RESUMO
In children with major neurologic impairment, gastrostomies are often used to alleviate malnutrition and feeding difficulties. There has been a trend toward performing "protective" antireflux surgery in these children. Nineteen children with major neurologic impairment and feeding failure were prospectively evaluated and followed up after placement of a percutaneous endoscopic gastrostomy (PEG) without any antireflux procedure. Mean age at PEG placement was 34 months with mean follow-up of 20.7 months. All parents would recommend PEG to families with disabled children, and if given the chance, 95% would elect PEG again for their child. No child developed choking, gagging, or retching postoperatively. At the time of follow-up, postoperative gastroesophageal reflux did not appear to be a major clinical problem.
Assuntos
Deficiências do Desenvolvimento/cirurgia , Nutrição Enteral/métodos , Refluxo Gastroesofágico/cirurgia , Gastrostomia/métodos , Procedimentos Desnecessários , Adolescente , Criança , Pré-Escolar , Deficiências do Desenvolvimento/complicações , Nutrição Enteral/efeitos adversos , Seguimentos , Refluxo Gastroesofágico/diagnóstico por imagem , Gastrostomia/efeitos adversos , Humanos , Lactente , Complicações Intraoperatórias , Complicações Pós-Operatórias , Estudos Prospectivos , Radiografia , Resultado do TratamentoRESUMO
Removal of foreign bodies from a joint usually involves an extensive surgical approach. The necessity for intraarticular bullet removal has been well documented in the literature. The conventional approach for bullet extraction usually requires an open arthrotomy, arthroscopic removal or, in most cases, a combination of the two. This report involves a previously undocumented technique for bullet removal from the hip. A Synthes DHS Triple Reamer was inserted through a limited lateral incision over a guide pin that had been placed under fluoroscopic guidance. The tip of the guide pin was positioned in contact against the bullet fragments in both the anteroposterior and lateral planes. The fragments were then removed through the reamed canal. This technique allows for bullet removal without the inherent risks associated with an open arthrotomy and without the special skills required for hip arthroscopy. It is relatively easy to perform and may prove to be a valuable tool in the arsenal of orthopedists who deal with specific gunshot wounds to the hip region.
Assuntos
Cabeça do Fêmur/lesões , Corpos Estranhos/cirurgia , Lesões do Quadril , Ortopedia/métodos , Ferimentos por Arma de Fogo/cirurgia , Adulto , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/cirurgia , Corpos Estranhos/diagnóstico por imagem , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Humanos , Masculino , Tomografia Computadorizada por Raios X , Ferimentos por Arma de Fogo/diagnóstico por imagemRESUMO
A diode-pumped, room-temperature Tm:LuAG laser demonstrated a total optical-to-optical efficiency of 0.073 and an optical-to-optical differential efficiency as high as 0.236. Laser performance and operating wavelength were investigated as a function of the Tm concentration. The highest laser output energy was achieved with a Tm concentration of 0.04 and at a wavelength of 2.0238 µm.