RESUMO
OBJECTIVE: Bunionette or 'tailor's bunion' is a deformity of the fifth ray, which comes along with a metatarsus quintus valgus and a varus deformity of the fifth toe with subluxation of the metatarsophalangeal joint. A minimally invasive osteotomy of the fifth metatarsal without internal fixation using burrs is an increasingly used alternative for symptomatic tailor's bunion deformity. Similar to open surgery procedures the type of osteotomy complies with the underlying pathology. Minimally invasive surgical (MIS) procedures allow comprehensive treatment of various types of tailor's bunion deformities. INDICATIONS: Symptomatic tailor's bunion deformity, failed conservative treatment, a closed epiphyseal gap. CONTRAINDICATIONS: Osteoporotic bone, poor patient compliance. SURGICAL TECHNIQUE: The technique comprises percutaneous resection of the lateral exostosis of the fifth metatarsal head with a straight burr and an osteotomy of the fifth metatarsal, either distally, diaphyseal or proximally with a conical burr due to the shape of the deformity, usually without internal fixation. POSTOPERATIVE MANAGEMENT: Redressive wrapping, partial pain-adapted weight bearing. Non-steroidal anti-inflammatory drugs for 3-5 days, lymphatic drainage, intermittent cooling. Radiographic assessment on postoperative day 1; radiographic follow-up 6 weeks postoperatively. Thromboembolic prophylaxis. RESULTS: The clinical outcome is comparable to standard surgical procedures with the advantages of MIS. Based on our results and the current literature, the minimally invasive distal metatarsal osteotomy without fixation is becoming a reliable treatment for tailor's bunion.
Assuntos
Joanete do Alfaiate , Ossos do Metatarso , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Joanete do Alfaiate/cirurgia , Hallux Valgus , Humanos , Ossos do Metatarso/cirurgia , Osteotomia , Resultado do TratamentoRESUMO
Between May 1988 und March 1989 all patients who underwent elective or emergency surgery followed by intensive care were randomly assigned to group A (n = 149): routine sonography at the postoperative day 1, 3, 7 and 9, group B (n = 151): sonography on demand. In these two groups, the following parameters were compared: number of relaparotomies, lethality of relaparotomies, total lethality, moment of relaparotomy, period of hospitalisation, time spent with sonography. In the analyzed parameters, our examination showed no difference between the two groups. For this we state that the routine sonographical control of the surgical patient with intensive care being opposed to the sonography on demand shows no significant advantage. The demand for a routine sonography as a postoperative control can not be generally supported.
Assuntos
Cuidados Críticos , Emergências , Complicações Pós-Operatórias/diagnóstico por imagem , Adulto , Idoso , Doenças do Sistema Digestório/diagnóstico por imagem , Doenças do Sistema Digestório/mortalidade , Doenças do Sistema Digestório/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/cirurgia , Estudos Prospectivos , Taxa de Sobrevida , UltrassonografiaRESUMO
A retrospective study was carried out to determine whether aortic arch size can be regarded as a reliable criterion for differentiating between congenital left-to-right shunt defects. The PA and AP plain chest films of children of all age groups with ductus arteriosus persistens (DAP) (n = 91), atrial septal defect (ASD) (n = 86), ventricular septal defect (VSD) (n = 87) and a normal control group (n = 387) were used to measure the size of the aortic arch, and an aortic index (AI) was calculated from aortic arch size and the height of the eighth thoracic vertebral body. Three age classes were defined from the AI values of the control group, and the diagnostic groups in each age class were compared with each other. Enlargement of the aortic arch, as reflected in an elevated AI value, was found most frequently in DAP cases. The size of the aortic arch is, however, of varying differential diagnostic value, depending on the age group. No correlation was found between aortic arch size and the size of the left-to-right shunt in cases of DAP.
Assuntos
Aorta Torácica/diagnóstico por imagem , Permeabilidade do Canal Arterial/diagnóstico , Comunicação Interatrial/diagnóstico , Comunicação Interventricular/diagnóstico , Adolescente , Fatores Etários , Antropometria/métodos , Aorta Torácica/anatomia & histologia , Aorta Torácica/crescimento & desenvolvimento , Criança , Pré-Escolar , Diagnóstico Diferencial , Humanos , Lactente , Recém-Nascido , Radiografia , Estudos Retrospectivos , Vértebras Torácicas/diagnóstico por imagemRESUMO
The instruments for laparoscopic surgery are usually available in a disposable and in a reusable type. We performed a prospective, randomized study, based on the most frequent laparoscopic operation, the cholecystectomy, in order to directly quantify and compare the advantages and disadvantages of both types of instruments. 158 patients, who planned to undergo a cholecystectomy, were randomly distributed into two groups. 80 patients (group A) underwent surgery with reusable instruments and 78 patients (group B) with disposable instruments. We investigated the following parameters and compared them for both groups: length of operation, complications, conversion rate to open surgery, subjective postoperative pain, length of inability to work, technical problems during operation, postoperative hospitalization time, satisfaction of operating room personnel. The analysis of the results demonstrates no difference in the postoperative hospitalization time, in the postoperative complication rate, subjective pain sensation and postoperative inability to work. Differences in favour for the group of patients, operated with disposable instruments, were found in the conversion rate, in the length of operation and, statistically significant, in the amount of intraoperative problems, caused by instrument-technical reasons. Even if considering the greater expenses in time and personnel costs, operations with reusable instruments are in average 1015 DM cheaper.
Assuntos
Equipamentos Descartáveis/economia , Reutilização de Equipamento/economia , Laparoscópios , Adolescente , Adulto , Idoso , Colecistectomia Laparoscópica/economia , Colecistectomia Laparoscópica/instrumentação , Análise Custo-Benefício , Feminino , Alemanha , Humanos , Laparoscopia/economia , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente/economia , Complicações Pós-Operatórias/economia , Estudos Prospectivos , Instrumentos Cirúrgicos/economiaRESUMO
The favorable response to nitrates in the case of coronary heart diseases is based on both reduction in left ventricular pre- and afterload and improvement in coronary flow. These effects were studied in the setting of a long-term ISDN therapy with reference to the prognosis of patients after myocardial infarction. Following acute treatment in the respective hospitals, 608 patients with myocardial infarctions were allocated to two double-blind treatment groups with different ISDN dosage levels (group 1 = 5 x 2.5 mg i.d.; group 2 = 5 x 40 mg i.d.) and followed up over a period of 2 years. No differences were found with regard to the end points sudden cardiac death, reinfraction, and indication for revascularization. There was, however, a more frequent additional administration of calciumantagonists to patients of the low-dose group (p less than 0.05), a more frequent drop-out due to the lack of beneficial therapeutic results, and a more exceptional drop-out due to side effects in patients treated with low doses of ISDN (n.s.). The absence of any significant difference with regard to the end points might be attributed to; 1) a loss of potency of high-dose ISDN and simultaneous ineffectiveness of low-dose ISDN; 2) an efficacy of low doses; 3) an absence of actual influence on the target parameters, and 4) an inadequate follow-up time period.