RESUMO
BACKGROUND: Pediatric hemato-oncological (HO) patients are highly susceptible to the occurrence of adverse events (AE), nevertheless few research has been done in this field. Our aim was to describe the incidence, type, severity and preventability of AE in these patients, including bone marrow transplant (BMT) patients, and to identify patient's risk factors for having an AE. METHODS: Retrospective cohort study. Children under 18yo hospitalized at the HO or BMT ward in 2016 were eligible for the study. Type of AE, severity and preventability were described as absolute and relative frequencies. Cumulative incidence of patients with at least one AE (CI_AE) and the rate of occurrence of all AE were calculated. Risk factors (sex, recovery probability, comorbidities and being a BMT patient) were analyzed using logistic regression. RESULTS: 114 patients were included, 58% were male, average age was 8.7yo and 25 were BMT patients. 44 had at least one AE, with CI_AE of 38.6% (95%CI 29.7-47.5). Overall rate of occurrence of AE was 2.5 cases per 100 patients-day (95%CI 2.15-2.98). For BMT and non-BMT patients they were 2.8 (95%CI 2.2-3.6) and 2.5 (95%CI 1.98-3.1) respectively. Healthcare related infection was the most frequent AE. Most AE were moderate and with high preventability. Being a BMT patient was the only independent factor associated with the occurrence of at least one AE (OR=11.5, p<0.001). CONCLUSIONS: Our findings suggest that AE tend to be moderate and preventable in HO pediatric patients. BMT patients seem to be at greater risk of having an AE. Strategies focused on patient safety need to account for their specific characteristics.
Assuntos
Segurança do Paciente , Criança , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Estudos Retrospectivos , Fatores de RiscoRESUMO
UNLABELLED: The presence of coliform bacteria, faecal coliforms, Escherichia coli, diarrhoeagenic E. coli pathotypes (DEP) and Salmonella were determined in ready-to-eat cooked vegetable salads (RECS) from restaurants in Pachuca city, Mexico. The RECS were purchased from three types of restaurants: national chain restaurants (A), local restaurants (B) and small restaurants (C). Two restaurants for each A and B, and three for C, were included. Forty RECS samples were purchased at each A and B restaurant and 20 at each C restaurant. Of the overall total of 220 analysed samples, 100, 98·2, 72·3, 4·1 and 4·1% had coliform bacteria, faecal coliforms, E. coli, DEP and Salmonella, respectively. Identified DEP included enteropathogenic E. coli (EPEC), enterotoxigenic E. coli (ETEC) and Shiga toxin-producing E. coli (STEC). The EPEC, ETEC and STEC were isolated each from 1·4% of samples. No E. coli O157:H7 were detected in any STEC-positive samples. The analysis of Kruskal-Wallis anova and median test of microbiological data showed that the microbiological quality of RECS did not differ between the different restaurants (P > 0·05). SIGNIFICANCE AND IMPACT OF THE STUDY: This is the first report regarding microbiological quality and Salmonella, enteropathogenic E. coli (EPEC), enterotoxigenic E. coli (ETEC) and Shiga toxin-producing E. coli (STEC) isolation from ready-to-eat cooked vegetable salads from Mexican restaurants. Ready-to-eat cooked vegetable salads could be an important factor contributing to the endemicity of EPEC, ETEC and STEC, and Salmonella caused gastroenteritis in Mexico.
Assuntos
Enterobacteriaceae/isolamento & purificação , Escherichia coli/isolamento & purificação , Microbiologia de Alimentos , Restaurantes , Salmonella/isolamento & purificação , Verduras/microbiologia , Análise de Variância , Culinária , Escherichia coli Enteropatogênica/isolamento & purificação , Escherichia coli Enterotoxigênica/isolamento & purificação , Escherichia coli O157/isolamento & purificação , Fezes/microbiologia , México , Escherichia coli Shiga Toxigênica/isolamento & purificaçãoRESUMO
Summary The objective of the present study was to evaluate the viability of frozen embryos obtained from various private farmers in a culture medium for 4 h. Forty-seven embryos were used that had been previously graded as good and fair. These embryos were evaluated using stereoscopic microscopy by experienced clinicians prior to freezing. Embryos were divided in two groups: the non-cultured group, made up of six good quality embryos, and five fair; and the cultured group that consisted of 20 good quality embryos and 16 fair. Fifty-four per cent of the good quality embryos achieved a favourable development during culture whereas just 42% of embryos determined to be fair were observed to have adequate development. This evaluation was undertaken by serial photographs obtained at the onset of culture and 4 h later. This finding was corroborated by a more specific technique: terminal deoxynucleotide transferase dUTP nick end labelling-bromodeoxyuridine (TUNEL-BrdU). These results are indicative of the necessity of tight quality controls for commercially produced frozen embryos, as once thawed it is unlikely that clinicians will examine them to determine their physiological status prior to transfer.
Assuntos
Apoptose , Blastocisto/citologia , Proliferação de Células , Criopreservação , Meios de Cultura/química , Técnicas de Cultura Embrionária , Embrião de Mamíferos/citologia , Humanos , Marcação In Situ das Extremidades Cortadas , Microscopia EletrônicaRESUMO
BACKGROUND: Rectal prolapse is defined as a falling out of place of the rectum through anus. Surgery is the treatment of choice to reverse abnormal anatomy and to improve anorectal function. OBJECTIVE: To review the experience in recent years of surgical management of rectal prolapse in the Hospital Central Militar and Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubiran. METHODS: All patients with rectal prolapse who underwent surgical treatment between January 1993 through December 2008 at two institutions in Mexico City were included. Clinical information was obtained of the clinical files in both hospitals. Main study variables were age, sex, degree of prolapse, morbility and type of surgery performed. RESULTS: Fifty seven patients were included, predominantly female (59.6%) with a mean age of 45 years. The most frequent diagnosis was complete rectal prolapse. Fifteen patients (26%) were treated by perineal procedure and 42 (74%) through abdomen: 17 (40%) open and 25 (60%) laparoscopic. Morbidity rate was lower in the laparoscopic group with less length of hospital stay and a lower blood loss, but with higher recurrence rate. CONCLUSIONS: Although the laparoscopic surgery showed advantage related with a less morbility, blood loss and hospital stay, it showed higher recurrence rates."
Assuntos
Prolapso Retal/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais Urbanos , Humanos , Masculino , México , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
An angiomyxoma is a pelvic neoplasia compound of myofibroblasts. This is a case report of a 41 years old female patient, who presented with a painful, pelvic mass, identified by a tomography with malignant characteristics. Total surgical excision was performed and coursed with good evolution time.
Assuntos
Mixoma/patologia , Mixoma/cirurgia , Neoplasias Pélvicas/patologia , Neoplasias Pélvicas/cirurgia , Adulto , Feminino , Humanos , Mixoma/diagnóstico por imagem , Neoplasias Pélvicas/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
The information regarding the association of gastric cancer and type 2 Lynch syndrome is limited. Previous studies have reported that both entities may be present in the same individual in less than 5% of the cases. The most frequent form of hereditary colorectal cancer is the Lynch syndrome or Hereditary Non-polyposic Colorectal Cancer, which is associated with germ-line mutation mostly of two genes, MLH1 and MSH2, which account for almost 90 percent of all identified mutations. The hereditary diffuse gastric cancer syndrome is caused by a germ-line mutation in the E-cadherin (CDH1) gene; only about 50 families with this syndrome have been reported. We present a case report of a patient who was diagnosed with both syndromes.
Assuntos
Adenocarcinoma/complicações , Neoplasias Colorretais Hereditárias sem Polipose/complicações , Neoplasias Gástricas/complicações , Proteínas Adaptadoras de Transdução de Sinal/genética , Adenocarcinoma/congênito , Adenocarcinoma/genética , Anastomose Cirúrgica , Caderinas/genética , Colectomia , Neoplasias Colorretais Hereditárias sem Polipose/genética , Procedimentos Cirúrgicos do Sistema Digestório , Mutação em Linhagem Germinativa , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Proteína 1 Homóloga a MutL , Proteína 2 Homóloga a MutS/genética , Proteínas Nucleares/genética , Neoplasias Gástricas/congênito , Neoplasias Gástricas/genéticaRESUMO
BACKGROUND: The liver is the organ in which often metastasize primary tumors. Knowledge of the etiology and forms of presentation of metastatic disease is key to deciding on the different treatment options. OBJECTIVE: Describe the surgical management of liver metastases in colorectal cancer and factors that affect the survival of patients. PATIENTS AND METHODS: We reviewed 43 cases of patients with metastatic liver cancer of the colon or rectum, who underwent liver surgery, attended January 1990 to December 2007. We analyzed demographic variables and perioperative associated with the survival of patients. There was the course and type of postoperative complications as well as the direct causes of mortality. RESULTS: Were conducted mostly metastasectomies (n = 25), followed by right hepatectomy (n = 9),and left hepatectomy (n = 9). Surgical mortality was 4.6% (n = 2). The survival rate at 1, 3 and 5 year were 45% (18 patients), 42.5% (18 patients)and 12.5% (5 patients), respectively. The presence of a single metastatic lesion (p = 0.006), size of the lesion larger than 5 cm (p = 0.003), positive lymph nodes (p = 0.002), synchronous tumor (p = 0.04),presence of extra hepatic disease (p = 0.01), positive margin (p = 0.001) and blood loss >2000 mL were significantly associated with a lower survival rate. CONCLUSION: After hepatic resection for metastatic colorectal cancer the presence of more than one tumor, > of 5 cm, with presence of synchronous tumor, nodes and positive margins, extra hepatic disease, as well blood loss > 2000 mL are factors associated with a worse survival.
Assuntos
Carcinoma/mortalidade , Carcinoma/cirurgia , Neoplasias Colorretais/patologia , Hepatectomia , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma/secundário , Estudos Transversais , Feminino , Hepatectomia/mortalidade , Humanos , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
INTRODUCTION: Attention deficit/hyperactivity disorder (ADHD) is a common behavioral disorder found mainly in males, thus current knowledge on its clinical expression in female adults is extremely limited. AIM. To evaluate the behavioral and neural substrates associated with the performance of a short-term memory task in female ADHD adults, with and without methylphenidate exposure, with respect to a control group. SUBJECTS AND METHODS: Two groups of eight young right-handed, female, university students with ADHD and healthy controls matched by age, gender, handedness and academic level, voluntarily participated. All subjects performed twice an easy auditory short-term memory task (ADHD group without, and 90 minutes post-intake of methylphenidate 0.4 mg/kg in a counterbalanced order). The BOLD-fMRI response was used as a measure of neural activity during task performance. RESULTS: ADHD subjects showed a tendency to improve their performances under medication, showing an increased widespread functional activation, especially relevant over left frontal and cerebellar areas, in comparison with control subjects. CONCLUSIONS: Methylphenidate slightly improves short-term memory task performance in adult female ADHD subjects by modifying underlying neural functioning patterns.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Memória de Curto Prazo , Metilfenidato/uso terapêutico , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Memória de Curto Prazo/efeitos dos fármacos , Memória de Curto Prazo/fisiologia , Testes Neuropsicológicos , Desempenho Psicomotor/efeitos dos fármacos , Desempenho Psicomotor/fisiologia , Adulto JovemRESUMO
BACKGROUND: The role of laparoscopic surgery in the management of colorectal pathologies is steal unclear. Some new evidence has shown some advantages over open procedures. Because it is a technically demanding procedure, the progress is very low, and used among few colorectal surgeons. OBJECTIVE: To describe the experience of laparoscopic colorectal surgery in a third level referral center, in a fourth year period. We analyzed short and median outcomes, for benign and malignant diseases. MATERIAL AND METHODS: A retrospective review of all colorectal laparoscopic procedures was analyzed in a period between June 2003 and July 2007. Procedures for benign and malignant diseases were included. RESULTS: One hundred and seventy cases were included, 52 (30%) for malignant and 118 (70%)for benign diseases. The main indication for surgery was diverticular disease followed by colorectal cancer and the most common procedure was sigmoidectomy followed by right colectomy. Conversion rate was 8.8% (15 patients) and overall morbidity and mortality were 12%, and less than 1% respectively.Oncologic results were evaluated with a median follow up of 2 years, for a loco regional recurrence rate of 6%. Mean number of nodes retrieved in the pathologic specimen were 15.69 (+/- 3.53). All malignant cases had negative margins. CONCLUSIONS: Laparoscopic colorectal procedures are safe and feasible, in large volume centers showing equivalent results when comparing with open procedures evidenced in world literature,about results of oncologic cases, due to the short follow up period we can t conclude about oncologic outcomes.
Assuntos
Doenças do Colo/cirurgia , Cirurgia Colorretal/métodos , Laparoscopia/métodos , Doenças Retais/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/cirurgia , Doença Diverticular do Colo/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
The objective of the present study was to determine the relative proportion of gonadotropin isoforms in bovine pituitary glands affected by progesterone. Twelve postpubertal heifers (Swiss-Zebu) were assigned to three groups (n=4): intact animals in the luteal phase of the estrous cycle (diestrus group); ovariectomized heifers with (OVXP) or without progesterone treatment (OVX). Prior to pituitary gland collection, a blood sample was taken from each animal to determine the circulating progesterone concentration. Pituitary protein extractions processed by chromatofocusing were eluted with a pH gradient ranging from 10.5 to 3.5. The LH and FSH eluent was grouped on the basis of the following three criteria: (1) as either a basic (pH>or=7.5), neutral (pH 7.4-6.5) and acid (pH
Assuntos
Bovinos/metabolismo , Ciclo Estral/metabolismo , Hormônio Foliculoestimulante/metabolismo , Hormônio Luteinizante/metabolismo , Hipófise/metabolismo , Progesterona/metabolismo , Animais , Bovinos/sangue , Cromatografia por Troca Iônica/veterinária , Ciclo Estral/sangue , Feminino , Ovariectomia/veterinária , Progesterona/sangue , Progesterona/farmacologia , Isoformas de ProteínasRESUMO
BACKGROUND: Since the introduction of laparoscopic colectomy in 1991, experience in laparoscopic bowel surgery has gradually increased. Several reports from specialized centers have demonstrated that laparoscopic colorectal resections are feasible and safe, providing an acceptable alternative to laparotomy for a variety of diseases. Some studies have shown the feasibility, safety, and good functional outcome of the minimally invasive procedures for ulcerative colitis (UC) and familial adenomatous polyposis (FAP). No known studies have investigated laparoscopic proctocolectomy in México. This report aims to describe the first laparoscopic proctocolectomies with ileal pouch anal anastomosis (IPAA) performed at the Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán (INCMNSZ). METHODS: All the patients in the authors' institution who underwent a one- or two-stage laparoscopic total proctocolectomy with IPAA between June 2005 and December 2006 were included in the study. All the operations were performed by the same surgeon, who had already completed the learning curve for colorectal laparoscopic procedures. RESULTS: For the study, 10 patients underwent a laparoscopic proctocolectomy with IPAA by a single surgeon. Eight of the patients underwent a one-stage procedure, whereas two patients with severe colitis underwent a two-step procedure. All the cases were managed with a diverting loop ileostomy. Six patients underwent a standard double-stapled IPAA anastomosis, and two patients with FAP underwent a mucosectomy with a manual IPAA anastomosis. The mean operative time was 187 min, and the mean blood loss was 46 ml. There were two postoperative complications. One patient presented with an early small bowel obstruction due to an internal hernia, which required reoperation. The other complication was a wound infection. The mean return to oral intake was 1.5 days, and the mean length of hospital stay was 3.4 days. CONCLUSION: Although this was not a comparative study and although sample size imposed limitations, with this preliminary data, we conclude that the laparoscopic approach to UC and FAP at our institution is safe, feasible, and effective. However, to achieve the benefits in postoperative outcome, this procedure should be performed only by experienced laparoscopic surgeons.
Assuntos
Polipose Adenomatosa do Colo/cirurgia , Colite Ulcerativa/cirurgia , Laparoscopia , Proctocolectomia Restauradora , Adulto , Perda Sanguínea Cirúrgica , Estudos de Viabilidade , Feminino , Hérnia/complicações , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Tempo de Internação , Masculino , México , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Proctocolectomia Restauradora/efeitos adversos , Proctocolectomia Restauradora/métodos , Reoperação , Infecção da Ferida Cirúrgica , Fatores de Tempo , Resultado do TratamentoRESUMO
Abstract: Carbamazepine is one of the most commonly used anticonvulsants for the treatment of epilepsy and its plasma concentrations must be monitored periodically to obtain a useful and safe clinical effect. There is not a good relationship between the dose of the carbamazepine and their effects in humans, but the effects of this drug have been well correlated with its plasma levels. Aim: To measure the correlation between plasma and saliva levels of carbamazepine in children with epilepsy. Material and Methods: Saliva and plasma levels of carbamazepine were measured by using instrumental planar chromatography in 11 epileptic children aged 8 to 15 years treated with the drug for at least six months. Results: The mean saliva/plasma ratio was 0.18±0.05 and the mean of carbamazepine concentration in saliva, expressed as a percentage of concentrations in plasma, was 17.97±5.40. There was a poor linear correlation (r =0.37) between the concentrations of carbamazepine in both fluids. Conclusions: In this group of epileptic children the correlation between saliva and plasma carbamazepine levels was weak.
Assuntos
Adolescente , Criança , Humanos , Anticonvulsivantes/análise , Carbamazepina/análise , Epilepsia/metabolismo , Saliva/química , Anticonvulsivantes/sangue , Anticonvulsivantes/uso terapêutico , Carbamazepina/sangue , Carbamazepina/uso terapêutico , Monitoramento de Medicamentos , Epilepsia/sangue , Epilepsia/tratamento farmacológico , Projetos PilotoRESUMO
Se presenta el estudio anatómico de la madera de 17 especies leñosas de la familia Malpighiaceae: Banisteriopsisacapulcensis, Bunchosia argentea, B. mollis, Byrsonima aerugo, B. arthropoda, B. chalcophylla, B. chrysophylla, B. coriacea, B. crassifolia, B. densa, B. frondosa, B. japurensis, B. ligustrifolia, B. rugosa, B. spicata, B. stipulacea y Malpighia glabra. Entre especies de un mismo género se observa una estructura homogénea; pero entre géneros existen diferencias en cuanto a tipo de parénquima, platinas de perforación, fibras septadas y ubicación de cristales. La presencia de células radiales perforadas y cristales en las fibras se reporta por primera vez para la familia Malpighiaceae. El desarrollo de platinas de perforación foraminadas se observó en, aproximadamente, el 70 por ciento de las especies estudiadas del género Byrsonima; siendo reportadas por primera vez para las especies Byrsonima aerugo, B. chalcophylla, B. crassifolia, B. densa, B. japurensis, B. ligustrifolia y B. spicata.
This paper deals about the wood anatomy of 17 woody species from Malpighiaceae family: Banisteriopsisacapulcensis, Bunchosia argentea, B. mollis, Byrsonima aerugo, B. arthropoda, B. chalcophylla, B. chrysophylla, B. coriacea, B. crassifolia, B. densa, B. frondosa, B. japurensis, B. ligustrifolia, B. rugosa, B. spicata, B. stipulacea and Malpighia glabra. In species from a same genus, the wood anatomy is very homogeneus; but between genus we can found differences in some features like parenchyma type, perforations plates, septate fibres and crystals ubication. The presence of perforated ray cells and prismatic crystals in fibres could be the first report about it in Malpighiaceae family. Foraminate perforations plates were observed in 70 percent of Byrsonima species and this could be the first report about this perforation type for Byrsonima aerugo, B. chalcophylla, B. crassifolia, B. densa, B. japurensis, B. ligustrifolia and B. spicata.
Assuntos
Madeira/anatomia & histologia , Madeira/classificação , Malpighiaceae/anatomia & histologia , Malpighiaceae/classificação , Filogenia , BotânicaRESUMO
The objective of the present study was to evaluate the quality of bovine embryos cryopreserved in different years in Chiapas, Mexico. The embryos were obtained from a government institution (FIMEGEN) dedicated to promoting embryo transfer among dual-purpose cattle farmers. Forty-three embryos frozen in 1988, 1989, 2000 and 2002 were analysed with the Tunel technique to detect programmed cell death (apoptosis). Eleven fresh embryos were used as controls. Analysis of variance was used in embryos stored in the different years with averages tested using Tukey's test. Student's t-test was employed to compare fresh and frozen cells. Embryos with shorter storage time presented a lower number (p < 0.001) of Tunel-positive cells compared with embryos stored for longer time. On the contrary, when comparing the number of apoptotic cells between frozen and fresh embryos a higher number of positive cells (p < 0.05) were found in the former. The present results suggest that the cryopreservation per se caused damage that compromises the viability of the embryo. Another explanation for the lower pregnancy rate found in the tropics could be irreversible damage caused by poor storage technique in these large operations.
Assuntos
Bovinos/embriologia , Criopreservação/veterinária , Embrião de Mamíferos/fisiologia , Preservação de Tecido/veterinária , Animais , Criopreservação/métodos , Transferência Embrionária/veterinária , Embrião de Mamíferos/ultraestrutura , Feminino , Marcação In Situ das Extremidades Cortadas/veterinária , Gravidez , Preservação de Tecido/métodosRESUMO
We present a new surgical subperiosteal endoscopic technique for the release of fibrosis of the quadriceps to the femur caused by gunshot injuries, postsurgical scarring, and fractures, that was developed at the Arthroscopy Group at Hospital Hermanos Ameijeiras in Havana, Cuba. The technique used is a proximal endoscopic subperiosteal extension of the usual arthroscopic intra-articular release of adhesions, using periosteal elevators and arthroscopic scissors placed through medial and lateral superior knee portals to release adhesions and bands of scar tissue beneath the quadriceps mechanism. The technique was used in a prospective case series of 26 male patients aged 19 to 22 years between February 1997 and March 1998 who presented with clinically and ultrasonically documented extra-articular fibrosis resulting in ankylosis of the knee in extension. Only patients who had reached a plateau in their aggressive physiotherapy program with no further progression in knee flexion for 3 months were selected. Those with joint instability, motion-limiting articular surface pathology, and muscle or neurologic injury were excluded. All patients had obtained satisfactory results at 2-year follow-up. The extra-articular release gained at final follow-up was between 30 degrees and 90 degrees of flexion in addition to that obtained at the completion of the standard intra-articular release. Complications included 1 case of deep vein thrombosis, 2 cases of scrotal edema, 5 cases of hemarthrosis, and 2 cases of reflex sympathetic dystrophy. We have found this technique useful in obtaining additional flexion and improved function in a difficult class of patients with ankylosis caused by extra-articular fibrosis of the quadriceps to the femur, allowing immediate aggressive rehabilitation and presenting a useful outpatient alternative with fewer and less severe complications than described with the classic open Thompson's quadricepsplasty.
Assuntos
Anquilose/cirurgia , Artroscopia , Articulação do Joelho/cirurgia , Músculo Esquelético/patologia , Músculo Esquelético/cirurgia , Adulto , Anquilose/etiologia , Fraturas do Fêmur/complicações , Fibrose , Seguimentos , Humanos , Instabilidade Articular/etiologia , Instabilidade Articular/fisiopatologia , Instabilidade Articular/prevenção & controle , Articulação do Joelho/fisiopatologia , Masculino , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Estudos Prospectivos , Amplitude de Movimento Articular , Aderências Teciduais/etiologia , Aderências Teciduais/cirurgia , Ferimentos por Arma de Fogo/complicaçõesRESUMO
We present a simple surgical technique created by the authors to address degenerative chondral lesions of the knee and its application in a limited prospective case series. The technique assumes the concept of beneficial epiphyseal changes caused by disruption of the subchondral bone in improving symptoms, as with drilling, microfracture, periarticular osteotomy, and other invasive procedures. Minimally invasive selective osteotomy (MISO) is an expansion of the arthroscopic treatment of the knee, specifically targeting symptomatic lesions with minimal additional trauma and cost, while avoiding disruption of the articular surface of the subchondral bone. The technique involves a mimimal access approach with selective saw cuts placed with a 1-cm oscillating blade parallel to the joint surface 1 to 1.5 cm deep to identified lesions. The technique does not address malalignment but can address lesions not addressed by classic osteotomies and, as such, may be combined with other corrective alignment procedures as necessary. We present the results of MISO of the knee in a case series of 62 outpatients carried out at the Orthopaedic Division of the Clinical and Surgical Hermanos Ameijeiras Hospital in Havana, Cuba. At 2-year follow-up, there was improvement of symptoms without significant complications.
Assuntos
Artroscopia , Artropatias/cirurgia , Articulação do Joelho/cirurgia , Osteotomia/métodos , Adulto , Idoso , Progressão da Doença , Feminino , Fêmur/cirurgia , Seguimentos , Humanos , Artropatias/complicações , Artropatias/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Dor/prevenção & controle , Medição da Dor , Estudos Prospectivos , Radiografia , Amplitude de Movimento Articular , Tíbia/cirurgia , Resultado do Tratamento , Suporte de CargaRESUMO
We describe a comprehensive approach to the endoscopic treatment of calcaneal spur syndrome developed by the Arthroscopic Group of the Orthopedic Service of Hospital Hermanos Ameijeiras in Havana, Cuba. The surgical technique involves treatment of the heel spur and plantar fasciitis commonly found in calcaneal spur syndrome, but it also addresses adjacent calcaneal periostitis and allows decompression of the nerve to the abductor digiti quinti. Medial endoscopy and lateral instrumentation are used in a sequential approach with exposure and debridement of the posterior roof of the calcaneal arch, followed by removal of the calcaneal spur, lateral to medial release of the medial 75% of the plantar fascia, and if necessary, debridement of the calcaneal tuberosity periosteum. This technique was used in a prospective case series from June 1997 to May 1998 to treat a select group of 38 feet in 30 patients who reported unacceptable levels of pain despite 5 months of conservative treatment, which included an aggressive 8-week physical therapy program prescribed by the treating physician. Good to excellent results were obtained at 3 months postoperatively in all patients with regard to pain relief and return to normal activity, although 5 patients required a short course of physical therapy to resolve symptoms brought on by sports, trauma, or impact loading before 1-year follow-up, at which time all patients reported good to excellent results. Complications included 3 superficial wound infections cured by oral antibiotics and 2 transient lateral paresthesias that resolved with rest and nonsteroidal inflammatory medications. The described technique may provide a useful method for treating refractory heel spur syndrome and warrants further study.
Assuntos
Calcâneo/cirurgia , Endoscopia , Fasciite/terapia , Doenças do Pé/terapia , Adulto , Anti-Inflamatórios não Esteroides/uso terapêutico , Calcâneo/diagnóstico por imagem , Desbridamento/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Periostite/terapia , Modalidades de Fisioterapia , Cuidados Pós-Operatórios , Radiografia , Síndrome , Resultado do TratamentoRESUMO
We present the rationale and technique for treating medial knee osteoarthritis by dynamically unloading the medial compartment of the knee. Recent advances in kinematic studies indicate a dynamic linkage between differing degrees of freedom in the knee joint. Both the adduction moment and the foot progression angle are important determinants of medial compartment loading. The medially osteoarthritic knee has progressive compromise of free motion in more than 1 plane. Arthroscopic decompressive medial release unloads the medial compartment by release of the medial capsule and medial collateral ligament in the presence of intact cruciate ligaments, which may allow a decreased adduction moment and decrease of the external rotation restraint in extension found in more severely osteoarthritic knees. A case series of 38 patients with medial gonarthrosis was treated by this technique at the Hermanos Ameijeiras Hospital in Havana, Cuba. All patients had good results without postoperative valgus instability or significant complications. We feel that this technique warrants further clinical and biomechanical study for its use in isolation or in combination with high tibial osteotomy or minimally invasive selective osteotomy for the treatment of medial gonarthrosis of the knee. A minimally invasive, selective approach to biomechanical factors in osteoarthritis may be combined with other modulating techniques in efforts to forestall or prevent the need for total joint replacement.