RESUMO
INTRODUCTION: The management of severely traumatized extremity continues to be a matter of debate. Gustilo-Anderson tibial fractures III-B have a wide spectrum of variants, there are no guidelines using this classification for management. MESS has demonstrated functional and prognostic association. OBJECTIVE: To identify the pattern of decision made by surgeons for the prescription of amputations in tibial fractures exposed grade III-B Gustilo-Anderson with MESS scale. Material and methods. RESULTS: There was no association between the variables, with the application of MESS. (2 = 1.28, p = 0.2575). Surgeons of more than 10 years, increased once the possibility of matching the result of experts (OR = 2.088, 95% CI) (p = 0.0066). CONCLUSION: Academic degrees, surgical experience, and frequent clinical practice do not influence the correct application of the MESS scale. Surgeons with more than 10 years of experience have doubled the possibility of a precise decision.
INTRODUCCIÓN: El manejo de la extremidad severamente traumatizada continúa siendo materia de debate. Las fracturas de tibia III-B de Gustilo-Anderson tienen un amplio espectro de variantes, no hay guías mediante esta clasificación para un manejo. MESS ha demostrado asociación funcional y pronóstica. OBJETIVO: Identificar el patrón de decisión por parte de los cirujanos para la prescripción de amputaciones en fracturas de tibia expuesta grado IIIB Gustilo-Anderson con escala MESS. MATERIAL Y MÉTODOS: Es un estudio descriptivo, observacional, prospectivo, transversal y analítico. Se evaluaron 131 ortopedistas de un centro de referencia de patología traumática, quienes con uso de la escala MESS evaluaron 10 casos clínicos representativos de fracturas de tibia expuesta grado III-B de Gustilo-Anderson presentados en dispositivo electrónico. Se evaluó la concordancia de las decisiones entre cirujanos que laboran y expertos. Se realizó análisis inferencial mediante 2 (p 0.05) de las variables del estudio: experiencia del cirujano, postgrados académicos, práctica clínica frecuente de amputaciones, concordancia de las decisiones con escala MESS con respecto al patrón de prescripción obtenido por expertos. RESULTADOS: No se encontró asociación entre las variables con la aplicación de MESS (2 = 1.28, p = 0.2575). Los cirujanos de más de 10 años incrementaron una vez la posibilidad de coincidir con el resultado de expertos (OR = 2.088, IC 95%) (p = 0.0066). CONCLUSIÓN: Las variables como postgrados académicos, experiencia quirúrgica y práctica clínica frecuente no influyen en la correcta aplicación de la escala MESS. Los cirujanos de más de 10 años de experiencia incrementaron al doble la posibilidad de una decisión precisa.
Assuntos
Amputação Cirúrgica , Fraturas Expostas , Fraturas da Tíbia , Tomada de Decisões , Fraturas Expostas/cirurgia , Humanos , Prognóstico , Estudos Retrospectivos , Tíbia , Fraturas da Tíbia/cirurgiaRESUMO
To compare the three-dimensional changes occurring in the maxillary arch during the use of modified pre-surgical nasoalveolar moulding (PNAM) and Hotz's plate. A clinical trial including 32 children with unilateral cleft lip and palate (UCLP), 16 treated with Hotz's plate and 16 with PNAM, was performed. Impressions of the maxillary arches were taken: A. prior to pre-surgical orthopaedics, B. before cheiloplasty and C. after cheiloplasty. Models were digitised using a stereophotogrammetric instrument, and geodesic distances were calculated: anterior, canine and posterior widths of the arch, and lengths and cleft depths of the larger and shorter segments. The time and treatment effects were assessed by two-factor anova. A significant effect of treatment was found for cleft depth at the larger segment: children treated with Hotz's plate had significantly deeper cleft than children treated with PNAM. All distances significantly changed during time: the anterior and canine widths decreased, while the posterior width, the lengths and depths of the cleft segments increased. Significant treatment per time interactions was found. The anterior and canine widths reduced more with PNAM between time points A and B while Hotz's treatment was more effective between B and C. The shorter segment depth increased more between B and C with PNAM, and between A and B with Hotz's plate. During pre-surgical orthopaedics, therapy with PNAM obtained the best results in reducing the width at the anterior segment of the cleft. This treatment gave a lower increase in cleft depth than treatment with Hotz's plate.
Assuntos
Processo Alveolar/cirurgia , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Procedimentos Ortopédicos/métodos , Obturadores Palatinos , Humanos , Imageamento Tridimensional , Lactente , Fotogrametria , Resultado do TratamentoRESUMO
Obesity is a main risk factor in the development of diseases, which are causes of death in elderly population. Socio-economic characteristics had an impact in the prevalence of obesity. The purpose of this study was to estimate the prevalence of obesity in elderly Mexican women living in a marginal community and compare their results with those of women of urban and rural areas in Mexico. The study has a cross sectional design. Standardised nutritionist carried out the measurements. The international techniques recommended were used to measure weight and height. To estimate the proportion of overweight and obesity, the body mass index (BMI) was used following the WHO categories. A total of 249 elderly women were examined. The mean age was 71.6 (sd 7.8). No difference in age was found in the three communities visited (p>0.05). The mean BMI in the urban women was 26.7 (sd 4.6), in the rural 24.5 (sd 3.9), and in the marginal group 28.6 (sd 5.5) (p<0.0001). The proportion of overweight and obese women was in the urban group 60.7%, in the rural 36.2%, and in the marginal women 76.5% (p<0.001). The results of this study indicated the presence of a high prevalence of overweight and obesity in elderly women of urban and particularly in the marginal areas. Marginality seams to be a risk marker of obesity in elderly women in Mexico. Intervention programs aimed to decrease the prevalence of obesity and improve nutritional condition in this group are urgent.
Assuntos
Envelhecimento/fisiologia , Obesidade/epidemiologia , Idoso , Estatura , Índice de Massa Corporal , Peso Corporal , Estudos Transversais , Feminino , Nível de Saúde , Humanos , México/epidemiologia , Prevalência , Saúde da População Rural , Saúde da População UrbanaRESUMO
Comunicamos el caso de un paciente masculino de 72 años con diagnóstico de rinofima de varios años de evolución. El paciente fue tratado con radiocirugía con exlente resultado cosmético. Se presenta a la radiocirugía como un tratamiento que utiliza un flujo de electrones por alta frecuencia para incidir, abatir o coagular tejido
Assuntos
Humanos , Masculino , Idoso , Radiocirurgia , Rinofima/cirurgia , Rosácea/complicaçõesRESUMO
Have been studied a 47 years old woman who present a facial deformity related to right hemifacial fat atrophy in dermal and subcutaneous tissues. This clinic finding with others from radiologic and electromyographic explorations are suggesting of Romberg's syndrome. We have done the more important differential diagnosis and reviewed the present surgical techniques for treatment.
Assuntos
Hemiatrofia Facial/diagnóstico , Diagnóstico Diferencial , Eletromiografia , Hemiatrofia Facial/cirurgia , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Se diseno y aplico cuestionario autoadministrable de alcoholismo (CUAAL) a 121 enfermos alcoholicos de um centro especializado, a 150 enfermos con diversos problemas medicos y quirurgicos del Instituto Nacional de la Nutricion (INN) y a 43 controles sanos. Los 121 pacientes del primer grupo (100%) y 26 pacientes del INN (17.3%) fueron clasificados como alcoholicos en base a los criterios del Consejo Nacional de Alcoholismo de los Estados Unidos. De estos, 132 contestaron el cuestionario en forma antodministrada alcanzando un puntaje de 21.0 +/- 5.5. En contraste, 108 pacientes no alcoholicos (todos del INN) obtuvieron una calificacion de 3.0 +/- 2.5 y los 43 controles de 2.0 +/- 1.2. Las diferencias entre el grupo de alcoholicos y los grupos de no alcoholicos resultaron estadisticamente significativas (p <0,001). El esto de los pacientes (15 alcoholicos y 16 no alcoholicos) contestaron el cuestionario en forma de entrevista por ser analfabetas, con resultados similares. La sensibilidad calculada para la prueba fue de 95%, la especificidad de 96% Los autores concluyen que el CUAAL puede ser un instrumento util que auxilie al clinico en el diagnostico precoz del alcoholismo