Hospital de Santa Maria
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Técnica de reconstrução de fratura do úmero proximal de 4 fragmentos
Get PDFOs autores apresentam um caso clínico e descrevem uma técnica de reconstrução de fratura do úmero proximal de 4 fragmentos. Apresenta-se um paciente de 60 anos do sexo feminino, que recorreu ao Serviço de Urgência (SU) pós queda sobre o ombro direito. Efectuou radiografia e verificou-se uma fractura-luxação da cabeça umeral em 4 fragmentos associada a lesão do nervo radial. Demonstramos na apresentação a radiografia prévia e após manobra de redução. A paciente ficou internada e a decisão terapêutica passava pela opção entre tentativa de osteossíntese ou a artroplastia gleno-umeral. Os autores optaram por tentativa de reconstrução da cabeça umeral. Para isso optou-se por uma redução aberta e estabilização com fios de Kirschner tipo Kapandji. De modo a reconstruir a cabeça umeral efetuou-se interposição com um bloco de aloenxerto de patela para apoio do fragmento cefálico e das tuberosidades, tendo-se reunindo as mesmas com sutura. Os autores demonstram na apresentação a radiografia pós-operatória e a redução anatómica conseguida, bem como um diagrama demonstrando a posição do aloenxerto, a osteossíntese e a posição dos fios de Kirschner utilizada. Seguiu-se então imobilização tipo Velpeau. O pós-operatório decorreu sem intercorrências. Apresentamos neste caso clínico uma técnica que pode ser útil para a reconstrução do úmero proximal nos casos em que se pretende dar uma oportunidade para a osteossíntese em fraturas em 4 fragmentos do úmero proximal. Uma oportunidade para a osteossíntese em fraturas em 4 fragmentos do úmero proximal.info:eu-repo/semantics/publishedVersio
Transformação maligna na osteomielite crônica
No full textINTRODUCTION:
Carcinomatous degeneration is a rare and late complication developing decades after the diagnosis of chronic osteomyelitis.
OBJECTIVES:
To present the results from a retrospective study of six cases of squamous cell carcinoma arising from chronic osteomyelitis.
METHODS:
Six cases of chronic osteomyelitis related to cutaneous squamous cell carcinoma were identified. The cause and characteristics of the osteomyelitis were analyzed, as well as time up to malignancy, the suspicion signs for malignancy, the localization and histological type of the cancer, and the type and result of the treatment.
RESULTS:
The mean time between osteomyelitis onset and the diagnosis of malignant degeneration was 49.17 years (range: 32-65). The carcinoma resulted from tibia osteomyelitis in five cases and from femur osteomyelitis in one. The pathological examination indicated cutaneous squamous cell carcinoma in all cases. All the patients were staged as N0M0, except for one, whose lomboaortic lymph nodes were affected. The treatment consisted of amputation proximal to the tumor in all patients. No patient presented signs of local recurrence and only one had carcinoma metastasis.
CONCLUSION:
Early diagnosis and proximal amputation are essential for prognosis and final results in carcinomatous degeneration secondary to chronic osteomyelitis.info:eu-repo/semantics/publishedVersio
Hyperglycemia and Hyperinsulinemia-Like Conditions Independently Induce Inflammatory Responses in Human Chondrocytes
Get PDFTo elucidate the mechanisms by which type 2 Diabetes Mellitus (DM2) constitutes a risk
factor for the development and progression of osteoarthritis (OA), this work determined whether
high glucose and/or high insulin, the hallmarks of DM2, are capable of activating the transcription
factor, Nuclear Factor-κB (NF-κB), which plays a critical role in OA by inducing the expression of
pro-inflammatory and catabolic genes. For this, we analyzed NF-κB activation by measuring the
nuclear levels of p65 by western blot. As readouts of NF-κB activity, Interleukin-1β, Tumor Necrosis
Factor-α, and inducible nitric oxide synthase (iNOS) expression were analyzed by real time RT-PCR
and western blot. Culture of the human chondrocytic cell line, C28-I2, in high glucose (30 mM)
increased nuclear NF-κB p65 levels in a time-dependent manner, relative to cells cultured in medium
containing 10 mM glucose (regular culture medium). High glucose-induced NF-κB activation was
inhibited by co-treatment with its specific inhibitor, Bay 11-7082, 5 µM. Culture of primary human
chondrocytes under high glucose for 24 h increased IL-1β and TNF-α mRNA levels by 97% (p = 0.0066)
and 85% (p = 0.0045), respectively, while iNOS mRNA and protein levels and NO production increased
by 61% (p = 0.0017), 148% (p = 0.0089), and 70% (p = 0.049), respectively, relative to chondrocytes
maintained in 10 mM glucose. Treatment of chondrocytic cells with 100 nM insulin was also sufficient
to increase nuclear NF-κB p65 levels, independently of the glucose concentration in the culture
medium. This study shows that hyperglycemia and hyperinsulinemia are independently sufficient to
induce inflammatory responses in human chondrocytes, namely by activating NF-κB. This can be a
relevant mechanism by which DM type 2 and other conditions associated with impaired glucose and
insulin homeostasis, like obesity and the metabolic syndrome, contribute to the development and
progression of OA.info:eu-repo/semantics/publishedVersio
Congenital Milium of the Nipple
Get PDFA 12-month-old girl presented with an asymptomatic, pearly nodule on the left nipple that had been present from birth and was currently 3 mm in diameter and growing. Assuming the diagnosis of congenital primary milium of the nipple, we took a "wait and see" approach. After 3 months, the pearl disappeared without any scarring.info:eu-repo/semantics/publishedVersio
Are Ankylosing Spondylitis Patients at Risk for Poor Total Hip Replacement Outcomes
No full textHip involvement in Ankylosing Spondylitis is common and leads to physical
and function restriction. Hip replacement surgery is a successful and effective
treatment for end-stage hip involvement; however in Ankylosing Spondylitis
patient’s prosthesis long-term survival is lesser than other causes of hip
osteoarthritis. We report a case of 61-year old Ankylosing Spondylitis male
patient with bilateral cementless hip replacement with 26-year and 25-year
follow-up.info:eu-repo/semantics/publishedVersio
Traumatologia da Articulação de Lisfranc
Get PDFAs lesões do complexo articular de Lisfranc são frequentes e muitas vezes subdiagnosticadas
em desportistas. São lesões com tempo prolongado de recuperação e que muitas vezes
colocam a carreira desportiva em risco, na medida em que a maioria evolui rapidamente
para osteoartrose sintomática. Um nível elevado de suspeita de reconhecimento dos sinais
clínicos de lesão e uso dos exames de imagem adequados são críticos para um diagnóstico
correto e precoce, de modo a se conseguir um tratamento adequado e garantir rápido
regresso à atividade desportiva. Os tratamentos ideais para as lesões de Lisfranc são
controversos e devem ser adequados ao tipo de lesão, estadio e características do atleta.
Este artigo apresenta uma revisão da atual evidência científica em relação aos princípios
de diagnóstico e tratamento das lesões do complexo articular de Lisfranc na população
praticante de desporto.info:eu-repo/semantics/publishedVersio
Burnout syndrome and wellbeing in anesthesiologists: the importance of emotion regulation strategies
Get PDFAnesthesiologists face stressful working conditions that can culminate in burnout syndrome. Despite various studies and protective measures which have attempted to prevent this situation, burnout continues to be a problem within the profession, impacting negatively on physicians' lives and their performance. In this review article mechanisms and consequences of burnout are described in addition to individual strategies for stress management and burnout reduction with potential impact on health care quality and wellbeing in anesthesiologists. Organizational strategies appear to have an important role in burnout reduction but need to be used in conjunction with individual programs. The latter are essential to both reducing stress and burnout in anesthesiologists and improving happiness and wellbeing. New measures of emotion regulation strategies such as mindfulness, self-compassion, resilience and empathy promotion have been shown to be approaches with substantial supporting evidence for reducing burnout and improving stress management. The evaluation and implementation of these self-regulatory competencies is a challenge. Further research is necessary to identify which programs will best suit the needs of anesthesiologists and to measure their effects on patient care and health care system quality.info:eu-repo/semantics/publishedVersio
Coronary artery bypass surgery in young adults: excellent perioperative results and long-term survival
Get PDFOBJECTIVES:
To analyse perioperative results, long-term survival and freedom from complications after coronary artery bypass grafting (CABG) in young adults.
METHODS:
A total of 163 patients, 40 years old or younger, had isolated CABG from January 1989 to December 2010. Pre- and perioperative demographic and clinical data were retrieved from a prospectively organised database. Follow-up data were obtained by letter or telephone interviews. The mean age of the patients was 37.6 ± 2.9 years and 146 were men (90%). Fifty-three patients (32.5%) had angina class III/IV; 106 (65.0%), previous myocardial infarction; and 23 (14.1%), impaired left ventricular function (ejection fraction <40%). Indication for surgery was 3-vessel disease in 101 cases (62.0%), 2-vessel disease in 30 (18.4%) and single-vessel disease in 32 (19.6%). The left main stem was affected in 16 patients (9.8%). The mean EuroSCORE II was 0.92 ± 0.71. A total of 417 grafts were constructed (mean 2.6 grafts/patient), 247 of which (59.2%) were arterial.
RESULTS:
There were no in-hospital deaths. The mean hospital stay was 7.1 ± 4.0 days. Four patients (2.5%) were lost to follow-up, which extended from 3 to 25 years (mean 15.1 ± 5.5 years). There were 22 late deaths, 72.7% of cardiac or unknown origin. The 5-, 10- and 20-year survival rates were 98.7 ± 10.9, 95.2 ± 1.8 and 79.4 ± 4.4%, respectively. Twenty-six patients (18.1%) had non-fatal cardiac adverse complications (myocardial infarct, percutaneous re-revascularization or class III/IV angina), for 5-, 10- and 20-year freedom from complications of 97.9 ± 1.2, 91.9 ± 2.5 and 65.7 ± 7.1%, respectively. Twenty-two patients (17.5%) needed re-revascularization, for 5-, 10- and 20-year freedom from re-revascularization of 97.6 ± 1.4, 91.9 ± 2.6 and 69.5 ± 6.7%, respectively.
CONCLUSIONS:
Despite the aggressive nature of coronary artery disease in young patients, perioperative death and morbidity rates are low, with good long-term survival and low rates of re-revascularization.info:eu-repo/semantics/publishedVersio
Surgical Complications in Early Post-transplant Kidney Recipients
Get PDFBACKGROUND:
The purpose of this study was to determine the incidence of early surgical complications of kidney transplantation in our institution and its association with donor and recipient factors, as well as patient and transplant outcome.
METHODS:
A retrospective cohort study of all kidney transplants performed during 2015 was made. We evaluated the incidence of surgical complications and the outcome of patients and grafts at a 3-month follow-up interval.
RESULTS:
During the study period, 141 kidney transplants occurred. Seventeen patients had surgical complications (6 urologic, 6 vascular, and 5 other complications). Five patients lost the graft during the follow-up. Older age was associated with other surgical complications (P = .023), and graft loss was associated with the existence of surgical complications, namely, vascular complications (P <.001). For both surgical complications in general and urologic complications, a statistically significant relationship was found with patient weight (P = .003 and P = .034, respectively). The correlation between body mass index (BMI) and surgical complications was not statistically significant.
CONCLUSIONS:
Our study reveals that older and heavier patients have a higher risk of surgical complications and that vascular complications are associated with graft loss. A statistically significant relationship was not found between BMI and surgical complications, which could indicate that BMI is not the ideal obesity marker. The incidence of surgical complications found in our study is similar to the literature. The selection of transplant recipients is a difficult task, and the possibility of additional surgical complications in older and overweight patients should be taken into account.info:eu-repo/semantics/publishedVersio