101 research outputs found
Youngswick osteotomy for treatment of moderate hallux rigidus: Thirteen years without arthrodesis
No full textPurpose: The purpose of this study was to evaluate the need for first metatarsophalangeal joint (MTPJ) arthrodesis as a measure of the Youngswick osteotomy survival, or any other secondary procedures in the long term follow up in patients with stage II and III hallux rigidus.Methods: We retrospectively evaluated 61 patients with stage II and III hallux rigidus who had undergone Youngswick osteotomy and analyzed their outcomes in the long term using first metatarsophalangeal arthrodesis as an end point. The candidates for inclusion underwent clinical and radiographic evaluation, including the Foot and Ankle Outcome Score (FAOS).Results: Mean follow-up time was 54.8 months. All patients had improved their FAOS, with all achieving postoperative scores >75 points at the final follow up (P < 0.05). Although 49 % (P < 0.05) of the patients depicted worsening of the radiological aspect of the MTPJ, over the long time, no patient needed a first MTPJ arthrodesis.Conclusion: Our results show satisfying long-term outcomes with regard to function, pain relief, and patient satisfaction of the Youngswick osteotomy in grade II as well as grade III hallux rigidus that sustained over the follow up period; even in patients followed up for over 13 years. (C) 2019 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved
CORR Insights®: PROMIS Pain Interference and Physical Function Scores Correlate With the Foot and Ankle Ability Measure (FAAM) in Patients With Hallux Valgus
No full textGenetic polymorphism associated with the occurrence of postoperative nausea and vomiting (PONV) in patients undergoing oncological surgeries
No full textIntrodução: A decisão clínica sobre qual população cirúrgica deve receber medicação antiemética profilática é baseada preferencialmente em sistemas de pontuação com base no risco clínico. No entanto, os fatores herdados podem desempenhar um papel significativo na sensibilidade basal para NVPO em populações específicas. Métodos: Um estudo de casocontrole foi conduzido para identificar possíveis diferenças clínicas, étnicas e genéticas interindividuais que podem ser responsáveis por prever NVPO em uma população submetida a cirurgia oncológica. Foram seguidos consecutivamente 310 pacientes cirúrgicos durante as primeiras 24 horas de pós-operatório. Um buffy coat foi obtido a partir de 10 mL de amostra de sangue e processado para genotipagem de 32 diferentes polimorfismos de nucleotídeo único (SNPs), a partir de 23 genes candidatos, usando PCR em tempo real. Resultados: Sexo feminino, idade, história de NVPO/enjoo, uso de opioide pós-operatório, escore APFEL e vômito induzido por quimioterapia foram encontrados como fatores de risco para NVPO na análise univariada (p <0,05). História de NVPO ou cinetose permaneceu como o único fator preditor independente para NVPO na análise multivariada (OR ajustado = 3,15; IC 95%: 1,34-7,37, p = 0,008). Destaca-se associação significativa de rs208294 (gene P2RX7) e NVPO nos modelos de genótipo, dominante e alelo (p <0,05). Os modelos de regressão multivariada (ajustados para história de NVPO ou cinetose) mostraram o alelo C polimórfico de rs208294 como protetor contra NVPO. Além disso, foram encontradas associações significativas do polimorfismo rs17641121 (gene KCNJ3) e NVPO (p <0,05) em uma amostra estratificada classificada como escore de alto risco de acordo com o escore APFEL. As raças autodeclaradas e a ancestralidade molecular apresentaram maiores percentuais de componentes europeus, africanos ou asiáticos em pessoas autodeclaradas como brancas, negras ou amarelas, respectivamente. No entanto, não houve diferença na incidência de NVPO relacionada à raça. Conclusão: Antecedente de NVPO/cinetose, polimorfismo rs208294 do gene P2RX7 e polimorfismo rs17641121 do gene KCNJ3 são os preditores mais importantes para NVPO no presente estudoClinical decision on which surgical population should receive prophylactic anti-emetic medication is based preferentially on clinical risk-based score systems. However, inherited factors may play a significant role in background sensitivity for PONV in specific populations. Methods: A case-control study was conducted to identify possible clinical, ethnic and genetic inter-individual differences that may account for PONV prediction in a population undergoing cancer surgery. We consecutively followed 310 surgical patients during the first 24 postoperative hours. A buffy coat was obtained from a 10 mL blood sample and processed for genotyping of 32 different single nucleotide polymorphisms (SNPs), from 23 candidate genes, using Real-time PCR. Results: Female gender, age, history of PONV/motion sickness, postoperative opioid use, APFEL score and chemotherapy-induced vomiting were found as risk factors for PONV in univariate analysis (p<0.05). History of PONV or motion sickness remained as the only independent predictor factor for PONV in the multivariate analysis (adjusted OR=3.15; 95% CI: 1.34-7.37, p=0.008). We detected significant association of rs208294 (P2RX7 gene) and PONV in Genotype, Dominant and Allele Models (p<0.05). The multivariate regression models (adjusted for history of PONV or motion sickness) showed the polymorphic C allele of rs208294 as protector against PONV. Furthermore, we found significant associations of rs17641121 polymorphism (KCNJ3 gene) and PONV (p<0.05) in a stratified sample classified as high-risk score according to APFEL Score. Self-declared races and molecular ancestry showed higher percentages of European, African or Asian components in people self-reported as White, Black or Yellow, respectively. However, there was no difference in the incidence of PONV related to race. Conclusion: Previous PONV/motion sickness, rs208294 polymorphism from P2RX7 gene and rs17641121 polymorphism from KCNJ3 gene are the most important predictors for PONV in the present stud
Proliferación osteocondromatosa parostal bizarra en la pierna y el pie
No full textBackground: Bizarre parosteal osteochondromatous proliferation is a rare pseudotumorous lesion commonly found
in hands and feet. Nora et al first described the lesion in
1983. Although it is a benign condition, it presents atypical
microscopic features and a strong tendency to recur.
Methods: In this study, we report 7 cases of bizarre parosteal osteochondromatous proliferation involving the
leg and the foot, treated surgically.
Results: In six patients we performed a surgical resection
with wide margins, and one patient underwent a hallux
amputation at the level of the metatarsophalangeal joint.
At 41 months follow-up, only one patient treated originally in another institution showed signs of recurrence.
Conclusions: In spite of its low incidence this lesion is
relevant since there exists a variety of differential diagnoses with benign and malignant bone tumors. Once the
diagnosis is confirmed through a bone biopsy, surgical
excision with wide margins is the treatment of choice.Introducción: La proliferación osteocondromatosa parostal bizarra (POPB), descrita por primera vez en 1983 por
Nora y cols., es una lesión ósea seudotumoral que suele localizarse en las manos y los pies. A pesar de su benignidad
posee la característica singular de mostrar atipias histológicas y una tendencia notable a la recurrencia local.
Materiales y métodos: En este trabajo se presentan 7 casos de proliferación osteocondromatosa parostal bizarra localizados en la pierna y el pie, tratados quirúrgicamente.
Resultados: En 6 pacientes se realizó la resección con
márgenes amplios, mientras que uno requirió la amputación del hallux a nivel metatarsofalángico. A 41 meses de
seguimiento promedio, sólo una lesión tratada inicialmente en otra institución mostró recidiva.
Conclusiones: A pesar de su baja incidencia se trata de una
lesión importante, ya que plantea diversos diagnósticos diferenciales radiológicos e histológicos con lesiones tumorales benignas y malignas. La indicación de una punciónbiopsia ante la sospecha clínica y la resección con márgenes amplios resultan de gran valor, dado que pueden condicionar el tipo de tratamiento y el pronóstico de la lesión
EOSINOPHILIC GRANULOMA OF BONE AND ITS RELATIONSHIP TO HAND-SCHÜLLER-CHRISTIAN AND LETTERER-SIWE SYNDROMES
No full text 1. The clinical, radiological and pathological features of 106 cases of eosinophilic granuloma of bone (solitary and multiple) are reported. 2. Our findings support strongly the concept that eosinophilic granuloma, Hand-Schüller-Christian and Letterer-Siwe syndrome are closely related manifestations of a single pathological disorder, characterised fundamentally by the proliferation of non-neoplastic histiocytes, intermingled with a variable amount of eosinophilic leucocytes and other inflammatory elements. 3. Lipid-bearing histiocytes (xanthoma cells) may be found in variable amounts in solitary and multiple lesions but are more abundant in the more extensive or chronic lesions of Hand-Schüller-Christian syndrome. 4. These entities may perhaps represent some type of immuno-allergic (hypersensitive) reaction to a still unknown infection, possibly viral. </jats:p
Analgesia, sedação e bloqueio neuromuscular em UTI
No full textA dor é um sintoma freqüentemente associado ao paciente crítico, O tratamento adequado desta condição está relacionado não apenas aos processos de humanização na UTI como também a modificar o prognóstico e reduzir os custos hospitalares. São apresentados métodos de avaliação da intensidade da dor e técnicas de tratamento, desenvolvidos pela equipe atuante na UTI. Exposição a um ambiente com grande sobrecarga de estímulos sensitivos, dolorosos, ruído, aspiração traqueal e a privação de sono pode requerer o uso de drogas para controlar a ansiedade e a inquietude. Além disso, algumas situações clínicas, tais como a ventilação mecânica, podem não dispensar a sedação para lograrem sucesso. A importância e as indicações clínicas do uso de relaxantes musculares são revistas.Pain is a major symptom which is often found in critically iii patients. Adequate management of this condition is implicated not only with humanization process in the ICU but may also to improve outcome and reduce hospital costs. Importance of measuring daily pain scores by the ICU team, as well as the available techniques of providing a good pain relief are pointed out. Exposition to a noxious environment which includes pain, noise, tracheal suctioning, sensory overload or sleep deprivation may require the use of drugs to promote sedation in order to control anger and mental stress. Furthermore, some clinical conditions, such as mechanical ventilation, may require sedation for its success. Some clinical aspects of neuromuscular blocking agents and their uses in the ICU are also reviewed
Juxta-articular bone cysts (intra-osseous ganglia): a clinicopathological study of eighty-eight cases
No full text The clinical, radiographic and pathological features of eighty-eight cases of histologically verified intra-osseous ganglia in eighty-three patients are described. All were located in the subchondral bone adjacent to a joint and most frequently involved the hip, the ankle (medial malleolus), the knee and the carpal bones. Forty-seven of the eighty-three patients were male and all the patients were between fourteen and seventy-three years of age, with an average age of forty-one years. There are two fundamental types of intra-osseous ganglia, one apparently arising by penetration of juxta-osseous ganglion into the underlying bone, a mechanism proved in fourteen of our eighty-eight cases (16 per cent); in the remaining seventy-four cases, the ganglion cyst was primarily intra-osseous ("idiopathic"). The initial cause of the intramedullary mucoid degeneration is discussed. We believe that mechanical stress and repeated minor trauma near the surface of the bone may lead to intramedullary vascular disturbance with consequent foci of aseptic bone necrosis. The revitalisation of these areas causes fibroblastic proliferation, followed by mucoid degeneration of the connective tissue, possibly due to some unknown local factor. Curettage or excision is usually effective, and recurrence (only four cases) is exceptional. </jats:p
Luxación metatarsofalángica del segundo dedo secundaria a rotura aguda de la placa plantar en un deportista: Informe de un caso y revisión bibliográfica
No full textIs a short stem suitable for patients with hip dysplasia? A report on technical problems encountered during femoral reconstruction
No full textIntroduction:A wide variety of stems have been used for the treatment of osteoarthritis secondary to advanced hip dysplasia. Since evidence for using short stems in dysplastic hips is limited, we planned to analyse the technical problems encountered when reconstructing the proximal femur of patients with osteoarthritis secondary to congenital dysplasia of the hip treated with total hip arthroplasty (THA) using a type 2B short stem.Methods:We prospectively analysed 17 patients (22 hips) treated with primary THA performed with a single-branded short uncemented stem with metaphyseal fixation (MiniHip™; Corin). We excluded cases in which other type of stems were used, or in which retrospective data was only available. Mean follow-up was 41.22 months (minimum 24). We analysed clinical outcome using the modified Harris Hip Score (mHHS) and pain using the visual analogue scale (VAS). Radiographs were examined in order to determine causes of complications and revision surgery.Results:All patients showed statistically significant improvement when preoperative and postoperative values for mHHS (54.19 vs. 94.57; p = 0.0001) and for pain VAS (8.71 vs. 0.71; p = 0.0003) were compared. No cases of thigh pain, instability or infection were found. 1 case of acetabular cup loosening and 1 case of periprosthetic fracture were diagnosed at 8 months and 45 days, respectively. Overall survival was 84.7% at 5 years (CI 95%, 64.4-105.3) with revision for any reason as an end point. When stem performance was separately evaluated, it showed a survival rate of 100% at 5 years with revision for aseptic loosening as an end point.Conclusions:THA with a type 2B short stem for the treatment of dysplastic osteoarthritis showed very few technical intraoperative problems, being a useful alternative for femoral reconstruction.</jats:sec
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