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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
Venous thromboembolic disease (VTED) is a public health problem worldwide. In the United States it causes 2 million annual cases. Its annual incidence is 1-2 cases per 1,000 individuals in the general population. It is a disease frequently associated with life threatening complications and its mortality rate is 1-5% of cases. Due to its high complication rate, its slow recovery, and the need for prolonged disability, it is considered as a high-cost disease. VTED may occur in both surgical and medical patients; the known associated risk factors include prolonged rest, active cancer, congestive heart failure, atrial fibrillation, and stroke, among the major medical conditions. Orthopedic surgery represents the main surgical risk factor for VTED, including mainly hip and knee replacements, as well as polytraumatized patients with severe spinal lesions, and major fractures. VTED may be prevented with the appropriate use of antithrombotics. The participants in this consensus defined thromboprophylaxis as the strategy and actions undertaken to reduce the risk of VTED in patients undergoing high risk orthopedic surgery. The position of the Mexican College of Orthopedics and Traumatology regarding the prevention of VTED in orthopedic surgery is described herein.
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Tromboembolia Venosa/prevenção & controle , Humanos , Procedimentos Ortopédicos/efeitos adversos , Fatores de Risco , Tromboembolia Venosa/etiologiaRESUMO
OBJECTIVE: Our aim was to determine the disability impact on quality of life (QOL) in Mexican adults with juvenile idiopathic arthritis polyarticular course (JIAPA) and juvenile ankylosing spondylitis (JAS). METHODS: A cross-sectional study was performed on 32 adult patients with juvenile idiopathic arthritis. Functional outcome was evaluated using Global Functional Status (GFS) according to American College of Rheumatology (ACR) and Spanish Health Assessment Questionnaire-Disability Index (HAQ-DI) arthritis-specific measurements for functional disability in patients with polyarticular course and Bath Ankylosing Spondylitis Functional Index (BASFI) for those who developed JAS. Quality of life (QOL) was assessed using SF-36 and EuroQol 5D (EQ-5D). Descriptive statistics and associations among clinical, functional, and QOL measurements were examined using Spearman's correlation test. Multiple regression analysis was used to estimate predictor factors for impaired QOL. Differences between groups were evaluated by Fisher exact and Mann-Whitney U tests, and p values of <0.05 were considered statistically significant. RESULTS: JIAPA and JAS had GFS III/IV in 65 and 50%, respectively. A HAQ-DI score of > 1.5 was found in 35% of JIAPA, and a BASFI score of > 5 in 92% of JAS. Patients with JIAPA and JAS reported lower scores for all physical domains and for mental domains (physical role, social functioning, and emotional role) compared with Mexican population scores (p < 0.005). Health status between both groups studied does not show significant differences (p > 0.05). EQ-5D showed impairment in all five dimensions for both groups studied. Multiple regression analysis showed that GFS was the only variable that affects QOL assessed by SF36. CONCLUSIONS: In our study population, JIAPA and JAS exhibited a great disability impact on QOL and poor functional outcome during the patients' adult life. GFS has a significant impact on quality of life.
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Artrite Juvenil/fisiopatologia , Pessoas com Deficiência , Qualidade de Vida , Espondilite Anquilosante/fisiopatologia , Adulto , Estudos Transversais , Feminino , Nível de Saúde , Humanos , Masculino , MéxicoRESUMO
Low molecular weight polypeptide (LMP) genes are located within the major histocompatibility complex and have been associated with autoimmune diseases such as ankylosing spondylitis. In order to define the distribution of LMP genes in Mexican populations, the LMP2 and LMP7 polymorphism was analyzed in 312 Mexican individuals (95 Mexican Mestizos, 48 Nahuas, 56 Mazatecans, 50 Teenek, and 63 Mayos) belonging to different ethnic groups. In Mexican populations both Mestizos and Amerindians presented similar distribution of LMP2 and LMP7 polymorphisms, except Nahuas and Mayos who presented the higher frequencies of LMP2-H/H and the lowest frequencies of LMP2-H/R genotypes (P < 0.05 when compared with Mexican Mestizos). The LMP7-K/K genotype was absent in Nahuas, Teenek and Mayos and only one Mazatecan individual presented this genotype. Differences with other populations were found in Mexicans. An increased frequency of LMP2-H and a decreased frequency of LMP2-R alleles were observed in Mexican Amerindians (Nahuas and Mayos) when compared with Brazilian Amerindians (Kaingang and Guarani) and Caucasians (Spaniards) (P < 0.05). All Mexican populations (Mestizos and Amerindians) presented an increased frequency of LMP7-Q allele and a decreased frequency of LMP7-K allele when compared to Brazilian Amerindians (Kaingang), Caucasians (United States) and Asian (Japan) populations (P < 0.05). Genetic distances showed that Mexican Mestizos have an important relation with Spaniards and with all Mexican Amerindians. The present data corroborate the influence of Spaniard and Amerindian genes in the Mexican Mestizo population and could help to define the true significance of LMP polymorphism as genetic and evolutive marker in the Amerindian populations.
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Cisteína Endopeptidases/genética , Complexos Multienzimáticos , Evolução Biológica , Marcadores Genéticos , Humanos , Complexo Principal de Histocompatibilidade/genética , México , Polimorfismo Genético , Complexo de Endopeptidases do ProteassomaRESUMO
Five patients with childhood scleroderma, were studied from a total group of 50 cases with the disease, 39 of them with diffuse systemic sclerosis and 11 with the CREST syndrome. The average age for these five patients when the disease onset was 13 (the age ranged from 5.5 to 16 years) with an average follow-up of 3.6 years (ranging from 1 to 6.5 years). Of the five, four girls were classified as having diffuse systemic sclerosis and the remaining boy, as suffering from the CREST syndrome. We found no family history or personal and occupational antecendents related with the appearance of the illness. Also excluded were conditions associated with changes similar to scleroderma as are seen in cases of diabetes mellitus, phenylketonuria, toxic oil syndrome, or graft-host rejection reactions. The clinical manifestations seen at the start of the disease included the Raynaud phenomenon, subcutaneous edema and muscular-skeletal abnormalities as arthralgia and myalgia with objective data of inflammatory myopathy. Proximal scleroderma was seen in all five patients; three of them, in addition, developed rapidly progressive cutaneous changes, causing the loss of elasticity and cutaneous hardening of the face during the first year of the disease. In all of the cases, the skin biopsy showed histopathological changes compatible with the diagnosis already given. The most important changes seen in the organs of these children were oesophageal dysfunction and fibrosis of the lung. The X-rays of three of the patients showed them to suffer from intestinal malfunction. We found no kidney, liver or nervous system disorders.(ABSTRACT TRUNCATED AT 250 WORDS)
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Escleroderma Sistêmico/complicações , Adolescente , Adulto , Fatores Etários , Idoso , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escleroderma Sistêmico/sangue , Escleroderma Sistêmico/fisiopatologiaRESUMO
To date the cause of growth retardation of children who have suffered physical abuse and emotional deprivation is unknown. Hypophyseal disturbances in these patients have been proposed of the cause but there are still several concerns on the dynamics of growth hormone secretion in these children. In this study, eleven out of sixteen patients had a low height without important diminution of corporal weight. Growth hormone under basal conditions was found to be elevated in battered children compared with a control group (15.2 +/- 4.7 ng/mL vs 9.6 +/- 1.9 ng/mL, p = 0.025). Two weeks after hospitalization a tendency towards normalization was apparent (13.8 +/- 3.0, NS vs controls). Cortisol, thyroid hormones T3 and T4 as well as thyrotrophin did not show significant changes under basal conditions with respect to control patients although there were some isolated cases with abnormal values. While chronic stress could adversely affect hypophyseal trophic hormone secretion, our study did not show either this were effect nor a clear association between growth retardation and a characteristic abnormal endocrine pattern. It seems that the cause growth and developmental retardation in battered children is of a multifactorial.
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Síndrome da Criança Espancada , Maus-Tratos Infantis , Hormônio do Crescimento/sangue , Hidrocortisona/sangue , Estresse Psicológico/sangue , Hormônios Tireóideos/sangue , Fatores Etários , Criança , Transtornos da Nutrição Infantil/complicações , Pré-Escolar , Feminino , Transtornos do Crescimento/etiologia , Humanos , Lactente , MasculinoRESUMO
We studied prospectively 22 children with systemic lupus erythematosus. Serologic tests included: immunoglobulins, C3 and C4 determinations. Antinuclear antibodies, by the indirect immunofluorescence test, anti-nDNA, anti-nRNP, anti-Sm and anti-SSB (La) studies were also obtained. From the 22 patients there were 16 girls and 6 boys. The mean age at the onset of the disease was 12.4 years (range 8-15 years). Four patients had the disease before being 10 years old. We mainly observed two clinical subgroups, those with kidney injury, which included 11 patients (50%), and a second group of 8 patients (36%) with prominent hematologic manifestations, 4 with hemolytic anemia and 4 with thrombocytopenic purpura. The patients with kidney disease included 7 with diffuse proliferative glomerulonephritis, one with focal and one with mesangial glomerulonephritis. No biopsies were obtained in two patients. From the group with hematological disturbances, only one patient with hemolytic anemia developed renal involvement during her evolution. Three of the 22 patients presented lymphoproliferative disorders in coexistence with systemic lupus erythematosus. The presence of anti-nDNA antibodies and the decrease of C3, were statistically associated with kidney disease, but not with the hematologic manifestations. Nevertheless 50% of patients with hemolytic anemia and thrombocytopenic purpura have positive anti-nDNA and low C3 determinations. If immunochemical differences between the anti-nDNA antibodies in these groups of patients with systemic lupus erythematosus can establish a distinction in their clinical evolution with or without nephropathy is an interesting question that remains to be determined.
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Anticorpos Antinucleares/análise , DNA/imunologia , Doenças Hematológicas/etiologia , Nefropatias/etiologia , Lúpus Eritematoso Sistêmico/complicações , Adolescente , Criança , Feminino , Doenças Hematológicas/imunologia , Humanos , Nefropatias/imunologia , Lúpus Eritematoso Sistêmico/imunologia , Masculino , Estudos ProspectivosRESUMO
Fifty-seven patients with the diagnosis of hepatosplenomegaly of unknown cause were studied. Most of the patients were infants and preschool age children. They were evenly distributed by sex. The patients were not undernourished nor did they have low height. However if such was the case, they were usually patients with a metabolic or neoplastic problem. Psychomotor retardation, paleness, jaundice and bleeding were the most common signs and symptoms. Hepatic function tests, complete blood count and urinalysis helped to establish the cause of hepatosplenomegaly in 19 of the 57 patients. Other studies only helped to establish the diagnosis of visceromegaly of unknown cause. Liver biopsy, bone marrow biopsy and a metabolic study were useful to establish the diagnosis in 34 cases. Infectious, metabolic and neoplastic problems were the usual cause for visceromegaly.
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Hepatomegalia/etiologia , Esplenomegalia/etiologia , Adolescente , Criança , Pré-Escolar , Feminino , Hepatomegalia/patologia , Humanos , Lactente , Masculino , Esplenomegalia/patologiaAssuntos
Síndrome da Imunodeficiência Adquirida/patologia , Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/transmissão , Aleitamento Materno , Portador Sadio , Doenças do Sistema Nervoso Central/etiologia , Feminino , Humanos , Lactente , Masculino , Infecções Oportunistas/etiologia , Gravidez , Complicações Infecciosas na Gravidez , Reação TransfusionalAssuntos
Abuso Sexual na Infância , Criança , Feminino , Humanos , Masculino , México , Problemas SociaisAssuntos
Doenças Autoimunes/patologia , Doença Mista do Tecido Conjuntivo/patologia , Adolescente , Autoanticorpos/análise , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/tratamento farmacológico , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Imunossupressores/uso terapêutico , Doença Mista do Tecido Conjuntivo/diagnóstico , Doença Mista do Tecido Conjuntivo/tratamento farmacológico , Prednisona/uso terapêuticoAssuntos
Anestesia Geral/efeitos adversos , Halotano/efeitos adversos , Hipertermia Maligna/etiologia , Aborto Incompleto/cirurgia , Adolescente , Adulto , Criança , Creatina Quinase/sangue , Feminino , Humanos , Histerectomia , Masculino , Hipertermia Maligna/enzimologia , Hipertermia Maligna/genética , Pessoa de Meia-Idade , GravidezRESUMO
Se presenta un caso de hiperpirexia maligna de una paciente obstetrica que ingresa a hospitalizacion con el diagnostico de aborto en evolucion; a la cual, se le practico legrado uterino instrumental presentando aumento de su temperatura corporal de hasta 41oC, durante la induccion con halotano; rebelde a tratamiento, que llevo a la paciente a estado de choque y muerte, habiendose efectuado tambien histerectomia. Se corrobora la predisposicion hereditaria, los datos de laboratorio sugerentes de esta entidad clinica y se hace hincapie en la importancia del control de la curva de temperatura corporal omitida en la mayoria de las veces, aportando con este caso datos a la estadistica mundial