Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 10 de 10
Filtrar
1.
Knee Surg Sports Traumatol Arthrosc ; 23(4): 1201-5, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24671385

RESUMO

PURPOSE: Rupture of the anterior cruciate ligament (ACL) is a common injury, often presenting with a typical injury pattern. Historically, the literature indicates that the accuracy of diagnosis of ACL ruptures is poor at the initial medical consultation. The aims of this study were to determine: the mechanism of injury; changes in accuracy of diagnosis of ACL ruptures at initial presentation over the last decade; and the effect of subsequent delay in diagnosis and definitive treatment. METHODS: A prospective cohort of one hundred and thirty-two consecutive patients who underwent ACL reconstruction between 2005 and 2009 were analysed. The median age of the patients was 18 years (12-57). Sixteen patients were excluded due to chronic ACL injury. RESULTS: One hundred and sixteen patients (117 ACL ruptures) were included in the analysis. A typical injury pattern was documented in 87 (74.4 %) of cases. The most common sporting activities associated with an ACL injury were football (35.3 %), skiing (21.6 %) and rugby (10.3 %). The majority of patients (67.5 %) sought medical attention within 1 week from time of injury. The correct diagnosis of an ACL rupture was made in 33 cases (28.2 %) at the initial medical consultation. The diagnosis was made following medical consultation in 13 (11.1 %) of cases with the use of magnetic resonance imaging and 6 (5.1 %) cases at arthroscopy. The median time to diagnosis was 6 weeks (0-192), and the median time to ACL reconstruction was 24 weeks (1-240). A delay in diagnosis of >6 months was associated with a medial meniscal tear rate of 72.2 % compared to 23.1 % if the diagnosis was made within 4 months of the injury (p < 0.05). CONCLUSIONS: Despite a 'typical' mechanism of injury leading to ACL rupture, the rate of initial diagnosis in the UK still remains poor. This often leads to an unnecessary delay in the diagnosis and subsequent treatment and increases the risk of secondary injury to the knee. A delay in diagnosis of >6 months was associated with an increased medial meniscal tear rate. Patients who present with a 'typical' injury pattern should therefore be referred for further assessment by a knee specialist within 6 weeks. LEVEL OF EVIDENCE: IV.


Assuntos
Lesões do Ligamento Cruzado Anterior , Diagnóstico Tardio , Traumatismos do Joelho/diagnóstico , Adolescente , Adulto , Ligamento Cruzado Anterior/patologia , Artroscopia , Criança , Feminino , Humanos , Articulação do Joelho/cirurgia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Fatores de Risco , Ruptura , Fatores de Tempo , Adulto Jovem
2.
Bone Joint J ; 95-B(9): 1165-71, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23997126

RESUMO

Coronal plane fractures of the posterior femoral condyle, also known as Hoffa fractures, are rare. Lateral fractures are three times more common than medial fractures, although the reason for this is not clear. The exact mechanism of injury is likely to be a vertical shear force on the posterior femoral condyle with varying degrees of knee flexion. These fractures are commonly associated with high-energy trauma and are a diagnostic and surgical challenge. Hoffa fractures are often associated with inter- or supracondylar distal femoral fractures and CT scans are useful in delineating the coronal shear component, which can easily be missed. There are few recommendations in the literature regarding the surgical approach and methods of fixation that may be used for this injury. Non-operative treatment has been associated with poor outcomes. The goals of treatment are anatomical reduction of the articular surface with rigid, stable fixation to allow early mobilisation in order to restore function. A surgical approach that allows access to the posterior aspect of the femoral condyle is described and the use of postero-anterior lag screws with or without an additional buttress plate for fixation of these difficult fractures.


Assuntos
Fraturas do Fêmur/cirurgia , Fraturas Intra-Articulares/cirurgia , Artroscopia/métodos , Parafusos Ósseos , Fraturas do Fêmur/diagnóstico , Fraturas do Fêmur/etiologia , Fixação de Fratura/métodos , Humanos , Fraturas Intra-Articulares/diagnóstico , Fraturas Intra-Articulares/etiologia , Cuidados Pós-Operatórios/métodos , Resultado do Tratamento
3.
Acta Chir Orthop Traumatol Cech ; 79(1): 21-30, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22405545

RESUMO

In this article the following areas will be reviewed; the anatomy of the midfoot; mechanisms of injury and current classification systems; diagnosis; treatment options and the evidence for current practice; areas of treatment uncertainty and recommended guidelines for management.


Assuntos
Fraturas Intra-Articulares , Ossos do Metatarso/lesões , Ossos do Tarso/lesões , Artrodese , Fixação Interna de Fraturas/métodos , Humanos , Fraturas Intra-Articulares/diagnóstico , Fraturas Intra-Articulares/cirurgia , Ossos do Tarso/cirurgia
4.
Acta Chir Orthop Traumatol Cech ; 79(6): 473-83, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23286678

RESUMO

Ankle fractures are common injuries that require meticulous technique in order to optimise outcome. The Lauge-Hansen and Danis-Weber classifications in addition to careful evaluation of the injury mechanism can help guide treatment but surgeons must be aware that there are injury patterns that will not always fit the afore mentioned patterns. The principles of atraumatic soft tissue handling, rigid internal fixation and early range of motion exercises are critical for successfully treating these injuries. There are still areas of treatment uncertainty and future directed research is needed in order to address some of these questions.


Assuntos
Traumatismos do Tornozelo , Fraturas Ósseas , Traumatismos do Tornozelo/classificação , Traumatismos do Tornozelo/cirurgia , Fixação Interna de Fraturas , Fraturas Ósseas/classificação , Fraturas Ósseas/cirurgia , Humanos
5.
Foot Ankle Surg ; 17(2): 74-8, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21549976

RESUMO

BACKGROUND: Neglected ruptures of the tendoachilles pose a difficult surgical problem. There are no data to determine the optimal positioning of the FHL tendon to the calcaneus. METHODS: Two computer programmes (MSC.visualNastran Desktop 2002™ and Solid Edge(®) V19) were used to generate a human ankle joint model. Different attachment points of FHL tendon transfer to the calcaneus were investigated. RESULTS: The lowest muscle force to produce plantarflexion (single stance heel rise) was 1355 N. Plantarflexion increased for a more anterior attachment point. The maximum range of plantarflexion was 33.4° for anterior attachment and 24.4° for posterior attachment. There was no significant difference in range of movement when the attachment point was moved to either a medial or lateral position. CONCLUSIONS: A more posterior attachment point is advantageous in terms of power and the arc of motion (24.4°) is physiological. We recommend that FHL is transferred to the calcaneus in a posterior position.


Assuntos
Tendão do Calcâneo/cirurgia , Parafusos Ósseos , Simulação por Computador , Modelos Biológicos , Implantação de Prótese/métodos , Transferência Tendinosa/métodos , Tendão do Calcâneo/lesões , Articulação do Tornozelo/fisiologia , Fenômenos Biomecânicos , Doença Crônica , Humanos , Imageamento Tridimensional , Ligamentos Articulares/fisiologia , Amplitude de Movimento Articular/fisiologia , Ruptura/cirurgia
7.
Clin Anat ; 18(6): 443-5, 2005 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-16015649

RESUMO

This study assesses the distribution of varying volumes of fluid within the peritoneal cavity of cadavers of different sizes (small < or =60 kg; medium = 60-100 kg; large > or =100 kg). The results help to predict the volumes of therapeutic solutions (e.g., adhesiolysis solutions used in the prevention of post-operative adhesion formation) that would be required to reach all the relevant spaces within the greater sac of the peritoneal cavity. Twenty-one cadavers (9 male, 12 female) were selected randomly. Midline laparotomy and bilateral subcostal incisions were made to visualize the distribution of 500 ml of water into the pelvic cavity, paracolic gutters, right subhepatic, and subphrenic spaces. A further 500 ml of water was then added and the distribution was again recorded. The results showed that 500 ml of water was found to distribute to all areas in 47.8% of cadavers, and 1,000 ml distributed to all areas in 81.0% of cadavers. One hundred percent of small cadavers achieved maximum distribution with 500 ml irrespective of gender. Seventy percent of medium cadavers achieved maximum distribution with 1,000 ml, and 75% of large cadavers achieved maximum distribution with 1,000 ml. Anatomical variation in the size of the phrenicocolic ligament was found to be an important limiting factor in the distribution of fluid to the space inferior to the left lobe of the liver and the left subphrenic space. Pre-existing intra-abdominal pathology and previous abdominal surgery also influenced the distribution of fluid within the peritoneal cavity.


Assuntos
Ascite/patologia , Líquido Ascítico/patologia , Compartimentos de Líquidos Corporais , Cavidade Peritoneal/patologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Ligamentos/patologia , Masculino , Peritônio/patologia , Aderências Teciduais/complicações , Aderências Teciduais/patologia
8.
J Immunol ; 166(6): 4141-7, 2001 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-11238664

RESUMO

The expression of the IL-2R alpha-, beta-, and gamma-chains, CD25, CD122, and CD132, respectively, was investigated on fibroblast-like synoviocytes (FLS) and dermal fibroblasts (DF). Both protein and mRNA for CD122 and CD132 were observed but there was no evidence of CD25 expression. Quantification of the Ag binding sites for CD122 showed that FLS expressed 4 times more receptor molecules than DF. The functional capability of these receptors was confirmed by the production of monocyte chemoattractant protein-1 (MCP-1) in direct response to stimulation by IL-2, which could be inhibited by neutralizing anti-CD122 mAb. Both rheumatoid arthritis (RA) and osteoarthritis (OA) FLS and DF spontaneously produced MCP-1 in culture over a similar range of concentrations. However, RA and OA FLS produced significantly greater levels of MCP-1 following stimulation by IL-2 and IL-1 beta; RA FLS produced significantly more MCP-1 than OA FLS. Addition of exogenous IL-2 caused a slight, but significant, decrease in MCP-1 production by DF. The addition of neutralizing anti-CD122 mAb to FLS cultures partially, but significantly, reduced the IL-2-induced MCP-1 secretion, but did not effect either the spontaneous or IL-1 beta-induced secretion of MCP-1. Increased tyrosine phosphorylation was observed in FLS lysates following 30-min incubation with IL-2. In conclusion, in the inflamed synovium, as activated T cells migrate through the sublining and lining layer, T cell-derived IL-2 may activate FLS to secrete MCP-1, thus recruiting macrophages into the rheumatoid synovium and perpetuating inflammation.


Assuntos
Quimiocina CCL2/biossíntese , Fibroblastos/imunologia , Fibroblastos/metabolismo , Interleucina-2/farmacologia , Receptores de Interleucina-2/biossíntese , Membrana Sinovial/imunologia , Membrana Sinovial/metabolismo , Anticorpos Bloqueadores/farmacologia , Artrite Reumatoide/imunologia , Artrite Reumatoide/patologia , Sítios de Ligação de Anticorpos , Movimento Celular/imunologia , Células Cultivadas , Quimiocina CCL2/antagonistas & inibidores , Fibroblastos/química , Fibroblastos/patologia , Técnica Direta de Fluorescência para Anticorpo , Regulação da Expressão Gênica/imunologia , Humanos , Soros Imunes/farmacologia , Imuno-Histoquímica , Ativação Linfocitária , Fosforilação , RNA Mensageiro/análise , Receptores de Interleucina-2/genética , Receptores de Interleucina-2/imunologia , Receptores de Interleucina-2/metabolismo , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Pele/química , Pele/citologia , Pele/imunologia , Pele/metabolismo , Membrana Sinovial/química , Membrana Sinovial/patologia , Linfócitos T/imunologia , Linfócitos T/patologia , Tirosina/metabolismo
10.
Diabetes Care ; 3(4): 530-2, 1980.
Artigo em Inglês | MEDLINE | ID: mdl-7460723

RESUMO

Patients with severe diabetic nephropathy often have diabetic retinopathy requiring eye surgery. During the course of their nephropathy, which was treated medically (group A, N = 34), with dialysis (group B, N = 18), or with renal transplantation (group C, N = 2), 54 diabetic patients have had eye surgery. The ophthalmologic procedures included cataract extraction, vitrectomy, scleral buckling, and cyclocryosurgery. The complications included postoperative hemorrhagic glaucoma and persistent retinal detachment. These were encountered in two patients of group A and in two of group B. All other cases showed uneventful intra- and postoperative courses. Major eye surgery can be performed safely during therapy for diabetic nephropathy, including hemodialysis with anticoagulation and transplantation with immunosuppression.


Assuntos
Nefropatias Diabéticas/complicações , Retinopatia Diabética/cirurgia , Adulto , Nefropatias Diabéticas/fisiopatologia , Retinopatia Diabética/complicações , Retinopatia Diabética/fisiopatologia , Glaucoma/cirurgia , Humanos , Pessoa de Meia-Idade , Corpo Vítreo/cirurgia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA