación y necrosis avascular y la valoración funcional de la escala de Constant. Resultados: En todos los casos se observó consolidación de la fractura a los seis meses. No se detectaron casos con necrosis avascular. Dos pacientes mostraron consolidación en varo (109o). Dos pacientes presentaron pinzamiento por la placa. El resultado funcional según la escala de valoración de Constant-Murley fue de 68.8 puntos. No hubo lesiones neurológicas asociadas. Conclusiones: La fijación con técnica mínimamente invasiva para las fracturas de húmero proximal con placas bloqueadas es una alternativa válida como tratamiento quirúrgico. La incidencia de necrosis avascular fue baja y se permitió una rehabilitación temprana en pacientes de mala calidad ósea.
Abstract: Objective: To report our experience in the treatment of 2-3 fragment proximal humeral fractures using a minimally invasive technique that involves an angular-stable locking implant and find out the factors affecting patients' outcomes. Material and methods: Descriptive, prospective study of the case series type. Twenty-two patients, 13 females and 9 males, were operated on between February 2010 and August 2012. Mean age was 50.8 years (24-82 years). Patients were placed in a beach-chair position. A lateral acromial approach was used under fluoroscopic guidance. Minimal follow-up period was 24.3 months (11-32). Follow-up consisted of X-ray review to check for bone healing and avascular necrosis, and functional assessment using the Constant-Murley scale. Results: Bone healing occurred in all cases at 6 months. There were no cases of avascular necrosis. Two patients had varus healing (109º), and two had plate impingement. The functional assessment score according to the Constant-Murley scale was 68.8. There were no associated neurologic lesions. Conclusions: Fixation of proximal humeral fractures with a minimally invasive technique using locking plates represents a valid surgical approach. The avascular necrosis rate was low and early rehabilitation was possible in patients with poor bone quality.
Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Fraturas do Ombro/cirurgia , Placas Ósseas , Fixação Interna de Fraturas , Fraturas do Úmero/cirurgia , Estudos Prospectivos , Resultado do Tratamento , Procedimentos Cirúrgicos Minimamente Invasivos , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Surgical site infection (ISO) is the most common nosocomial infection and is a process associated with multiple factors, which together generate a condition that directly affects the welfare of the patient. MATERIAL AND METHODS: Cross-sectional study, conducted over 1 year period, the sample size was established for all patients who met the inclusion criteria. An instrument takes the variables; double tabulation of patients is performed in Excel 2013 and data are analyzed in Stata version 11. RESULTS: The average age was 44.3 ± 18.8 years and the male: female ratio is 1.7:1. Clinical features, lower limbs are the most affected and 21.9 % of cases affect the femur. A prevalence of 6.6 % was found, being the most common deep infection classification. Staphylococcus aureus was cultured in 38.5% of which 40% were methicillin sensible. CONCLUSION: ISO prevalence in patients with closed fractures in HUS is 6.6% higher compared with literature data. The findings of this study it was established that hemoglobin below 10 g/dl, transfusion, reoperation and surgical risk ASA were associated statistically with ISO.
La infección de sitio operatorio (ISO) es la infección nosocomial más común y es un proceso asociado a múltiples factores, los cuales en conjunto generan una alteración que afecta directamente el bienestar del paciente.
Assuntos
Fraturas Fechadas , Infecções Estafilocócicas , Infecção da Ferida Cirúrgica , Adulto , Estudos Transversais , Feminino , Fraturas Fechadas/complicações , Fraturas Fechadas/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/etiologiaRESUMO
This survey to detect anthelmintic resistance in nematode parasites of sheep was conducted on 11 farms in the Occidental and 26 farms in the Oriental Regions of Paraguay using the faecal egg count reduction test (FECRT). The anthelmintic groups tested were the benzimidazoles, levamisole and avermectins (both oral and injectable). Overall the levels of resistance were 73%, 68%, 73% and 47%, respectively. Levels of resistance were similar for all three important nematode genera, viz. Haemonchus contortus, Ostertagia and Trichostrongylus. This survey clearly indicates that a large, and ever increasing, proportion of sheep farmers are rapidly approaching the time when they will have exhausted all chemotherapeutic options to control parasites. Unless they face having to abandon their sheep farming operations, radical changes will need to be implemented with urgency.
Assuntos
Anti-Helmínticos/uso terapêutico , Resistência a Múltiplos Medicamentos , Nematoides/efeitos dos fármacos , Infecções por Nematoides/veterinária , Doenças dos Ovinos , Ovinos/parasitologia , Animais , Demografia , Haemonchus/efeitos dos fármacos , Infecções por Nematoides/tratamento farmacológico , Ostertagia/efeitos dos fármacos , Paraguai , Contagem de Ovos de Parasitas , Trichostrongylus/efeitos dos fármacosRESUMO
We studied 26 patients (p) with end stage renal failure (RF) and 26 healthy volunteers (HV) to investigate the prevalence of Helicobacter pylori (Hp) and its relation with chronic gastritis (CG) and chronic duodenitis (CD). We analyzed 312 gastric and duodenal mucosal biopsies stained with H & E and Giemsa. Categorical data were assessed by the X2 and Fisher's exact test. Probability values of p < 0.05 were considered significant. Endoscopic lesions correlated with histological gastritis and duodenitis and Hp was positive in antrum of 6/8p (75%) (p < 0.05). The prevalence of Hp was 54.5% (15/26p) in RF and 47.2% (12/26s) in HV. Hp was found more frequently in pathological mucosa (p < 005.). CG of the antrum and CD were more commonly in RF (88.5% vs 69.5% and 42.3% vs 23.1% respectively). HP was more frequently located in the antrum than in body and duodenum in both groups (p < 0.05). Chronic gastritis of the body was more frequently in HV (p < 0.05). Active chronic antral gastritis and superficial gastritis were more frequently associated to Hp. Hp was associated to chronic inflammatory gastroduodenal diseases in both groups and may be a cofactor in its pathogenesis. We recommended Hp treatment before renal transplantation.
Assuntos
Duodenite/patologia , Gastrite/patologia , Infecções por Helicobacter/patologia , Helicobacter pylori , Uremia/patologia , Adolescente , Adulto , Idoso , Distribuição de Qui-Quadrado , Doença Crônica , Duodenite/epidemiologia , Duodenite/microbiologia , Endoscopia Gastrointestinal , Feminino , Gastrite/epidemiologia , Gastrite/microbiologia , Infecções por Helicobacter/epidemiologia , Infecções por Helicobacter/microbiologia , Helicobacter pylori/isolamento & purificação , Humanos , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/microbiologia , Falência Renal Crônica/patologia , Masculino , Pessoa de Meia-Idade , Prevalência , Uremia/epidemiologia , Uremia/microbiologiaRESUMO
Non-ulcer dyspepsia is a frequent clinical entity characterized by chronic upper gastrointestinal symptoms without organic lesions by radiology, sonography or endoscopy. We studied simultaneously the rate of gastric emptying and gallbladder contraction in 10 patients with non-ulcer dyspepsia and in 10 healthy controls after ingestion of 500 cc of isotonic saline, and 500 cc of a liquid mixed meal, hypercaloric and hyperosmotic. The measurements were done by direct real-time ultrasonic imaging in fasting and were repeated at regular intervals (15-30 minutes) after the liquid meal, until complete gastric emptying was established. We found with the liquid mixed meal, the patients with non-ulcer dyspepsia had a significant delay in gastric emptying and gallbladder hypokinesis with faulty contraction and slow refilling. Dynamic ultrasonographic studies are useful in patients with non-ulcer dyspepsia.
Assuntos
Dispepsia/fisiopatologia , Vesícula Biliar/fisiopatologia , Esvaziamento Gástrico/fisiologia , Adulto , Dispepsia/diagnóstico por imagem , Feminino , Humanos , Soluções Isotônicas , Masculino , Pessoa de Meia-Idade , UltrassonografiaRESUMO
This paper reports a case of an histological non aggressive thymoma with myasthenic symptoms as the first clinical manifestation. Three years after its complete surgical resection liver metastases appeared without evidence of intrathoracic neoplastic disease. The extrathoracic metastases are uncommon and the thymomatous myasthenia gravis is present in 25 to 50% of cases. We reviewed the literature and analyzed its clinical pathological characteristics and therapeutics approach.
Assuntos
Neoplasias Hepáticas/secundário , Miastenia Gravis/etiologia , Timoma/complicações , Neoplasias do Timo/complicações , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Mediastino/diagnóstico por imagem , Pessoa de Meia-Idade , Timoma/diagnóstico por imagem , Timoma/patologia , Timoma/cirurgia , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/patologia , Neoplasias do Timo/cirurgia , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
The rate of gastric emptying of different liquid solutions was measured in 80 voluntary normal young male subjects (mean age 19.9 +/- 1.6 years) by direct real-time ultrasonic imaging. Multiple US scans were repeated at regular intervals (15-30 minutes) until complete gastric emptying was established, after ingestion of 500 cc of 8 different liquid test meals: isotonic saline, 50% glucose, 5% glucose, 40 g of proteins, 20 g of protein, 40 g of fat, 20 g of fat and mixed (carbohydrates, proteins and fat). Eight groups of ten subjects were studied, each one with a different test meal. Three types of gastric emptying were identified: slow (177 +/- 12 minutes) in subjects receiving 50% glucose, 40 and 20 grs of proteins and mixed test meals; intermediate (83 +/- 9 minutes) with 5% glucose, 40 and 20 g of fat; rapid (40 +/- 6 minutes) with isotonic saline. The mixed diet had the slowest emptying time (210 +/- 6 min). Our results are in accordance with published data regarding gastric motor physiology and demonstrates the usefulness of ultrasound in the study of gastric emptying of fluids.
Assuntos
Alimentos Formulados , Esvaziamento Gástrico/fisiologia , Trânsito Gastrointestinal/fisiologia , Ultrassonografia , Adolescente , Adulto , Gorduras na Dieta/administração & dosagem , Proteínas Alimentares/administração & dosagem , Solução Hipertônica de Glucose/administração & dosagem , Humanos , Masculino , Antro Pilórico/diagnóstico por imagem , Antro Pilórico/fisiologia , Solução Salina Hipertônica/administração & dosagemRESUMO
There are many discrepancies between reports about gallbladder motility in gallstones disease. We studied gallbladder volume and contraction in 65 patients with asymptomatic gallstones and compared with 65 healthy controls by ultrasonography. The mass of the stones was less of the 25% of the gallbladder volume. We related stone size and number with its motor function. The results of the gallbladder contraction (GC) in the control group was 79.5% (DS = 9.5) and in the cholelithiasis group was 59.9% (DS = 19) with (p < 0.01). We found that the cholelithiasis group was heterogeneous and on closer inspection the patients fell into two subgroups separated by the inferior limit of normal GC (60%). The subgroup I (41 patients) had a fasting volume (FV) of 26.6 ml (DS = 14.1), a postprandial volume (PV) of 6.5 ml (DS = 3.8) and a GC of 75.3% (DS = 8.5). The subgroup II (24 patients) had a FV of 27.3 ml (DS = 20.3), a PV of 16.9 ml (DS = 15) and a GC of 40.5% (DS = 11.8). There was significant differences in PV and GC (p < 0.01). We concluded that defective gallbladder emptying is evident in a subgroup of patients but gallbladder contraction may be normal in patients with cholelithiasis and there are, not correlation between GC and the number and size of the stones.