RESUMO
INTRODUCTION: Loss of bone stock and anatomical alteration of the proximal femur make femoral revision surgery a complex procedure in which the choice of implant will be critical. Our goal is to assess the clinical and radiological results of complete coating Monoblock stems. MATERIAL AND METHODS: Retrospective study of 78 consecutive cases of femoral review surgery intervened by our unit. RESULTS: The average follow-up was 122 months. The average score on the Harris Hip Score was 81.2 ± 11.4 points. An age of less than 65 years, a minor femoral defect according to Paprosky classification (I, II and IIIA), the existence of a single previous surgery and the non-occurrence of intra or postoperative complications, was associated with better clinical and functional outcomes (p < 0.05).Cumulative survival was 96.7% at age 10 if we consider as failure the removal of the stem by aseptic loosening and 92% if we consider withdrawal for any cause to fail. CONCLUSION: Despite the current tendency to use modularity in femoral review surgery and given the results presented, we consider that complete coating monoblock stems provide a firm and stable fixation. However, the worst results in patients with major defects have led to other options being considered.
INTRODUCCIÓN: La pérdida de stock óseo y la alteración anatómica del fémur proximal hacen de la cirugía de revisión femoral un procedimiento complejo en la que la elección del implante será fundamental. Nuestro objetivo es valorar los resultados clínicos y radiológicos de los vástagos monobloque de recubrimiento completo. MATERIAL Y MÉTODOS: Estudio retrospectivo de 78 casos consecutivos de cirugía de revisión femoral intervenidos por nuestra unidad. RESULTADOS: El seguimiento medio fue de 122 meses. La puntuación media en la escala de Harris Hip Score fue de 81.2 ± 11.4 puntos. Una edad menor de 65 años, un defecto femoral menor según la clasificación de Paprosky (I, II y IIIA), la existencia de una única cirugía previa y la no aparición de complicaciones intraoperatorias o postoperatorias se asoció con mejores resultados clínicos y funcionales (p < 0.05). La supervivencia acumulada fue de 96.7% a los 10 años si consideramos como fracaso la retirada del vástago por aflojamiento aséptico y de 92% si consideramos como fracaso la retirada por cualquier causa. CONCLUSIÓN: Pese a la tendencia actual al uso de la modularidad en cirugía de revisión femoral y dados los resultados presentados, consideramos que los vástagos monobloque de recubrimiento completo proporcionan una fijación firme y estable. Sin embargo, los peores resultados obtenidos en pacientes con defectos óseos mayores han provocado que se valore otro tipo de opciones.
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Artroplastia de Quadril , Prótese de Quadril , Idoso , Criança , Fêmur/cirurgia , Humanos , Desenho de Prótese , Falha de Prótese , Reoperação , Estudos Retrospectivos , Resultado do TratamentoRESUMO
INTRODUCTION: There is no single criterion to select a posterior stabilization system for an arthroplasty; the ultracongruent system may avoid the complications observed with the drawer and the post. OBJECTIVE: To assess the clinical and functional status of total knee arthroplasty with the ultracongruent system and compare the results with those published in the international literature. MATERIAL AND METHODS: A retrospective study was carried out with a descriptive and comparative analysis of the total knee arthroplasties in which the Consensus system was used, to determine the operative time, the range of motion, pain, the Western Ontario and McMaster Universities Osteoarthritis Scale (WOMAC), and the level of satisfaction. RESULTS: Sixty-six arthroplasties were performed; mean age was 70.58 years; 45.5% were right and 54.5% left; the operative time was 76.84 minutes, the VAS pain score was 2.02, the WOMAC score was 17.11, and the range of motion was 96.5 +/- 14.04. Ninety-two percent of the patients are satisfied with the surgical procedure. CONCLUSIONS: The prosthesis with the ultracongruent insert is an effective option to relieve pain in patients with knee pathology. The clinical and functional results were similar to those reported with other stabilization systems. The system is well accepted by the patients. It is recommended as an alternative to prevent the possible complications that occur with the drawer and post system.
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Artroplastia do Joelho , Prótese do Joelho , Idoso , Feminino , Seguimentos , Humanos , Masculino , Desenho de Prótese , Estudos Retrospectivos , Tíbia , Fatores de TempoRESUMO
BACKGROUND: Sentinel lymph node (SLN) biopsy in patients with breast cancer has emerged as a conservative and promising procedure. One of the most important issues is the intraoperative evaluation of the SLN with a high degree of accuracy by frozen section and/or imprint cytology. The objective of this study was to test the ability of intraoperative touch imprint cytology (ITIC) to predict metastasis on SLN. METHODS: SLNs were freshly examined, bisected in <0.5 cm or serially sectioned at 2 mm intervals on the long axis. Each surface of the section was touched on the glass slide, and stained. Results of ITIC were compared with permanent sections. Sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), and accuracy (Acc) were calculated. False negatives were reviewed. RESULTS: We analyzed 179 SLN from 110 patients. The comparison between ITIC and final results of the SLN showed 139 (77.6%) true negative imprints, and 28 (15.6%) true positive. There were 12 (6.70%) false negative (FN) imprints which included 6 macrometastases, 3 micrometastases, and 3 isolated tumor cells. Re-screening after the definitive results of false negative imprints showed again 10 negative imprints, one with two groups of cells and one with multiple groups of cells. The overall Se was 70% (73.6% for micro/macrometastases and 82.3% for macrometastases), Sp and PPV were 100% in all cases. NPV was 92.1% overall (93.4% micro/macrometastases and 96% in macrometastases).Global accuracy was 93.3% (94.4% for micro/macrometastases and 96% for in macrometastases). CONCLUSIONS: ITIC is excellent to detect macrometastases, however, it fails to detect micrometastases. False negative imprints for macrometastases are mainly due to sampling error. The immediate availability, low cost, high Sp, PPV, preservation of the lymph node for histopathologic examination, avoiding of a second surgery are the major advantages of intraoperative evaluation of SLN.
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Neoplasias da Mama/diagnóstico , Neoplasias da Mama/cirurgia , Cuidados Intraoperatórios/métodos , Biópsia de Linfonodo Sentinela/métodos , Tato , Adulto , Idoso , Técnicas Citológicas , Feminino , Humanos , México , Pessoa de Meia-Idade , Manejo de Espécimes/métodosRESUMO
In the Third World Countries, little attention has been paid to health and nutrition aspects of the elderly population. In Mexico, there are no data that provides anthropometric parameters of this group. The purpose of this study was to obtain anthropometric measurements of 60-year-old-and older Mexican men and women in Mexico City. A cross sectional study was carried out. The sample was selected from men and women registered as retired or pensioned by the Mexican Social Security Institute (IMSS) and from those requesting identification cards from the Elderly National Institute (INSEN). Standardized protocols were used to register anthropometric measurements. The group examined included 1091 people, 484 males and 607 females. The mean age of the population was 66.1 (s.d. 6.1). The values in the male group were higher than in the female group in height, weight and waist circumference; women showed higher values in body mass index (BMI), arm circumference, triceps skinfold and hip circumference (p < 0.01). The data gathered up were divided in five age groups; each one in a five-year interval. Percentiles of the anthropometric measurements according to the age group and gender are presented. Regression analysis indicated that the measurements of weight, body mass index, arm circumference and arm muscle area, showed lower values in the older groups. An important segment of the population studied had a BMI higher to the normal values. Additional studies covering other communities in Mexico with a different socioeconomic and ethnic composition, would be necessary to obtain a better characterization of the Mexican elderly.
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Antropometria/métodos , Avaliação Geriátrica/métodos , População Urbana/estatística & dados numéricos , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Estatura , Índice de Massa Corporal , Peso Corporal , Estudos Transversais , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Análise de Regressão , Dobras CutâneasRESUMO
The incidence of developing malignancy in a mature cystic teratoma of the ovary is 1-2%. Most of the reported cases occur in postmenopausal women. This paper reports two cases of squamous cell carcinoma arising in a mature cystic teratoma of the ovary of which one occurred in a young woman. In the other case we could support the fact that the carcinomatous component has its origin in the columnar epithelium and epidermis of the teratomatous tissues.