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BACKGROUND: Endoscopic endonasal transsphenoidal surgery (EETS) is a standard technique used to approach sellar tumors. It is relatively safe, minimally invasive and carries a low risk of complications. However, one of the common complications reported with this technique is CSF leakage which causes morbidity, an increase in recovery time and hospital costs. This complication usually occurs from violation of the diaphragma sellae and a defect in the structures of the sellar floor or incomplete repair. In this article we report the first case with the use of a novel bilaminar chitosan scaffold which can be potentially used in the repair of the sellar floor, primarily aiming to the bony part of this structure. CASE PRESENTATION: After a personalized design employing a tissue engineering strategy, we reconstructed the sellar floor in a 65-year-old woman who had undergone EETS for a pituitary adenoma with progressive bilateral visual loss. To repair the bony defect of the sellar floor, we used a novel bilaminar chitosan scaffold. The patient had an unremarkable postoperative course with no evidence of CSF leak. The polymer was well tolerated without toxicity, infection or complications. After 2 years of follow up the patient remains neurologically intact, and in good endocrinological status. CONCLUSION: This is the first report of the use of this biomaterial and its biocompatibility in a clinical setting for the repair of the sellar floor during EETS. Our experience with chitosan bilaminar scaffold and in several preclinical studies in the literature have demonstrated good biocompatibility and effective bioengineered bone regeneration due to its excellent osteoconductive properties, this study pretends to be one landmark for further clinical research and larger case series with the use of this personalized tissue engineering materials in order to see they real efficacy to increase the surgeon armamentarium.
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OBJECTIVE: This study aimed to compare clinical outcomes and radiographic findings between patients who received 2 different implants (smooth-stemmed modular implant or an anatomic press-fit implant) on patients with acute terrible triad injuries. DESIGN: Prospective cohort. SETTING: Level II Trauma center, University hospital. PATIENTS/PARTICIPANTS: Thirty-four patients with an isolated terrible triad injury were divided into 2 study groups (n = 17 each) with different sets of radial head implants and followed for 2 years. A total of 14 patients in each group (n = 28) completed the study. INTERVENTION: Group 1 received a smooth-stemmed round modular monopolar implant. Group 2 received an in-growth modular monopolar press-fit anatomic implant. MAIN OUTCOME MEASUREMENTS: Clinical outcomes were evaluated using the Visual Analog Scale, Mayo Index, and Disabilities of the Arm, Shoulder, and Hand (DASH) survey. Radiographs were evaluated for ectopic bone formation and loosening. RESULTS: No difference in clinical outcome when comparing range of motion and functionally scores between groups. Ectopic bone formation occurred equally with implants. Bone formation at the proximal radius under the implant occurred more in group 1 (85.7%), (P = 0.046). Five press-fit stems had radiolucent lines at 2-year follow-up. Two were removed because of symptomatic loosening. CONCLUSIONS: Short-term outcomes for both implants showed to be equally effective treatment options. The in vitro biomechanical advantages of anatomic implants do not translate into short-term improved outcomes. Symptomatic aseptic loosening in anatomic implants is common. Bone formation at the proximal radial neck was observed more with smooth-stemmed implants; further studies should assess this findings and clinical implication. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Assuntos
Artroplastia de Substituição/métodos , Articulação do Cotovelo/imunologia , Luxações Articulares/cirurgia , Desenho de Prótese , Fraturas do Rádio/cirurgia , Adulto , Estudos de Coortes , Articulação do Cotovelo/cirurgia , Feminino , Consolidação da Fratura/fisiologia , Hospitais Universitários , Humanos , Escala de Gravidade do Ferimento , Luxações Articulares/diagnóstico por imagem , Prótese Articular , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Fraturas do Rádio/diagnóstico por imagem , Amplitude de Movimento Articular/fisiologia , Recuperação de Função Fisiológica , Centros de Traumatologia , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Open tibial shaft fractures require emergent care. Treatment with intravenous antibiotics and fracture débridement within 6 to 24 hours is recommended. Few studies have examined outcomes when surgical treatment is performed >24 hours after occurrence of the fracture. METHODS: This retrospective study included 227 patients aged ≥18 years with isolated open tibial shaft fractures in whom the time to initial débridement was >24 hours. The statistical analysis was based on time from injury to surgical débridement, Gustilo-Anderson classification, method of fixation, union status, and infection status. RESULTS: Fractures débrided within 24 to 48 hours and 48 to 96 hours after injury did not show a statistically significant difference in terms of infection rates (P = 0.984). External fixation showed significantly greater infection rates (P = 0.044) and nonunion rates (P = 0.001) compared with intramedullary nailing. CONCLUSION: Open tibial shaft fractures should be débrided within 24 hours after injury. Our data indicate that after the 24-hour period and up to 4 days, the risk of infection remains relatively constant independent of the time to débridement. Patients treated with external fixation had more complications than did patients treated with other methods of fixation. Primary reamed intramedullary nailing appears to be a reasonable option for the management of Gustilo-Anderson types 1 and 2 open tibial shaft fractures. LEVEL OF EVIDENCE: Level III retrospective study.
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Desbridamento/métodos , Fixação de Fratura/métodos , Fraturas Expostas/cirurgia , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Trigeminal neuralgia secondary to a posterior fossa AVM has been seldom reported in the literature. Most of the cases have been published on a case report basis, and there is not a general agreement about the best way of treatment. METHODS: In this work, we analyze our experience with 5 cases of TN secondary to a posterior fossa AVM, treated at the Division of Neurosurgery from the National Institute of Neurology and Neurosurgery, "Manuel Velasco Suarez," Mexico City, Mexico, from January 1985 to December 2004. RESULTS: Trigeminal neuralgia associated with an AVM occurred in 1.3% of 375 brain AVMs and 9.8% of 37 posterior fossa AVMs. All had received drug therapy unsuccessfully, and 2 of them underwent a percutaneous thermocoagulation without solving the neuralgia. In 4 patients, a microvascular decompression was completed with excellent results. CONCLUSIONS: Even when different ways of treatment have been reported, it seems that percutaneous procedures (glycerol injection, thermocoagulation, or microcompression of the gasserian ganglia) give variable clinical results. The reported experience and our own results support the microvascular decompression of the trigeminal nerve as the best treatment whenever the total excision of the AVM cannot be accomplished.