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OBJECTIVES: To investigate attitude of community pharmacists toward patients with a substance-related disorder (heroin, alcohol and tobacco). MATERIAL AND METHODS: The attitudes were assessed thanks to the Attitude to Mental Illness Questionnaire (AMIQ) for heroin, alcohol and tobacco-related disorders in three independent groups of pharmacists. Estimation of substance-related harmfulness, knowledge of substance-related disorders and activities/needs for continuing education on substance-related disorders were also recorded. RESULTS: Thirty-five pharmacists were included (heroin: 11, alcohol: 10 and tobacco: 14). AMIQ scores for heroin-related disorder were negative and lower than for alcohol (P<0.01) and tobacco (P<0.001). AMIQ scores for alcohol-related disorder were lower than for tobacco (P<0.05). The estimation of heroin-related harmfulness was higher than for alcohol and tobacco (P<0.001). The estimations of knowledge of substance-related disorders were lower for opioid and alcohol than for tobacco (P<0.001). AMIQ scores and the needs for continuing education on each associated addiction showed a positive relation (P<0.01). CONCLUSION: Pharmacists had a negative attitude toward heroin and alcohol-related disorders. A positive attitude toward patients with a substance-related disorder was associated with a need for continuing education. Efforts should be made to change attitudes and to promote continuing education on heroin and alcohol-related disorders.
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Transtornos Relacionados ao Uso de Álcool , Transtornos Relacionados ao Uso de Substâncias , Humanos , Heroína , Farmacêuticos , Estudos Transversais , Nicotiana , Analgésicos Opioides , Transtornos Relacionados ao Uso de Substâncias/complicações , Etanol , Educação Continuada , Atitude , Atitude do Pessoal de SaúdeRESUMO
The Malaysian society is experiencing and coping with a fast modernization process, which is characterized by a rapid urbanization and rural exodus, an important reduction of the size of households, and the emergence of a new middle class. The Malaysian Food Barometer launched in 2013 has provided better understanding how these macro issues have affected the lifestyles and especially the food habits of the Malaysians. The country has indeed undergone a transition period from under-nutrition to over-nutrition in a few decades, with the prevalence of overweight and obesity having markedly and rapidly increased. A quantitative survey (n = 2000), elaborated from a qualitative preliminary phase, was carried out with the aim of analyzing the transformation of food habits at the national level. The present article focuses on the BMI issue in Malaysia, and investigates its relationships with the socio-demographic variables of the population, as well as their eating patterns. The mean BMI is 23.64 kg/m2, with 9.5% of the sample being obese, and 22% overweight. Strong statistical associations have been identified between BMI and independent variables such as size of the living area, ethnicity, level of education, gender, and age. Contrary to general believe, overweight and obesity were neither associated with the number of food intakes taken per day (including snacks) nor with the frequency of eating out. Nonetheless, obesity is over-represented in people who have dissonant eating behaviors, i.e. who declare having fewer food intakes a day (food norms) than they do actually (food practices). This process testifies that the Malaysians are experiencing a "food transition", which is linked with socio-economic development.
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Povo Asiático/estatística & dados numéricos , Índice de Massa Corporal , Comportamento Alimentar/etnologia , Obesidade/epidemiologia , Urbanização/tendências , Adulto , Povo Asiático/etnologia , Ingestão de Alimentos/etnologia , Feminino , Humanos , Estilo de Vida , Malásia/epidemiologia , Masculino , Obesidade/etnologia , Sobrepeso/epidemiologia , Sobrepeso/etnologia , Prevalência , Pesquisa Qualitativa , Inquéritos e QuestionáriosRESUMO
We report on the first experimental investigation of the spectral dynamics of a synchronously pumped optical parametric oscillator (OPO) by use of dispersive Fourier transformation. For standard pumping rates, we observe a reproducible steady-state pulse-to-pulse spectrum. However, at high pumping levels, the OPO delivers pulse trains with nontrivial oscillatory spectral patterns. So as to benefit from a tailored broadband gain spectrum, the investigated OPO contains a chirped quasi-phase matching (QPM) nonlinear crystal. We explore the specific impacts of using such a remarkable parametric amplification medium where nonlinearly coupled frequencies vary with position. Depending on the QPM chirp rate sign, a red- or blue-shift of the emitted wavelength occurs when the OPO is switched on, leading to different spectral steady-states. These singular spectrotemporal dynamics are evidenced and explained for the first time.
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We report on a self-guided microwave surface-wave induced generation of ~60 µm diameter and 6 cm-long column of argon-plasma confined in the core of a hollow-core photonic crystal fiber. At gas pressure of 1 mbar, the micro-confined plasma exhibits a stable transverse profile with a maximum gas-temperature as high as 1300 ± 200 K, and a wall-temperature as low as 500 K, and an electron density level of 10¹4 cm⻳. The fiber guided fluorescence emission presents strong Ar⺠spectral lines in the visible and near UV. Theory shows that the observed combination of relatively low wall-temperature and high ionisation rate in this strongly confined configuration is due to an unprecedentedly wide electrostatic space-charge field and the subsequent ion acceleration dominance in the plasma-to-gas power transfer.
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Every year, new cases of individuals suffering from traumatic spinal injuries are detected. Advances in numerical models have allowed for the understanding of the damage caused by trauma and its impact on the patient's life. However, the kinematics and dynamics of vertebral fracture formation from its point of origin to the speed of propulsion of the fragments remain unknown. This is mainly due to the lack of data that essentially includes high-speed videos, load and displacement measurements during experimental tests reproducing spinal traumatic loading conditions. This lack of data can be addressed by the analysis of X-Ray images of animal specimens acquired during the traumatic spinal injury formation process. Thus, the purpose of this study was to develop an approach to automatically detect and track in vitro vertebral fractures using high-speed cine-radiography imaging. Four segments of porcine thoracolumbar vertebrae were dynamically compressed using a servo-hydraulic test bench. The compression process was filmed with a custom high-speed cine-radiography device, and the imaging parameters were optimized based on the physical properties of vertebrae. This paper demonstrates the feasibility of using high-speed cine-radiography imaging in this way, combined with an image processing pipeline to allow automatic documentation of the fracture's appearance and its evolution in the vertebra over time.Clinical Relevance- The proposed method will provide helpful information for proper handling of traumatic spinal injuries.
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Fraturas da Coluna Vertebral , Traumatismos da Coluna Vertebral , Humanos , Suínos , Animais , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral , Radiografia , PressãoRESUMO
BACKGROUND AND PURPOSE: Mechanical thrombectomy appears to be a promising option for distal medium-vessel occlusions, for which intravenous thrombolysis is effective but may be insufficient when used alone. This study aimed to determine the optimal technique for these distal mechanical thrombectomies using the human placenta model. MATERIALS AND METHODS: Twenty-four procedures were performed, allowing comparison of direct aspiration (n = 12) versus the combined technique (n = 12). Two positions of the aspiration catheter were tested for each of these techniques: in direct contact with the clot and at a distance from it (5-10 mm). Two types of clots were tested: red blood cell-rich clots and fibrin-rich clots. First-pass recanalization and induced arterial collapse and traction were assessed. RESULTS: The first-pass recanalization was less frequent for direct aspiration than for the combined technique, without reaching statistical significance (41.7% versus 75.0%, P = .098). Full collapse (P < .001) and extended arterial traction (P = .001) were significantly less frequent for direct aspiration. For direct aspiration with the aspiration catheter not in direct contact with the clot, there was not a single first-pass recanalization and there was systematic arterial collapse, resulting in a no-flow in the aspiration syringe. CONCLUSIONS: The combined technique appears to be more harmful, and although direct aspiration has a lower rate of first-pass recanalization, it seems appropriate to try direct aspiration as a first-line procedure. However, if the aspiration catheter cannot reach the clot, it is not useful or even risky to try aspiration alone. These results need to be confirmed by clinical studies.
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Acidente Vascular Cerebral , Trombose , Humanos , Trombectomia/métodos , Resultado do Tratamento , Artérias , Stents , Estudos RetrospectivosRESUMO
Interpreting ultrasound (US) images of the spine is challenging due to the high variability of the contrast during freehand US acquisitions. In this paper, an automatic method to extract vertebral landmarks (spinous process and laminae) from US images acquired in the transverse plane is presented. Prior knowledge about the vertebral shape and the associated hyper-echoic property is incorporated using the horizontal and vertical projections of the image intensities. After detrending, the mean-value crossing of the projections is used to define the concept of mean boundary and locate landmarks without the need for thresholding or parameter adjustment. The method was evaluated using two datasets: a porcine cadaver dataset (PC) with CT data registered to the US data used as a gold standard, and a healthy human subjects dataset (HH) with a silver standard generated from manual landmarks located on the US data acquired with a curvilinear (6C2) and linear (14L5) probe. The mean sum of distances (MSD) of the landmark extraction to the gold and silver standards is respectively MSD=0.90±1.05 mm for PC, MSD=1.14±1.08 mm (6C2) and MSD=3.54±2.69 mm (14L5) for HH. Results are satisfying on PC and HH with 6C2. Variable contrast quality for 14L5 gives satisfying results for the spinous process but not for the laminae. The proposed approach has the potential to be used for different applications in the context of US spine imaging such as scoliosis follow-up and intra-operative surgical guidance.
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Escoliose , Coluna Vertebral , Animais , Humanos , Projetos Piloto , Coluna Vertebral/diagnóstico por imagem , Suínos , UltrassonografiaRESUMO
This paper presents the modeling of microwave (2.45GHz) discharges with cylindrical symmetry, produced in the absence of an external magnetic field by TM00 surface waves (SW) within either cylindrical or coaxial structures. A stationary, one-dimensional (radial) moment model (including the continuity and the momentum-transfer equations for electrons and positive ions, and the electron mean energy transport equations) is solved self-consistently coupled to Poisson's equation for the space-charge electrostatic field and the appropriated Maxwell's equations for the SW electromagnetic field. The model is solved for argon discharges over a broad range of operating conditions: Average electron densities from 10;{11}to3x10;{12}cm;{-3} and gas pressures from 10;{-2}to5Torr . Results are compared to those of a simplified classical model that disregards charge separation near discharge boundaries, ignoring also the development of electron-plasma resonances caused by the severe electron density gradients within space-charge sheath regions. Simulations show that the presence of a sheath-resonance region has a strong influence on the values of the SW attenuation constant, particularly at low pressures and high electron densities, affecting also the local budget of the discharge power deposition (hence discharge maintenance).
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ABSTRACT Objective. To provide a comprehensive overview of geographical patterns (2001-2010) and time trends (1993-2012) of cancer incidence in children aged 0-19 years in Latin America and the Caribbean (LAC) and interpret the findings in the context of global patterns. Methods. Geographical variations in 2001-2010 and incidence trends over 1993-2012 in the population of LAC younger than 20 years were described using the database of the third volume of the International Incidence of Childhood Cancer study containing comparable data. Age-specific incidence per million person-years (ASR) was calculated for population subgroups and age-standardized (WSR) using the world standard population. Results. Overall, 36 744 unique cases were included in this study. In 2001-2010 the overall WSR in age 0-14 years was 132.6. The most frequent were leukemia (WSR 48.7), central nervous system neoplasms (WSR 23.0), and lymphoma (WSR 16.6). The overall ASR in age group 15-19 years was 152.3 with lymphoma ranking first (ASR 30.2). Incidence was higher in males than in females, and higher in South America than in Central America and the Caribbean. Compared with global data LAC incidence was lower overall, except for leukemia and lymphoma at age 0-14 years and the other and unspecified tumors at any age. Overall incidence at age 0-19 years increased by 1.0% per year (95% CI [0.6, 1.3]) over 1993-2012. The included registries covered 16% of population aged 0-14 years and 10% of population aged 15-19 years. Conclusions. The observed patterns provide a baseline to assess the status and evolution of childhood cancer occurrence in the region. Extended and sustained support of cancer registration is required to improve representativeness and timeliness of data for childhood cancer control in LAC.
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RESUMO Objetivo. Apresentar uma visão abrangente dos padrões geográficos (2001 a 2010) e das tendências temporais (1993 a 2012) da incidência de câncer em crianças e jovens de 0 a 19 anos na América Latina e no Caribe (ALC) e interpretar os resultados no contexto de padrões mundiais. Métodos. Foram descritas variações geográficas de 2001 a 2010 e tendências de incidência de 1993 a 2012 na população com menos de 20 anos da ALC usando informações comparáveis da base de dados do terceiro volume do estudo International Incidence of Childhood Cancer. Foram calculadas taxas de incidência específica por idade por milhão de pessoas-ano (ASR, na sigla em inglês) para subgrupos populacionais e taxas padronizadas por idade usando a população padrão mundial (WSR, na sigla em inglês). Resultados. No total, foram incluídos 36 744 casos únicos. No período de 2001 a 2010, a WSR para todos os tumores combinados na faixa etária de 0 a 14 anos foi de 132,6. Os diagnósticos mais frequentes foram leucemia (WSR de 48,7), neoplasias do sistema nervoso central (WSR de 23,0) e linfoma (WSR de 16,6). A ASR para todos os tumores combinados na faixa etária de 15 a 19 anos foi de 152,3, e a maior taxa foi a de linfoma (ASR de 30,2). A incidência foi maior no sexo masculino do que no sexo feminino e maior na América do Sul do que na América Central e no Caribe. De modo geral, em comparação com as estimativas mundiais, a incidência na ALC foi menor, exceto para leucemia e linfoma entre 0 e 14 anos e para outros tumores e tumores não especificados em qualquer idade. A taxa de incidência na faixa etária de 0 a 19 anos aumentou em 1,0% ao ano (IC de 95% [0,6, 1,3]) entre 1993 e 2012. Os registros incluídos cobriam 16% da população de 0 a 14 anos e 10% da população de 15 a 19 anos. Conclusões. Os padrões observados servem de referência para avaliar o status e a evolução da ocorrência de câncer infantil na região. É necessário garantir um apoio ampliado e consistente aos registros de câncer para aprimorar a representatividade e a disponibilidade das informações em tempo adequado para o controle do câncer infantil na ALC.
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While necrotic cell death is attracting considerable interest, its molecular bases are still poorly understood. Investigations in simple biological models, taken for instance outside the animal kingdom, may benefit from less interference from other cell death mechanisms and from better experimental accessibility, while providing phylogenetic information. Can necrotic cell death occur outside the animal kingdom? In the protist Dictyostelium, developmental stimuli induced in an autophagy mutant a stereotyped sequence of events characteristic of necrotic cell death. This sequence included swift mitochondrial uncoupling with mitochondrial 2',7'-dichlorofluorescein diacetate fluorescence, ATP depletion and increased oxygen consumption. This was followed by perinuclear clustering of dilated mitochondria. Rapid plasma membrane rupture then occurred, which was evidenced by time-lapse videos and quantified by FACS. Of additional interest, developmental stimuli and classical mitochondrial uncouplers triggered a similar sequence of events, and exogenous glucose delayed plasma membrane rupture in a nonglycolytic manner. The occurrence of necrotic cell death in the protist Dictyostelium (1) provides a very favorable model for further study of this type of cell death, and (2) strongly suggests that the mechanism underlying necrotic cell death was present in an ancestor common to the Amoebozoa protists and to animals and has been conserved in evolution.
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Dictyostelium/citologia , Modelos Biológicos , Necrose , Animais , Morte Celular/efeitos dos fármacos , Membrana Celular/efeitos dos fármacos , Membrana Celular/metabolismo , Dictyostelium/efeitos dos fármacos , Fluoresceínas/farmacologia , Fluorescência , Glucose/farmacologia , Hexanonas/farmacologia , Hidrocarbonetos Clorados/farmacologia , Mitocôndrias/efeitos dos fármacos , Mitocôndrias/metabolismo , Desacopladores/farmacologiaRESUMO
AIM: The prevalence of cardiovascular autonomic neuropathy (CAN) in diabetes mellitus is well documented. However, the rate and predictors of both the development and progression of CAN have been less studied. Hereby, we assessed the rate and the major risk factors for CAN initiation and progression in a cohort of type 1 diabetic patients followed over a three-year period. METHODS: 175 type 1 diabetic patients (mean age: 50 ± 11 years; female/male: 76/99) with positive bedside screening for CAN were included and underwent 2 standardized autonomic testings using 4 standardized tests (deep breathing, Valsalva maneuver, 30/15 ratio, and changes in blood pressure during standing), separated by 3 ± 1 years. CAN staging was achieved according to the Toronto Consensus Panel on Diabetic Autonomic Neuropathy into 4 categories: absent, possible, confirmed, or severe CAN. RESULTS: Out of the 175 patients included, 31.4% were free of CAN, 34.2% had possible CAN, 24.6% had confirmed CAN, and 9.7% exhibited severe CAN at the first assessment. Among the 103 patients with nonsevere CAN at inclusion, forty-one (39.8%) had an increase of at least one category when reassessed and 62 (60.2%) remained stable. A bivariate analysis indicated that only BMI and exposure to selective serotonin reuptake inhibitors (SSRIs) were significantly different in both groups. A multivariate analysis indicated that lower BMI (OR: 0.15, CI 95%: 0.05-0.48, p = 0.003) and SSRI exposure (OR: 4.18, CI 95%: 1.03-16.97, p = 0.04) were the sole predictors of CAN deterioration. In the 55 patients negative for CAN at the first laboratory assessment, 12 became positive at the second assessment. CONCLUSION: No clear predictive factor for CAN onset was identified. However, once present, CAN progression was related to low BMI and SSRI exposure.
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Doenças do Sistema Nervoso Autônomo/etiologia , Sistema Nervoso Autônomo/fisiopatologia , Doenças Cardiovasculares/etiologia , Sistema Cardiovascular/inervação , Diabetes Mellitus Tipo 1/complicações , Neuropatias Diabéticas/etiologia , Adulto , Doenças do Sistema Nervoso Autônomo/diagnóstico , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Índice de Massa Corporal , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/fisiopatologia , Distribuição de Qui-Quadrado , Diabetes Mellitus Tipo 1/diagnóstico , Neuropatias Diabéticas/diagnóstico , Neuropatias Diabéticas/fisiopatologia , Progressão da Doença , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Exame Neurológico , Razão de Chances , Fatores de Risco , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Fatores de TempoRESUMO
The main objective of this study was to develop a 3-D X-ray reconstruction system of the spine and rib cage for an accurate 3-D clinical assessment of spinal deformities. The system currently used at Sainte-Justine Hospital in Montreal is based on an implicit calibration technique based on a direct linear transform (DLT), using a sufficiently large rigid object incorporated in the positioning apparatus to locate any anatomical structure to be reconstructed within its bounds. During the time lapse between the two successive X-ray acquisitions required for the 3-D reconstruction, involuntary patient motion introduce errors due to the incorrect epipolar geometry inferred from the stationary object. An approach using a new calibration jacket and explicit calibration algorithm is proposed in this paper. This approach yields accurate results and compensates for involuntary motion occurring between X-ray exposures.
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Algoritmos , Imageamento Tridimensional/métodos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Costelas/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem , Humanos , Intensificação de Imagem Radiográfica/métodos , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
Claw toe deformity after posterior leg compartment syndrome is rare but incapacitating. When the mechanism is flexor digitorum longus (FDL) shortening due to ischemic contracture of the muscle after posterior leg syndrome, a good treatment option is the Valtin procedure in which the flexor digitorum brevis (FDB) is transferred to the FDL after FDL tenotomy. The Valtin procedure reduces the deformity by lengthening and reactivating the FDL. Here, we report the outcomes of FDB to FDL transfer according to Valtin in 10 patients with posttraumatic claw toe deformity treated a mean of 34 months after the injury. Toe flexion was restored in all 10 patients, with no claw toe deformity even during dorsiflexion of the ankle.
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Traumatismos do Tornozelo/complicações , Deformidades do Pé/cirurgia , Síndrome do Dedo do Pé em Martelo/cirurgia , Músculo Esquelético/cirurgia , Transferência Tendinosa/métodos , Dedos do Pé/cirurgia , Adolescente , Adulto , Idoso , Traumatismos do Tornozelo/fisiopatologia , Traumatismos do Tornozelo/cirurgia , Feminino , Deformidades do Pé/etiologia , Síndrome do Dedo do Pé em Martelo/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Dedos do Pé/lesões , Adulto JovemRESUMO
A 31-year-old man experienced bilateral posterior glenohumeral dislocation during seizures. He had cleidocranial dysplasia with complete absence of both clavicles. Cleidocranial dysplasia is a rare inherited disease also known as Marie-Sainton syndrome and responsible for dental abnormalities well-known to stomatologists and dentists. Other manifestations include defective development of the skull bones and hypoplastic or aplastic clavicles. We found no previous reports of bilateral posterior glenohumeral dislocation in patients with cleidocranial dysplasia. The objective of this work was to look for an association between clavicular aplasia and posterior glenohumeral dislocation.
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Displasia Cleidocraniana/complicações , Procedimentos Ortopédicos/métodos , Luxação do Ombro/etiologia , Adulto , Clavícula/anormalidades , Humanos , Masculino , Luxação do Ombro/diagnóstico , Luxação do Ombro/terapiaRESUMO
INTRODUCTION: Surgical management of meniscal lesion consists of either a meniscectomy or meniscal repair. Although repair offers immediate recovery after surgery, it is also associated with higher rates of revision. A meniscectomy, on the other hand is known to be associated with an early onset of osteoarthritis. The present study compared clinical and radiological results at 10 years between meniscectomy and meniscal repair in isolated vertical lesion in an otherwise stable knee. The hypothesis was that repair shows functional and radiological benefit over meniscectomy. PATIENTS AND METHOD: A multi-centric retrospective comparative study of 32 patients (24 male, 8 female). Mean follow-up was 10.6 years (range, 10-13 years). There were 10 meniscal repairs (group R) and 22 meniscectomies (group M), in 17 right and 15 left knees. Mean age at surgery was 33.45±12.3 years (range, 9-47 years). There were 28 medial and 4 lateral meniscal lesions; 26 were in the red-red zone and 6 in red-white zone. RESULTS: Functional score: KOOS score was significantly higher in group R than M on almost all parameters: 98±4.69 versus 77.38±21.97 for symptoms (P=0.0043), 96.89±7.20 versus 78.57±18.9 for pain (P=0.0052), 99.89±0.33 versus 80.88±19.6 for daily life activities (P=0.0002), 96.11±9.83 versus 54.05±32.85 for sport and leisure (P=0.0005), but 91±16.87 versus 68.15±37.7 for quality of life (P=0.1048). Radiology score: in group R, 7 patients had no features of osteoarthritis, and 2 had grade 1 osteoarthritis. In group M, 5 patients had grade 1 osteoarthritis, 10 grade 2, 3 grade 3 and 3 grade 4. Mean quantitative score was 0 (mean, 0.22±0.44) in-group R and 2 (mean, 2.19±0.98) in group M (P<0.0001). DISCUSSION: At more than 10year's follow-up, functional scores were significantly better with meniscal repair than meniscectomy on all parameters of the KOOS scale except quality of life. Functional and radiological scores correlated closely. These results show that meniscal repair for vertical lesions in stable knees protects against osteoarthritis and is therefore strongly recommended. LEVEL OF EVIDENCE: IV; retrospective study.
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Articulação do Joelho , Meniscos Tibiais/cirurgia , Osteoartrite/etiologia , Lesões do Menisco Tibial , Atividades Cotidianas , Adolescente , Adulto , Criança , Feminino , Seguimentos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/etiologia , Osteoartrite/diagnóstico por imagem , Qualidade de Vida , Radiografia , Estudos Retrospectivos , Esportes , Adulto JovemRESUMO
INTRODUCTION: Symptomatic horizontal meniscal tears are rare but worrisome lesions in young adults. These are overuse injuries not amenable to the classic arthroscopic sutures. An open meniscal repair allows the meniscal lesion to be suture vertically, perpendicular to its in the vascularized zone. The purpose of this study was to evaluate the short and long-term clinical and radiological outcomes of the aforementioned surgical technique. MATERIAL AND METHOD: The first cohort consisted of 24 patients operated between 2009 and 2011 (6 women, 18 men; mean age 26years) having 11 lateral and 13 medial meniscal tears. The second cohort was of 10 patients operated between 2001 and 2002 (3 women, 7 men; mean age 24years) having 8 lateral and 2 medial meniscal tears. Patients were reviewed at the last follow-up using the IKDC, Lysholm and KOOS scores. Patients in the first cohort had an MRI, while those in the second cohort had X-rays. RESULTS: Eighteen patients in the first cohort were reviewed with a mean follow-up of 2 years (12-45 months) and 9 patients from the second cohort were reviewed after 10years (97-142 months). In the first cohort, one patient required secondary menisectomy. The mean Lysholm score was 90 and the subjective IKDC was 85. Every MRI examination found reduced extent and intensity of the hyperintense signal. In the second cohort, no patients required secondary meniscectomy. Two patients had joint space narrowing (less than 50%) on radiographs. The mean Lysholm score was 99 and the subjective IKDC was 91. CONCLUSION: Open repair of horizontal meniscal tears in young adults leads to good subjective and objective results in the short term, which are maintained in the long-term. LEVEL OF EVIDENCE: Level IV - retrospective study.
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Lesões do Menisco Tibial , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Escore de Lysholm para Joelho , Imageamento por Ressonância Magnética , Masculino , Meniscos Tibiais/diagnóstico por imagem , Meniscos Tibiais/cirurgia , Pessoa de Meia-Idade , Radiografia , Reoperação , Estudos Retrospectivos , Técnicas de Sutura , Adulto JovemRESUMO
BACKGROUND: Meniscal suture provides well-documented benefits. Integrity of the cruciate ligaments of the knee is a prerequisite for meniscal healing. Nevertheless, reconstruction of the anterior cruciate ligament (ACL) does not consistently prevent recurrent tearing of a sutured meniscus. We evaluated meniscal survival rates, 5 and 10 years after meniscal suture concomitant with an ACL reconstruction. We compared the outcomes of these repaired menisci to those in which no menisci tears were detected during ACL reconstruction. METHODS: In this multi-centric retrospective study, we included two groups. One group consists of patients who underwent a meniscal repair. This group was further divided into two subgroups based on whether follow-up was 5 years (n=76) or 10 years (n=39). The control group included 120 patients with normal menisci observed during surgery. We studied meniscal survival rates in each group, and we analyzed risk factors associated with the recurrence of meniscal lesions. RESULTS: The 5-year meniscal survival rate was significantly higher in the control group than in the meniscal-repair group (95% vs. 80%, respectively; P=0.0029). The controls group also had a higher meniscal survival rate after 10 years, although the difference was not statistically significant (88% vs. 77%, P=0.07). A difference in knee laxity greater than 4mm was associated with a 5-fold increase in the risk of recurrent meniscal tears (P=0.0057). After 5 years, the risk of recurrence was higher for the medial than for the lateral meniscus, whereas after 10 years the difference was no longer statistically significant. DISCUSSION: Although insufficient healing after meniscal suturing contributes to the risk of further meniscal tears, new lesions can develop in menisci that were undamaged at the time of ACL reconstruction. The risk of a new meniscal lesion is strongly associated with inadequate control of antero-posterior and rotational laxity. Some apparently "new menisci lesions" seems to have been missed during ACL reconstruction. LEVEL OF EVIDENCE: IV, retrospective study.
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Reconstrução do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirurgia , Meniscos Tibiais/cirurgia , Lesões do Menisco Tibial , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Instabilidade Articular/complicações , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Cicatrização , Adulto JovemRESUMO
There is ambiguity concerning the nomenclature and classification of fractures of the ring of the second cervical vertebra (C2). Disruption of the pars interarticularis which defines true traumatic spondylolisthesis of C2, is often wrongly called a pedicle fracture. Our aim in this study was to assess the influence of asymmetry on the anatomical and functional outcome and to evaluate the criteria of instability established by Roy-Camille et al. We studied the plain radiographs and CT scans of 24 patients: 13 were judged to be asymmetrical, ten were considered unstable and 14 stable. Treatment was with a Minerva jacket in 15 fractures and by operation in nine. Surgery was undertaken in patients with severe C2 to C3 sprains. One patient with an unstable lesion refused operation and was treated conservatively with a poor radiological result. Our study showed that asymmetry of the fracture did not affect the outcomes of treatment and should not therefore influence decisions in treatment. The criteria of Roy-Camille seem to be reliable and useful. We prefer the posterior approach to the cervical spine, which allows both stabilisation of the fracture and correction of a local kyphosis.
Assuntos
Vértebra Cervical Áxis/lesões , Fraturas da Coluna Vertebral/classificação , Adolescente , Adulto , Idoso , Vértebra Cervical Áxis/diagnóstico por imagem , Vértebra Cervical Áxis/cirurgia , Feminino , Seguimentos , Humanos , Imageamento Tridimensional , Disco Intervertebral/lesões , Luxações Articulares/classificação , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Cifose/diagnóstico por imagem , Cifose/cirurgia , Ligamentos Longitudinais/lesões , Masculino , Pessoa de Meia-Idade , Aparelhos Ortopédicos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/cirurgia , Fraturas da Coluna Vertebral/terapia , Espondilolistese/diagnóstico por imagem , Espondilolistese/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Articulação Zigapofisária/lesõesRESUMO
Fatigue is a common complaint for the cancer patient during and after radiotherapy, according to the published studies. Fatigue is a subjective symptom mostly underestimated by oncologists and other care givers. Etiology is complex, poorly understood in spite of obvious causes like insomnia, nausea, pain, depression, psychological distress, anemia, hypothyroidism, menopause disturbances, treatment adverse effects. Fatigue presents multifactorial and multidimensional aspects. To evaluate it, many tools can be used as single-item, unidimensional and multidimensional instruments. Practically, the open discussion with the patient throughout radiotherapy is essential to define it. Taking charge fatigue requires its acknowledgment by radiotherapist, treatment of associated symptoms with a multidisciplinary approach.
Assuntos
Fadiga/etiologia , Radioterapia/efeitos adversos , Anemia/complicações , Depressão/complicações , Fadiga/fisiopatologia , Fadiga/terapia , Humanos , Hipotireoidismo/complicações , Náusea/complicações , Neoplasias/radioterapia , Dor/complicações , Dor/etiologia , Índice de Gravidade de Doença , Distúrbios do Início e da Manutenção do Sono/complicações , Estresse PsicológicoRESUMO
This paper reports the patient care experience during the course of the radiotherapy. Plights are multiple. Patients are confronted with a complex and unknown distressing space, an irrelavant information, a banalization of side effects, an isolation with a frequent inadequate support of their family or the caregivers team, with the fear of a definitive abandonment at the end of the treatment without comforting follow-up. It is imperative to state a real policy in order to improve the patient support. Sensibilization and training of the caregivers, in spite of a frequent overbooking technical work, is required in a pluridisciplinary approach to provide a relevant reception with the collaboration of psychologists, social workers and self care groups and associations. The personal implication of the physicians and technologists is also essential. The simple smile is the intangible proof of the reliable emotional support.