RESUMO
OBJECTIVE: To detect oral soft tissue injuries in older people. METHOD: A quantitative analytical cross-sectional study conducted in Fortaleza, Ceará. Individual interviews addressed age, gender, marital status, income, and education. The community oral health indicator was used to detect oral soft tissue injuries and their location. RESULTS: Most of the 821 participants aged 60-100 years were women (580; 70.6%), attended school for up to 5 years (401; 48.8%), were illiterate (201; 24.5%), were retired (608; 74.1%), and received up to 2 wages (701; 85.4%). A total of 604 participants (73.6%) wore dentures. Injuries included red patches (152; 55.9%), blisters (58; 21.3%), lesions and/or wounds (39; 14.3%), and white patches (30; 11%). Locations of injuries were the roof of the mouth (167; 61.4%), gums (62; 22.8%), cheeks (39; 14.3%), tongue (15; 5.5%), lips (15; 5.5%), and the floor of the mouth (12; 4.4%). Injuries were associated with age (p<0.001), retirement (p=0.005), education (p=0.010), dentures (p<0.001) and red patches (p<0.001). CONCLUSION: Tracking soft tissue injuries and referring older adults with suspected malignant lesions to the health team should be included as oral cancer identification and prevention measures. Furthermore, health care providers should raise older adults' awareness of the importance of regular preventive examinations.
Assuntos
Doenças da Boca/diagnóstico , Neoplasias Bucais/prevenção & controle , Saúde Bucal , Lesões dos Tecidos Moles/diagnóstico , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças da Boca/epidemiologia , Doenças da Boca/patologia , Neoplasias Bucais/patologia , Encaminhamento e Consulta , Fatores de Risco , Lesões dos Tecidos Moles/epidemiologia , Lesões dos Tecidos Moles/patologiaRESUMO
INTRODUCTION: A traumatic event to the tibia with more than 14 cm of bone and soft tissue loss represents a challenge to most orthopedic surgeons and is considered a limb-threatening condition. Few solutions are available in such clinical situations and among them is the acute shortening and re-lengthening of bone and soft tissue. MATERIALS AND METHODS: Our study presents the management of 7 patients with grade III B open fractures (according to the Gustillo-Anderson classification) of the tibia who underwent resection of all the devitalized tissues, acute limb shortening to close the defect, application of an external fixator, and metaphyseal osteotomy for re-lengthening. The patient outcomes were based on different parameters using the evaluation system established by Paley et al. RESULTS: Results acquired during the study show an average bone loss of 19cm (with a minimum of 14 cm and a maximum of 31.50cm). The average time to full recovery of all patients was 19 months with a minimum of 14 months and a max of 34 months. Patient presented with excellent bony union and none existent or small refractory leg length discrepancy and did not require bone grafts or free flaps. Complications that the patients had were contractures, which required secondary procedures such as Achilles tendon re-lengthening and recurrent infections. DISCUSSION: Overall patients had excellent bone union and were able to perform activities of their daily living. The Ilizarov technique of compression-dis- traction osteogenesis is an elegant treatment option that should be considered in patients suffering such traumatic events providing excellent bony union and good functional outcomes for the patient.
Assuntos
Fraturas Expostas/cirurgia , Desigualdade de Membros Inferiores/cirurgia , Lesões dos Tecidos Moles/etiologia , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Fixadores Externos , Fixação de Fratura/métodos , Consolidação da Fratura/fisiologia , Humanos , Técnica de Ilizarov , Desigualdade de Membros Inferiores/etiologia , Osteotomia/métodos , Recuperação de Função Fisiológica , Lesões dos Tecidos Moles/patologia , Fraturas da Tíbia/complicações , Fatores de Tempo , Adulto JovemRESUMO
In this study, we examined the treatment and mechanism of BMMSC on a deep II degree scald of the hamster skin. A deep II degree scald model on the skin of 40 hamsters was duplicated and divided randomly into a stem cell plantation group (group A) and model control group (group B). Skin cells were cultured in vitro until the allogeneic BMMSCs of the 5th generation formed with a cell count of 1 x 10(7)/mL. Local injection plus liquid supernatant smearing was used to plant the cells into the position of the scald in the stem cell plantation group. The control group was given an equivalent amount of normal saline to observe the healing action, and 5 samples were taken in each group after 1, 3, 7, and 14 days for hematoxylin and eosin staining for physiological observation. Polymerase chain reaction was used to detect the amount of chymotrypsin in mast cells. The speed of healing in the stem cell transplantation group was greater than that in the control group; staining results showed that the quality of healing in the transplantation group was better than that in the control group. Chymotrypsin expression was detected in both groups, reaching a peak on day 3. BMMSCs can accelerate wound healing, and chymotrypsin in mast cells may participate in the wound healing process.
Assuntos
Células-Tronco Mesenquimais/citologia , Pele/citologia , Lesões dos Tecidos Moles/terapia , Transplante de Células-Tronco , Animais , Células da Medula Óssea/citologia , Células da Medula Óssea/metabolismo , Quimotripsina/biossíntese , Cricetinae , Diabetes Mellitus Experimental , Modelos Animais de Doenças , Mastócitos/citologia , Mastócitos/metabolismo , Células-Tronco Mesenquimais/metabolismo , Pele/crescimento & desenvolvimento , Lesões dos Tecidos Moles/metabolismo , Lesões dos Tecidos Moles/patologia , Cicatrização/genéticaRESUMO
Sports injuries at the knee are very common, not only in contact sports such as football but also in sports with jumping and pivoting. In addition, overuse injuries can affect the tendons, ligaments, and bone with degeneration, friction, and stress response. Radiologists and sports medicine professionals should be familiar with the range of injury occurring at the knee and patterns of injury that can be used to predict other more subtle pathology. These topics and others will be discussed.
Assuntos
Fraturas Ósseas/patologia , Fraturas de Cartilagem/patologia , Traumatismos do Joelho/patologia , Imageamento por Ressonância Magnética/métodos , Traumatismo Múltiplo/patologia , Lesões dos Tecidos Moles/patologia , Humanos , Aumento da Imagem/métodosRESUMO
Understanding of ankle injuries has evolved for the past few decades, influenced by capability to visualize ligaments, tendons, and bone marrow on magnetic resonance imaging (MRI). Natural history of injury progression, complications, and healing has also been characterized using MRI. Stress injury is particularly common at the ankle in athletes and "weekend warriors" alike. This article will discuss manifestations of ankle injury on MRI as well as associated findings that should be addressed.
Assuntos
Fraturas do Tornozelo/patologia , Traumatismos do Tornozelo/patologia , Traumatismos em Atletas/patologia , Imageamento por Ressonância Magnética/métodos , Lesões dos Tecidos Moles/patologia , Traumatismos dos Tendões/patologia , HumanosRESUMO
Sports injuries of the midfoot and forefoot encompass a spectrum of osseous and soft tissue trauma. Magnetic resonance imaging serves as a primary or important supplementary diagnostic modality in evaluation of various injuries, most important of which include Lisfranc complex injury, stress fractures, and injury to the first metatarsophalangeal joint, aka "turf toe." Current technical advances in magnetic resonance and improved knowledge of regional anatomy enable thorough evaluation of the complex anatomic structures of the foot and facilitate accurate diagnosis in the setting of trauma.
Assuntos
Traumatismos do Pé/patologia , Antepé Humano/lesões , Antepé Humano/patologia , Fraturas Ósseas/patologia , Imageamento por Ressonância Magnética/métodos , Lesões dos Tecidos Moles/patologia , Humanos , Aumento da Imagem/métodosRESUMO
Prescription drug abuse ranks as the second most common class of illicit drug use in the United States, and one mechanism of opiate abuse involves intravenous injection of enteral narcotics such as oxycodone or hydrocodone. The authors describe a patient who sustained significant soft tissue necrosis after intravenously injecting a solution made from crushed enteral narcotics, with a focus on the operative course that resulted due to a delay in initial definitive treatment. The patient's wounds encompassed 8% total body surface area and covered 247 cm2. A 55-year-old female was admitted to the burn unit (West Penn Burn Center, Western Pennsylvania Hospital, Pittsburgh, PA) after she initially presented with infection and cellulitis to her bilateral upper extremities 3 weeks after intravenously injecting herself with crushed oxycodone/acetaminophen. She underwent numerous sequential operative repairs including initial debridement, placement of dermal replacement templates, and several split-thickness autografts and xenografts. Her total length of stay was 59 days, broken into an initial 47-day stay, and a subsequent 12-day readmission due to graft failure secondary to poor follow-up. As the number of prescription drug abusers rises, it is possible that an increase in attempts to intravenously abuse enteral narcotics may also rise. As such, burn centers should be prepared for the extent of potential limb necrosis and the operative treatment that may ensue.
Assuntos
Acetaminofen/efeitos adversos , Analgésicos não Narcóticos/efeitos adversos , Entorpecentes/efeitos adversos , Oxicodona/efeitos adversos , Uso Indevido de Medicamentos sob Prescrição/efeitos adversos , Infecções dos Tecidos Moles/induzido quimicamente , Celulite (Flegmão)/induzido quimicamente , Celulite (Flegmão)/patologia , Desbridamento/métodos , Combinação de Medicamentos , Toxidermias/etiologia , Toxidermias/patologia , Toxidermias/cirurgia , Feminino , Rejeição de Enxerto , Humanos , Pessoa de Meia-Idade , Necrose/induzido quimicamente , Necrose/patologia , Necrose/cirurgia , Transplante de Pele/métodos , Infecções dos Tecidos Moles/patologia , Infecções dos Tecidos Moles/cirurgia , Lesões dos Tecidos Moles/induzido quimicamente , Lesões dos Tecidos Moles/patologia , Lesões dos Tecidos Moles/cirurgia , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/patologiaRESUMO
Flaps from the forearm are often used to reconstruct soft-tissue defects in the hand. The retrograde ulnar dorsal flap has the advantage that it does not sacrifice a major vascular axis. The anatomic bases of this flap are the proximal and distal branch of the ulnar dorsal artery. The distal branch is partially accompanied with the dorsal branch of the ulnar nerve, and arrives under the abductor digiti quinti muscle making anastomoses with the deep branch of the ulnar artery. The proximal branch reaching the proximal third of the forearm, and anastomose with perforating branches of the ulnar artery. I used this island flap in 12 patients with coverage defects on the hand. The biggest flap was 13×6 cm. Only 1 flap had partial necrosis which did not lead to problems. The retrograde ulnar dorsal flap is a flap designed with reverse flow from the distal branch of the ulnar dorsal artery, and which does not sacrifice the ulnar artery. The donor defect on the forearm ulnar side had a greater esthetic acceptance. Knowing other distal anastomoses, described by other authors later, dorsal at the base of the fourth interdigital space grant greater security to the retrograde ulnar dorsal flap. It is worth highlighting the importance of preserving the adipofascial tissue around the pedicle. Experience with this flap permits us to state that it is a safe and reproducible flap to cover any defect on the dorsal of the hand as well as the first web space.
Assuntos
Traumatismos da Mão/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos/irrigação sanguínea , Adolescente , Adulto , Criança , Feminino , Traumatismos da Mão/patologia , Humanos , Masculino , Estudos Retrospectivos , Lesões dos Tecidos Moles/patologia , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: To present the results from early diagnosis and delayed surgical treatment of a cohort of patients who were diagnosed with Morel-Lavallée lesions. METHODS: Between January 2006 and December 2013, we performed delayed surgical debridement on Morel-Lavallée lesions, after delimitation of the local tissue necrosis, followed by closure through second intention and/or use of grafts/flaps. RESULTS: All the patients evolved with complete closure of the lesion after the delayed debridement, granulation of the operative wound and primary suturing or construction of pedunculated flaps. Three patients (50%) evolved with deep infectious processes due to the successive operative procedures. CONCLUSION: Whatever the treatment methods used are, they should be performed in a radical manner. If not, the patient will be at risk of evolution to septicemia and death. .
OBJETIVO: apresentar os resultados do diagnóstico precoce e do tratamento cirúrgico tardio de uma coorte de pacientes diagnosticada com a lesão de Morel-Lavallée (LML). MÉTODOS: de janeiro de 2006 a dezembro de 2013 os autores fizeram o desbridamento cirúrgico tardio da LML, após a delimitação da necrose tecidual local, seguido de fechamento por segunda intenção e/ou enxertos/retalhos. RESULTADOS: todos os pacientes evoluíram com fechamento total da lesão após o desbridamento tardio a granulação da ferida operatória e a(os) sutura primária/retalhos pediculados. Três pacientes (50%) evoluíram com processo infeccioso profundo devido aos sucessivos procedimentos operatórios. CONCLUSÃO: sejam quais forem os métodos de tratamento empregados, estes devem ser feitos de maneira radical, sob risco de evolução dos pacientes para septicemia e óbito. .
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Lesões dos Tecidos Moles/cirurgia , Lesões dos Tecidos Moles/patologia , Avaliação de Resultados em Cuidados de Saúde , Ferimentos e LesõesRESUMO
La lipotransferencia hace referencia a la cosecha de tejido adiposo desde un sitio donante, que se aplica a modo de injerto libre en un sitio receptor. Su primer reporte aparece hace más de un siglo y desde entonces, sobre todo en las últimas décadas, se ha venido indicando para su uso como relleno en pacientes con defectos de volumen en tejidos blandos. Presentamos 4 casos de pacientes en edad pediátrica a quienes se les realizó lipotransferencia para simetrizar defectos de volumen, por diferentes etiologías, en el Hospital Italiano de Buenos Aires, los cuales cursaron con buena evolución y resultados satisfactorios.
Lipofi lling refers to the harvest of adipose tissue from a donor site, which is applied as a free graft in a receptor site. The fi rst report appears over a century ago and since then, especially in recent decades, it has been indicated for use as fi lling in patients with soft tissue volume defects. We report 4 cases of pediatric patients who were performed this technique to symmetrize volume in diff erent pathologies with soft tissue defects at the Hospital Italiano of Buenos Aires, which progressed with good performance and satisfactory results
Assuntos
Humanos , Masculino , Feminino , Adolescente , Tecido Adiposo/transplante , Lesões dos Tecidos Moles/patologia , Procedimentos de Cirurgia Plástica/métodos , Retalhos de Tecido Biológico/cirurgiaRESUMO
Background: The soft tissues injury in periarticular fractures of the lower extremities determines the proper time to perform bone fixation. Objective: The aim of this study was to determine the intra and interobserver agreement in the Tscherne classification. Methods: This is a descriptive, prospective study for patients admitted to the Pablo Tobón Uribe Hospital (PTUH) with tibial plateau or tibial pilon fractures. We performed a standardize evaluation using video photography at the time of admission and 24, 48, and 72 h after admission. Fifteen five reviewers who had various levels of training produced a total of 1,200 observations. The intra- and interobserver agreement was assessed using a weighted kappa for multiple raters and more than two categories. Results: Twenty patients were admitted with tibial plateau and tibial pilon fractures. The intraobserver agreement for all 15 raters was kappa 0.81 (95% CI 0.79-0.83), and the interobserver agreement for all 15 raters was kappa 0.65 (95% CI 0.55-0.73). The interobserver agreement at 24 h was kappa 0.67 (95% CI 0.46-0.86). Conclusions: Classifying the severity of soft tissue injury is critical in planning the surgical management of fractures of the lower extremities. Based on our results, we can reasonably argue that the Tscherne classification produced an adequate level of agreement and could be used to standardize and to guide the treatment, and to conduct research studies.
Antecedentes: La lesión de los tejidos blandos en fracturas periarticulares del miembro inferior determina el momento adecuado para realizar la fijación ósea. Objetivo: El propósito de este estudio fue determinar la concordancia intra e interobservador para la clasificación de Tscherne. Métodos: Estudio descriptivo, prospectivo en pacientes ingresados al Hospital Pablo Tobón Uribe con fracturas de platillos tibiales o pilón tibial. Se realizó una evaluación estandarizada utilizando videos y fotografías al momento del ingreso y 24, 48 y 72 h después. Quince evaluadores que tenían diferentes niveles de entrenamiento produjeron 1200 observaciones. La concordancia intre e interobservador fue evaluada utilizando kappa ponderado para múltiples evaluadores y más de dos categorías. Resultados: Veinte pacientes fueron admitidos con fracturas de los platillos o del pilón tibial. La concordancia intraobservador para los 15 evaluadores fue kappa 0.81 (95% IC 0.79-0.83), y la concordancia interobservador para los 15 evaluadores fue kappa 0.65 (95% IC 0.55-0.73). La concordancia interobservador a las 24 h del ingreso fue kappa 0.67 (95% IC 0.46-0.86). Conclusión: Clasificar la gravedad de la lesión de los tejidos blandos es un paso fundamental en la planeación del manejo quirúrgico de las fracturas periarticulares del miembro inferior, con base en nuestros resultados podemos afirmar razonablemente que la clasificación de Oestern y Tscherne tiene un nivel de concordancia adecuado y podría utilizarse de forma sistemática para estandarizar la evaluación entre los ortopedistas para orientar el tratamiento y también con fines investigativos.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Fraturas Fechadas/classificação , Lesões dos Tecidos Moles/classificação , Fraturas da Tíbia/classificação , Fraturas Fechadas/patologia , Variações Dependentes do Observador , Estudos Prospectivos , Lesões dos Tecidos Moles/patologia , Fatores de Tempo , Índices de Gravidade do Trauma , Fraturas da Tíbia/patologiaRESUMO
A legislação do SUS garante a saúde para todos e de maneira integral, do homem como um ser holístico, desde problemas básicos e simples até cirurgias avançadas de nível terciário. A saúde bucal faz parte dessa garantia de atendimento e um dos problemas mais graves enfrentados é câncer de boca, que tem na educação e no conhecimento dois pilares para sua prevenção e diagnóstico precoce, sendo eles: a percepção dos usuários que é apurada pelo conhecimento dos profissionais que capacitam a população referenciada a ele e o encaminhamento correto dos casos. É exatamente esse o objetivo do nosso estudo realizado nas Unidades de Saúde da Família do Distrito Sanitário III, Recife - Pernambuco com os usuários que estiveram em atendimento. De acordo com a pesquisa, 13,63% dos dentistas não têm segurança para diagnosticar, referenciam o paciente para o serviço correto, porém não notificam a lesão, e a população precisa ser melhor instruída em relação às lesões de boca.
The legislation ensures health care to all and in a general way through a holistic approach, including basic and simple procedures as well as advanced third level surgeries. Oral health is part of this service and one of the most serious problems faced is oral cancer, which has on the education and knowledge two pillars for its prevention and early diagnosis: the perception of users is determined by the knowledge of professionals who enable the enrolled population, as well as the proper routing of cases. That was precisely the aim of our study with the users of the Family Health Unit of Sanitary District III (Recife-PE). According to the survey, 13.63% of dentists do not have security to diagnose, refer the patient to the correct service, but do not report the injury, and the population needs to be better educated about the mouth lesions.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Boca/lesões , Odontologia em Saúde Pública/educação , Percepção , Saúde da Família/educação , Interpretação Estatística de Dados , Diagnóstico Bucal , Conhecimentos, Atitudes e Prática em Saúde , Lesões dos Tecidos Moles/patologia , Inquéritos e QuestionáriosRESUMO
PURPOSE: The aim of the present study was to assess histologic changes in the temporomandibular joint (TMJ) of adult rats subjected to unilateral fracture of the mandibular condyle and soft tissue injury. MATERIALS AND METHODS: The animals were divided into 2 groups: one had surgical treatment for soft tissue repair and the other had no soft tissue treatment. All histologic evaluations were performed according to the presence or absence of synovitis, vascularity, presence or absence of joint inflammation, and presence or absence of the articular disc. The contralateral TMJs also were evaluated. RESULTS: The results showed few histologic changes in the synovial membrane and joint disc for the 2 groups and in the synovial membrane and disc of the contralateral side, where indirect trauma occurred in the unoperated joint. CONCLUSION: This study showed that treating or not treating soft tissues does not change the treatment results of condyle fracture or interfere with TMJ pathosis.
Assuntos
Cápsula Articular/lesões , Côndilo Mandibular/lesões , Fraturas Mandibulares/cirurgia , Lesões dos Tecidos Moles/cirurgia , Articulação Temporomandibular/lesões , Animais , Artrite/patologia , Vasos Sanguíneos/patologia , Hemartrose/patologia , Cápsula Articular/patologia , Cápsula Articular/cirurgia , Luxações Articulares/patologia , Luxações Articulares/cirurgia , Masculino , Côndilo Mandibular/cirurgia , Ratos , Ratos Wistar , Lesões dos Tecidos Moles/patologia , Membrana Sinovial/patologia , Sinovite/patologia , Articulação Temporomandibular/patologia , Articulação Temporomandibular/cirurgia , Disco da Articulação Temporomandibular/lesões , Disco da Articulação Temporomandibular/patologia , Disco da Articulação Temporomandibular/cirurgiaRESUMO
As infecções que afetam a cavidade bucal são de origem polimicrobiana e, muitas vezes, ocorrem devido presença de fungos do gênero Candida. Esses microrganismos comportam-se como anfibiontes, isto é, são capazes de agredir o hospedeiro quando as condições ambientais e imunológicas são favoráveis, como em pacientes imunocomprometidos, com disfunções metabólicas ou que sofreram traumas mecânicos, químicos ou térmicos. O objetivo do presente estudo foi verificar a ocorrência de fungos do gênero Candida em próteses totais de idosos institucionalizados em uma Instituição asilar de Passo Fundo RS. Os dados foram coletados a partir de amostras das 42 próteses com auxílio de swab estéril. As amostras foram semeadas em gar Sabouraud Dextrose com cloranfenicol e incubadas por 72 horas a 37§C. Os resultados mostraram que do total de amostras, 33 (79%) apresentaram leveduras do gênero Candida. Dentre essas, 18 (54,5%) foram de C. albicans, 8 de (24,3%) de C. kruzei e 7 (21,2 %) de C. tropicalis
Infections that affect the oral cavity are polymicrobial and often occur due to the presence of Candida. These microorganisms behave as anfibiontes, it means they are able to attack the host when immunological and environmental conditions are favorable, as in immunocompromised patients with metabolic dysfunctions or that underwent mechanical, chemical or thermal trauma. The aim of this study was to verify the occurrence of Candida in dentures used by elderly institutionalized in an asylum in Passo Fundo (Rio Grande do Sul -Brazil). Data were collected from samples of 42 prostheses with the aid of a sterile swab. The samples were plated on Sabouraud dextrose agar with chloramphenicol and incubated for 72 hours at 37 øC. The results showed that from the overall number of samples, 33 (79%) had Candida yeasts. Among these, 18 (54.5%) were C. albicans, 8 (24.3%) of C. kruzei, and 7 (21.2%) of C. tropicalis
Assuntos
Humanos , Idoso , Idoso de 80 Anos ou mais , Candida albicans/patogenicidade , Candida/patogenicidade , Saúde do Idoso Institucionalizado , Higiene Bucal , Lesões dos Tecidos Moles/patologia , Prótese TotalRESUMO
BACKGROUND: The soft tissues injury in periarticular fractures of the lower extremities determines the proper time to perform bone fixation. OBJECTIVE: The aim of this study was to determine the intra and interobserver agreement in the Tscherne classification. METHODS: This is a descriptive, prospective study for patients admitted to the Pablo Tobón Uribe Hospital (PTUH) with tibial plateau or tibial pilon fractures. We performed a standardize evaluation using video photography at the time of admission and 24, 48, and 72 h after admission. Fifteen five reviewers who had various levels of training produced a total of 1,200 observations. The intra- and interobserver agreement was assessed using a weighted kappa for multiple raters and more than two categories. RESULTS: Twenty patients were admitted with tibial plateau and tibial pilon fractures. The intraobserver agreement for all 15 raters was kappa 0.81 (95% CI 0.79-0.83), and the interobserver agreement for all 15 raters was kappa 0.65 (95% CI 0.55-0.73). The interobserver agreement at 24 h was kappa 0.67 (95% CI 0.46-0.86). CONCLUSIONS: Classifying the severity of soft tissue injury is critical in planning the surgical management of fractures of the lower extremities. Based on our results, we can reasonably argue that the Tscherne classification produced an adequate level of agreement and could be used to standardize and to guide the treatment, and to conduct research studies.
ANTECEDENTES: La lesión de los tejidos blandos en fracturas periarticulares del miembro inferior determina el momento adecuado para realizar la fijación ósea. OBJETIVO: El propósito de este estudio fue determinar la concordancia intra e interobservador para la clasificación de Tscherne. MÉTODOS: Estudio descriptivo, prospectivo en pacientes ingresados al Hospital Pablo Tobón Uribe con fracturas de platillos tibiales o pilón tibial. Se realizó una evaluación estandarizada utilizando videos y fotografías al momento del ingreso y 24, 48 y 72 h después. Quince evaluadores que tenían diferentes niveles de entrenamiento produjeron 1200 observaciones. La concordancia intre e interobservador fue evaluada utilizando kappa ponderado para múltiples evaluadores y más de dos categorías. RESULTADOS: Veinte pacientes fueron admitidos con fracturas de los platillos o del pilón tibial. La concordancia intraobservador para los 15 evaluadores fue kappa 0.81 (95% IC 0.79-0.83), y la concordancia interobservador para los 15 evaluadores fue kappa 0.65 (95% IC 0.55-0.73). La concordancia interobservador a las 24 h del ingreso fue kappa 0.67 (95% IC 0.46-0.86). CONCLUSIÓN: Clasificar la gravedad de la lesión de los tejidos blandos es un paso fundamental en la planeación del manejo quirúrgico de las fracturas periarticulares del miembro inferior, con base en nuestros resultados podemos afirmar razonablemente que la clasificación de Oestern y Tscherne tiene un nivel de concordancia adecuado y podría utilizarse de forma sistemática para estandarizar la evaluación entre los ortopedistas para orientar el tratamiento y también con fines investigativos.
Assuntos
Fraturas Fechadas/classificação , Lesões dos Tecidos Moles/classificação , Fraturas da Tíbia/classificação , Adolescente , Adulto , Feminino , Fraturas Fechadas/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Estudos Prospectivos , Lesões dos Tecidos Moles/patologia , Fraturas da Tíbia/patologia , Fatores de Tempo , Índices de Gravidade do Trauma , Adulto JovemRESUMO
BACKGROUND: Degloving injuries may be a challenge when it comes to deciding the surgical approach to be used. Repositioning of the flap and suturing are faster and more straightforward, but often these procedures often lead to total or partial loss of the avulsed flap. Pharmacological agents with vascular properties that enhance the viability of the reattached flap could be beneficial to patients with degloving injuries. Experimental models with which to test this hypothesis are scarce. An experimental model reproducing a degloving injury of the hind limb of rats was developed in our department, and the effects of pentoxifylline (Ptx) and allopurinol (Alp) were assessed. METHODS: In all, 3 groups of rats were studied (25 rats each). A hind limb degloving model was used in all groups, resulting in a reverse flow flap. The flap was then repositioned and sutured. The control (Ct) group received only saline solution, the Ptx group received pentoxifylline (25 mg/kg), and the Alp group received allopurinol (45 mg/kg). The rats were observed for 7 days, after which they were killed, and the flap was removed. The total area of the avulsed flap and the necrotic area were measured. RESULTS: The median total flap area (cm) was 5.6 for the Ct group, 5.5 for the Ptx group, and 5.8 for the Alp group (P = 0.9465). Thus, the flaps were similar. The median necrotic flap area (cm) was 3.3 for the Ct group, 2.3 for the Ptx group, and 1.9 for the Alp group (P = 0.0001). There was a statistical difference between the Ct and Ptx groups and the Ct and Alp groups (P < 0.05). CONCLUSIONS: The areas of necrosis observed in the degloved flaps of the rats' hind limbs were smaller in the pentoxifylline and allopurinol groups. Although allopurinol seems to be more efficient, the difference was not significant.
Assuntos
Alopurinol/farmacologia , Pentoxifilina/farmacologia , Lesões dos Tecidos Moles/patologia , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos/irrigação sanguínea , Retalhos Cirúrgicos/patologia , Animais , Antioxidantes/farmacologia , Sobrevivência Celular/efeitos dos fármacos , Sobrevivência de Enxerto/efeitos dos fármacos , Membro Posterior/lesões , Membro Posterior/cirurgia , Masculino , Necrose/patologia , Necrose/prevenção & controle , Ratos , Ratos Wistar , Pele/irrigação sanguínea , Pele/efeitos dos fármacos , Pele/lesões , Pele/patologia , Lesões dos Tecidos Moles/tratamento farmacológico , Vasodilatadores/farmacologia , Xantina Oxidase/antagonistas & inibidoresRESUMO
Este estudo visou quantificar a presença de Cândida sp em indivíduos portadores de prótese total convencional de ambos os sexos, com idade entre 40 e 80 anos (média 60,32 ± 10,82 anos), usuários do Serviço de Prótese do Centro de Especialidades Odontológicas do município de Cataguases/MG. Especificamente, três espécies de Cândida sp foram quantificadas em indivíduos com presença e/ou ausência de lesões bucais. Participaram deste estudo, 22 pacientes que foram divididos em dois grupos: G1) usuários de prótese total sem lesões, onde foi coletado material apenas da prótese total e G2) usuários de prótese total com lesões, onde o material foi coletado da prótese total e da região que apresentou alguma lesão, com rigoroso padrão de biossegurança. As placas foram incubadas à temperatura de 35ºC e o crescimento acompanhado por até 48h. Houve prevalência de 77,30% no sexo feminino e de 81,81% nos leucodermas. A C. albicans obteve a maior média (2,13 ± 2,43) na prótese. A prova de Mann-Whitney apontou uma diferença estatisticamente significante (p = 0,039) para a C. albicans na prótese em relação às outras espécies e locais pesquisados. Concluiu-se que após a instalação das próteses totais, as lesões fúngicas podem ser prevenidas com orientações quanto aos métodos de higienização e manutenção da saúde bucal
This study aimed at quantifying the presence of Candida sp in individuals with conventional full denture from both gender, aged between 40 and 80 years (average 60.32 ± 10.82 years), users of the Dental Specialties Service Center in the city of Cataguases - MG. Three species of Candida were specifically quantified in individuals with and/or without absence of oral lesions. The study included 22 patients divided into two groups: G1) composed by denture users without lesions, with samples collected only from the denture and G2) composed by denture users with injuries, with samples collected from the denture and from the injured region according to rigorous standard of biosecurity. The plates were incubated at 35°C and growth monitored for up to 48 hours. There was a prevalence of 77.30% in females and 81.81% in Caucasian patients. C. albicans obtained the highest average (2.13 ± 2.43) in the prosthesis. The Mann-Whitney test showed a statistically significant difference (p = 0.039) for C. albicans in denture in comparison to other species and areas also tested. It was concluded that after the installation of dentures, fungal lesions can be prevented by guidance on methods of cleaning and maintenance of oral health
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Candida , Lesões dos Tecidos Moles/patologia , Lesões dos Tecidos Moles , Saúde Bucal , Higiene Bucal , Prótese Total , Distribuição de Qui-Quadrado , Estatísticas não ParamétricasRESUMO
La abfracción es una lesión por pérdida del tejido duro en la unión amelo cementaría del diente en vestibular o lingual, acompañada generalmente de sensibilidad. El estrés emocional, la acción de fuerzas excéntricas generadas por interferencias oclusales, el bruxismo, pueden ser considerados factores predisponentes; por ello se planteó un estudio observacional descriptivo con componente analítico, el objetivo fue determinar la prevalencia de abfracciones, para luego asociarlas con el estrés emocional en 110 pacientes de 15 a 59 años en edad en la Facultad de Odontología de la Universidad Nacional de Asunción y una clínica privada en el año 2008. Para determinar el nivel de estrés emocional se utilizó un cuestionario, Maslach Burnout Inventory, valorado en una escala de alto/moderado, leve y bajo, se utilizó la inspección clínica y el sondeo para diagnosticar la abfracción. Se encontró una prevalencia de abfracción de 44%, de los cuales el 49% correspondió al sexo masculino. El diente más afectado fue el primer premolar inferior izquierdo (9,9%). El 100% de los pacientes presentaban estrés y hubo asociación estadísticamente significativa entre la abfracción y el bruxismo 0,004 p<0,005(F), también con el estado civil de los pacientes 0,001 p<0,005(F) entre los que prevalecían los casados 59%. Un alto porcentaje de pacientes presentaban abfracciones y estrés, pero no hubo asociación estadísticamente significativa p=0,3(F).
Abfraction is a lesion due to hard tissue loss at the cementoenamel junction either on buccal or lingual surface of a tooth, generally accompanied by sensitivity. Emotional estrés, eccentric forces generated by occlusal interferences, bruxism can be considered as predisposing factors, therefore an observational descriptive study with an analytic component was set out in order to determine the prevalence of abfractions and to relate them to emotional estrés in 110 patients ages 15 - 59 at the Facultad de Odontología de la Universidad Nacional de Asunción as well as at a private clinic in 2008. In order to determine emotional estrés, a questionnaire by Maslach Burnout Inventory was used, ranging from high, moderate, mild and low. Clinical checkup and probing were the means to diagnose abfraction. A prevalence of 44% was found, 49% of which were males. The most affected tooth was lower left first premolar (9.9%). 100% presented estrés and there was statistically significant relationship between abfraction and bruxism 0,004 p<0,005(F), also regarding marital status, there was more prevalence among married patients (59%). A high percentage of patients presented both abfraction and estrés, but there was no statistically significant association p=0,3(F).
Assuntos
Humanos , Masculino , Adolescente , Adulto , Feminino , Pessoa de Meia-Idade , Bruxismo/patologia , Oclusão Dentária , Estresse Psicológico/patologia , Lesões dos Tecidos Moles/diagnóstico , Lesões dos Tecidos Moles/patologia , Lesões do Pescoço/diagnósticoAssuntos
Fenitoína/efeitos adversos , Fenitoína/farmacocinética , Lesões dos Tecidos Moles/metabolismo , Lesões dos Tecidos Moles/patologia , Feminino , Humanos , Infusões Intravenosas , Pessoa de Meia-Idade , Necrose , Fenitoína/administração & dosagem , Lesões dos Tecidos Moles/induzido quimicamenteRESUMO
Estudio analítico no concurrente, 48 pacientes >65 años con fracturas intertrocantericas tratadas con DHS, comparando el abordaje mínimo con el lateral extendido, 75% sexo femenino, 62,5% grupo de edad 65-74 años, 50% fracturas 3.1 A 1.1, hipertensión arterial 31,5% y diabetes 27,8%. El 85% camino con independencia total en su hogar, la perdida sanguínea < de 300 cc. en el 100%, el 68% del tiempo quirúrgico < 60 minutos, mortalidad de 12,5% al año, el abordaje mínimo lateral es una técnica que reduce el daño de los tejidos blandos y disminuye la perdida sanguínea.