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1.
Am J Trop Med Hyg ; 106(3): 857-860, 2022 01 10.
Artigo em Inglês | MEDLINE | ID: mdl-35008061

RESUMO

Cutaneous leishmaniasis (CL) frequently entails chronic skin lesions that heal only slowly. Until now, the available therapeutic options are very limited. Here, we present a case of a 5½-year-old Syrian refugee with two progressive lower-leg skin ulcers caused by Leishmania tropica. The patient received topical treatment with LeiProtect®, a newly developed, hydroxypropylcellulose-based, filmogenic gel containing nontoxic concentrations of pharmaceutical sodium chlorite. The skin lesions completely healed within 8 weeks and did not relapse during 1 year of follow-up, underlining the efficacy of this novel local therapy of CL.


Assuntos
Leishmania tropica , Leishmaniose Cutânea , Criança , Cloretos , Humanos , Leishmaniose Cutânea/tratamento farmacológico , Pessoa de Meia-Idade , Preparações Farmacêuticas , Síria
2.
J Orthop Surg Res ; 8: 16, 2013 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-23758869

RESUMO

BACKGROUND: Calcium phosphate cements are used frequently in orthopedic and dental surgeries. Strontium-containing drugs serve as systemic osteoblast-activating medication in various clinical settings promoting mechanical stability of the osteoporotic bone. METHODS: Strontium-containing calcium phosphate cement (SPC) and calcium phosphate cement (CPC) were compared regarding their local and systemic effects on bone tissue in a standard animal model for osteoporotic bone. A bone defect was created in the distal femoral metaphysis of 60 ovariectomized Sprague-Dawley rats. CPC and SPC were used to fill the defects in 30 rats in each group. Local effects were assessed by histomorphometry at the implant site. Systemic effects were assessed by bone mineral density (BMD) measurements at the contralateral femur and the spine. RESULTS: Faster osseointegration and more new bone formation were found for SPC as compared to CPC implant sites. SPC implants exhibited more cracks than CPC implants, allowing more bone formation within the implant. Contralateral femur BMD and spine BMD did not differ significantly between the groups. CONCLUSIONS: The addition of strontium to calcium phosphate stimulates bone formation in and around the implant. Systemic release of strontium from the SPC implants did not lead to sufficiently high serum strontium levels to induce significant systemic effects on bone mass in this rat model.


Assuntos
Cimentos Ósseos/farmacologia , Fosfatos de Cálcio/farmacologia , Osseointegração/efeitos dos fármacos , Osteoporose/fisiopatologia , Estrôncio/farmacologia , Animais , Densidade Óssea/fisiologia , Conservadores da Densidade Óssea/sangue , Conservadores da Densidade Óssea/farmacologia , Avaliação Pré-Clínica de Medicamentos/métodos , Feminino , Osteogênese/efeitos dos fármacos , Ovariectomia , Projetos Piloto , Ratos , Ratos Sprague-Dawley , Estrôncio/sangue
3.
Clin Lymphoma Myeloma ; 9(5): 375-80, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19858057

RESUMO

INTRODUCTION: Only in recent years has balloon kyphoplasty gained significance in the treatment of vertebral fractures as an adequate minimally invasive vertebral stabilization technique. Kyphoplasty has also increasingly been used to treat vertebral osteolyses caused by multiple myeloma (MM). PATIENTS AND METHODS: In our cohort of 76 patients with MM with a total of 190 vertebral fractures treated with kyphoplasty, we performed a 30-day postoperative analysis of cement leakage, neurologic symptoms, pulmonary embolism, and infections. RESULTS: Painful osteolytic or fractured vertebrae or even imminent vertebral instability caused by osteolyses were seen as indications for kyphoplasty. One case of pulmonary embolism was observed because of cement leakage as the only postoperative complication. CONCLUSION: By careful interdisciplinary indication setting and a standardized treatment model, kyphoplasty presents a very safe and effective procedure for the treatment of vertebral osteolyses and fractures caused by MM.


Assuntos
Mieloma Múltiplo/cirurgia , Vertebroplastia/efeitos adversos , Vertebroplastia/métodos , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
4.
Orthopedics ; 32(2): 90, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19301801

RESUMO

In our cohort of 555 patients with a total of 1150 vertebral fractures treated with kyphoplasty we performed a 30-day postoperative analysis of cement leakage, neurological symptoms, pulmonary embolism, and infections. In our department, 22% of kyphoplasties were performed with calcium phosphate cement and the remainder with polymethylmethacrylate. All patients were initially assessed by an interdisciplinary kyphoplasty colloquium, composed of consultants in traumatology, radiology, and endocrinology. Indications included fresh traumatic vertebral fractures; painful sintered osteoporotic vertebrae; osteolysis and painful vertebral body collapse caused by multiple myelomas; and lymphomas and pathological fractures due to metastases of malignant tumors (prostate cancer, breast cancer, ovarian cancer, and malignant melanoma) or benign vertebral tumors (hemangioma). Contraindications included patients with instability of the posterior wall and/or pedicles, an infection of the fractured vertebra, a severe hemorrhagic diathesis, known allergies to the cements, pregnancy, and ASA score of 4. The standard postoperative computed tomography scan of the kyphoplasty-treated vertebrae revealed a dorsal cement leakage in 38 vertebrae representing 3.3% of all levels. A permanent monoparesis of the left leg, 2 cases of temporary neurological deficits, 2 cases of hemorrhage, and 1 asymptomatic pulmonary embolism were observed as postoperative complications. We observed no complications relating to polymethylmethacrylate described in the literature. By careful interdisciplinary indication setting and a standardized treatment model, kyphoplasty presents a safe and effective procedure for the treatment of various vertebral fractures.


Assuntos
Complicações Intraoperatórias/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fraturas da Coluna Vertebral/epidemiologia , Vertebroplastia/efeitos adversos , Adulto Jovem
5.
Spine (Phila Pa 1976) ; 33(11): 1284-90, 2008 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-18469705

RESUMO

STUDY DESIGN: A comparative prospective trial evaluating 3-year outcome. OBJECTIVE: To compare clinical and morphologic outcomes as well as follow-up fractures after kyphoplasty of painful osteoporotic vertebral fractures with calcium-phosphate (CaP) cement (group 1) and with polymethylmethacrylate (PMMA)-cement (group 2). SUMMARY OF BACKGROUND DATA: CaP cements seem to be an alternative material for usage in kyphoplasty of vertebral fractures. CaP cements are biodegradable and replaceable by newly formed bone after implantation. Concerns have been raised with regard to the stability of resorbable CaP-cements after implantation into vertebrae post kyphoplasty. Calcibon is a possible CaP cement, which exhibited adequate stability in short-term observations. MATERIALS AND METHODS: Kyphoplasty was performed in 40 consecutive patients with primary osteoporosis and painful vertebral fractures, 20 received CaP-cement, 20 were treated with PMMA-cement. All patients received a pharmacological antiosteoporosis treatment (1000 mg calcium, 1000 IU vitamin D3, and oral aminobisphosphonate), pain medication, and physiotherapy. Pain (visual analog scale [VAS]; range, 0-100), mobility (EVOS-score; range, 0-100) and radiomorphologic measurements were assessed at baseline and after 6, 12, and 36 months. RESULTS: There were no statistically significant differences between the CaP and PMMA-cement group regarding VAS-scores, EVOS-scores, or height-restoration at any time point. Furthermore, there was no significant difference in the occurrence of vertebral follow-up fractures between both groups during the 3-year follow-up period. CONCLUSION: CaP cement, e.g., Calcibon, is as effective and safe as conventional PMMA-cement with regard to immediate and sustained pain reduction and improvement of mobility after kyphoplasty of patients with painful osteoporotic vertebral fractures. CaP cement has the potential of being resorbed and replaced by newly formed bone tissue; thus, it seems to be a promising alternative for PMMA also in younger patients with painful vertebral fractures.


Assuntos
Fosfatos de Cálcio/administração & dosagem , Osteoporose/cirurgia , Dor/cirurgia , Polimetil Metacrilato/administração & dosagem , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia/métodos , Idoso , Cimentos Ósseos/uso terapêutico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteoporose/complicações , Osteoporose/patologia , Dor/complicações , Dor/patologia , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/patologia , Tempo , Resultado do Tratamento
6.
Graefes Arch Clin Exp Ophthalmol ; 246(2): 281-4, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-17934753

RESUMO

BACKGROUND: To analyze the ability of bevacizumab (Avastin) eye drops to inhibit corneal neovascularization. DESIGN: interventional case series involving five patients (age: 42 +/- 14 years). METHODS: Patients with aggressive corneal neovascularisation not responding to conventional therapy were treated with bevacizumab (Avastin) eye drops (5x/day; 5 mg/ml) for 0.5 to 6 months (mean: 3.6 +/- 2; four patients with limbal stem cell deficiency [three due to chemical burns and one inherited] and one after perforating keratoplasty). RESULTS: Bevacizumab eye drops were well tolerated without obvious corneal side-effects. All five patients showed a reduction in the neovascularized area (decrease 48 +/- 28%; 13-75%). CONCLUSIONS: Bevacizumab eye drops seem to inhibit corneal neovascularization without obvious corneal epithelial side-effects.


Assuntos
Inibidores da Angiogênese/administração & dosagem , Anticorpos Monoclonais/administração & dosagem , Neovascularização da Córnea/prevenção & controle , Soluções Oftálmicas/administração & dosagem , Administração Tópica , Adulto , Idoso , Anticorpos Monoclonais Humanizados , Bevacizumab , Neovascularização da Córnea/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fator A de Crescimento do Endotélio Vascular
7.
Eur Radiol ; 17(9): 2248-52, 2007 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17522865

RESUMO

This study investigated the prevalence of the intravertebral vacuum phenomenon (IVP) and osteonecroses in vertebral compression fractures (VCFs). We therefore performed an histological analysis of biopsies obtained from VCFs prior to balloon kyphoplasty. Computed tomography (CT) scans were reviewed regarding the presence of an IVP (i.e. cleft sign, Kümmell disease). We reviewed the data of 266 consecutive patients treated by balloon kyphoplasty in 501 procedures from 2002 to 2004. From 180 patients (68%) we obtained adequate bone tissue for histological evaluation. Biopsy specimens were analysed regarding the presence of osteoporosis, infection, malignancy and osteonecrosis. CT scans of all 180 patients were reviewed for presence of an IVP. Histological examination revealed 135 (75%) osteoporoses, 20 (11%) neoplasms, 12 (7%) trauma cases and 13 (7%) osteonecroses. An IVP was present in 12 (7%) patients. There was a significant association of osteonecrosis and IVP (P < 0.0001). Eleven of 12 patients with a vacuum phenomenon showed an osteonecrosis on histology, whereas 11 of 13 patients with osteonecrosis showed an IVP on CT. The IVP is a specific sign of osteonecrosis in vertebral compression fractures (sensitivity 85%, specificity 99%, positive predictive value 91%). Our findings strongly support the thesis that an IVP indicates local bone ischemia associated with a non-healing vertebral collapse and pseudarthrosis.


Assuntos
Fraturas por Compressão/diagnóstico por imagem , Disco Intervertebral/patologia , Osteonecrose/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Biópsia , Feminino , Fraturas por Compressão/patologia , Fraturas por Compressão/cirurgia , Gases , Humanos , Disco Intervertebral/diagnóstico por imagem , Masculino , Osteonecrose/patologia , Osteonecrose/cirurgia , Valor Preditivo dos Testes , Fraturas da Coluna Vertebral/patologia , Fraturas da Coluna Vertebral/cirurgia , Estatísticas não Paramétricas
8.
Eur J Trauma Emerg Surg ; 33(3): 262-7, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26814490

RESUMO

Secondary dislocation, non-union, re-fracture and implant failure are generally known complications after intramedullary fixation of proximal femur fractures with the PFN(®) (Synthes GmbH, Solothurn, Switzerland). The goal of our study was to assess the impact of patient- and treatment-specific risk factors on these complications. Complex fracture type and poor bone quality were defined as patient-specific risk factors. Inadequate fracture reduction and implant position were defined as treatment-specific risk factors. One hundred and seventy-eight cases were retrospectively analyzed. All patients had at least one clinical and radiological follow-up examination 3-6 months after the operation. Fifty percent of the patients were available for one more follow-up at least 1 year after the operation. All patients without patient-specific risk factors had a good outcome, irrespective of whether treatmentspecific risk factors were present or absent. In 153 of the 178 cases, patients had a complex type of fracture and/or poor bone quality. Of these patients, 27 (15.2%) had a poor result. Twenty-four of these patients needed re-operation within 6 months. Complication rate in these patients highly depended on treatment-specific risk factors. We conclude that the PFN is a secure implant for the stabilization of simple cases. Stabilization of complex proximal femoral fractures with the PFN, however, has a relevant complication rate and should therefore be considered a challenge.

9.
Knee Surg Sports Traumatol Arthrosc ; 15(4): 378-80, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17072655

RESUMO

Two cases are reported in which, after ACL reconstruction with autologous hamstring grafts, tibial polylactide interference screws migrated into the knee joint. Clinically, both patients presented with recurrent locking of the joint. In one case, a broken 15 mm-long tip of the screw was found intra-articularly. In the other case, the whole screw had migrated into the joint cavity. The degradation process of polylactic acid, operative technique and bone quality are discussed as possible reasons for these complications.


Assuntos
Implantes Absorvíveis/efeitos adversos , Lesões do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirurgia , Parafusos Ósseos/efeitos adversos , Migração de Corpo Estranho/complicações , Migração de Corpo Estranho/cirurgia , Articulação do Joelho/fisiopatologia , Adulto , Artroscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Reoperação , Transferência Tendinosa , Tíbia
10.
Arch Orthop Trauma Surg ; 126(8): 533-40, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16835779

RESUMO

INTRODUCTION: It is a generally accepted standard surgical practice to fill-in the metaphyseal defect zones resulting from the reduction of tibia compression fractures. The development of various innovative bone substitutes is also currently on the increase. MATERIALS AND METHODS: In our prospective study, we used Ostim, a novel resorbable nanocrystalline hydroxyapatite paste, together with Cerabone, a solid hydroxyapatite ceramic, in combination with angularly stable osteosynthesis to treat 24 tibia compression fractures. Types B2 and B3, as well as types C2 and C3 fractures, according to the AO classification, were included in the study. RESULTS: The mean total range of joint motion in terms of flexion and extension was improved from the immediate postoperative value of 79 +/- 14 degrees to 97 +/- 13 degrees at 6 weeks after surgery, to 109 +/- 16 degrees at 3 months, and finally to 118 +/- 17 degrees at 1 year. In three patients, a delayed wound healing was observed as a local complication. CONCLUSION: The use of the Ostim and Cerabone combination is an effective method in treating tibia compression fractures with large defect zones left after reduction.


Assuntos
Cimentos Ósseos/uso terapêutico , Substitutos Ósseos/uso terapêutico , Fraturas por Compressão/cirurgia , Hidroxiapatitas/uso terapêutico , Nanopartículas/uso terapêutico , Fraturas da Tíbia/cirurgia , Implantes Absorvíveis , Adulto , Idoso , Idoso de 80 Anos ou mais , Cerâmica/uso terapêutico , Feminino , Fraturas por Compressão/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Radiografia , Amplitude de Movimento Articular , Tíbia/patologia , Fraturas da Tíbia/diagnóstico por imagem
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