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1.
Eur J Orthop Surg Traumatol ; 29(2): 397-403, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30225667

RESUMO

Supracondylar fracture of the humerus is a common displaced type childhood fracture that is treated by two methods. To compare open and closed methods of reduction with 2 cross k-wire fixation, a retrospective comparative study of 66 paediatric patients with type III supracondylar fracture of the humerus, who were treated in two different hospitals utilizing two different protocols, was conducted. Group 1 was treated with open reduction and 2 cross k-wire fixation, and group 2 received the closed reduction and k-wire fixation protocol. Functional and cosmetic assessments were conducted utilizing the Flynn et al. outcome criteria. The test population consisted of 25 female (37.9%) and 41 male (62.1%) patients. There were 43 fractures (65.2%) in the right elbow and 23 fractures (34.8%) in the left. Group 2 (81.81%) stayed less than 4 days in the hospital, while 69.7% of group 1 stayed more than 5 days. Statistically, there were no significant differences (P > 0.05) between patients of both groups regarding the Flynn et al. criteria. Closed reduction technique was preferred because it required less hospitalization time and resulted in almost no visible surgical scars.


Assuntos
Redução Fechada , Fixação Interna de Fraturas , Fraturas do Úmero/cirurgia , Redução Aberta , Fios Ortopédicos , Criança , Pré-Escolar , Cicatriz/etiologia , Articulação do Cotovelo/fisiopatologia , Feminino , Consolidação da Fratura , Humanos , Fraturas do Úmero/diagnóstico por imagem , Fraturas do Úmero/fisiopatologia , Tempo de Internação , Masculino , Redução Aberta/efeitos adversos , Amplitude de Movimento Articular , Estudos Retrospectivos
2.
Am J Transplant ; 17(4): 893-900, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-27529688

RESUMO

Despite generally positive outcomes and high rates of satisfaction, living kidney donors are at risk for both medical and psychosocial problems. In this review, the authors summarize non-end-stage renal disease (ESRD) risks for donors and describe limitations to the data. We review the evidence of medical risks (e.g. increased cardiovascular disease and mortality, preeclampsia) and psychosocial risks (e.g. mood disturbance, financial burden). We then discuss the evidence of differential risks among subsets and the impact of postdonation events (e.g. development of diabetes). Collectively, available evidence indicates the following. (1) Recognizing the importance of non-ESRD risks has been overshadowed by analyses of the reported risk of ESRD. This imbalance should be remedied. (2) There is little quantification of the true contribution of donation to medical and psychosocial outcomes. (3) Most studies, to date, have been retrospective, with limited sample sizes and diversity and with less-than-ideal controls for comparison of outcomes. (4) Many postdonation events (diabetes and hypertension) can now be reasonably predicted, and their association with adverse outcomes can be quantified. (5) Mechanisms and systems need to be implemented to evaluate and care for donors who develop medical and/or psychosocial problems. (6) Costs to donors are a significant burden, and making donation financially neutral should be a priority.


Assuntos
Nefropatias/etiologia , Transplante de Rim/métodos , Doadores Vivos , Nefrectomia/efeitos adversos , Complicações Pós-Operatórias , Coleta de Tecidos e Órgãos/efeitos adversos , Humanos , Fatores de Risco
3.
Am J Transplant ; 17(12): 3141-3148, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28681494

RESUMO

Whether diabetes after kidney donation is associated with an accelerated GFR decay in the remaining kidney has not been studied. We determined the incidence of diabetes in kidney donors, and compared GFR change over time in diabetic to nondiabetic donors, in addition to the effect of diabetes mellitus (DM) on the development of proteinuria, hypertension, and end-stage renal disease (ESRD). Of the 4014 donors, 309 (7.7%) developed diabetes at a median age of 56.0 years and after a median of 18 years after donation. The difference in annual estimated GFR (eGFR) change between diabetic and nondiabetic donors in the 7 years before the development of DM was -0.08 mL/min/year; p = 0.51. After DM development, the difference was -1.10 mL/min/year for diabetic donors with hypertension and proteinuria, p < 0.001; -0.19 for diabetic donors with hypertension but no proteinuria, p = 0.29; -0.75 mL/min/year for diabetic donors with proteinuria but no hypertension, p = 0.19; and -0.09 mL/min/year for diabetic donors without proteinuria or hypertension, p = 0.63. When DM was considered as a time-dependent covariate, it was associated with the development of proteinuria (hazard ratio [HR] 2.65, 95% confidence interval [CI] 1.89-3.70; p < 0.001) and hypertension (HR 2.19, 95% CI 1.74-2.75; p < 0.001). It was not, however, associated with ESRD. eGFR decline after DM development exceeds that of nondiabetic donors only in diabetic donors with concomitant proteinuria and hypertension.


Assuntos
Diabetes Mellitus/etiologia , Taxa de Filtração Glomerular , Rim/fisiopatologia , Doadores Vivos , Nefrectomia/efeitos adversos , Proteinúria/etiologia , Coleta de Tecidos e Órgãos/métodos , Adulto , Estudos de Casos e Controles , Diabetes Mellitus/patologia , Feminino , Seguimentos , Humanos , Hipertensão/etiologia , Hipertensão/patologia , Incidência , Testes de Função Renal , Transplante de Rim , Masculino , Prognóstico , Proteinúria/patologia , Fatores de Risco
4.
Clin Transplant ; 29(3): 261-7, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25619874

RESUMO

Generous and even excessive fluid intake is routinely recommended to kidney transplant recipients despite minimal evidence to support this practice. We hypothesized that increased fluid intake, ascertained by 24-h urine volume output, may adversely affect graft outcomes as it would impose an extra workload on a limited number of nephrons. Kidney transplant recipients who were randomized to losartan vs. placebo in the Angiotensin II Blockade for Chronic Allograft Nephropathy (ABCAN) trial (n = 153) underwent baseline, five-yr biopsies, and annual iothalamate glomerular filtration rate assessment. Recipients with higher urine volume at randomization had higher urinary sodium and also higher urinary protein. The proportion using diuretics or CNI based regimens were similar across urinary volume tertiles. The highest urinary volume tertile (>2.56 L/d) did not predict the development of interstitial volume doubling or end-stage renal disease (ESRD) from interstitial fibrosis/tubular atrophy (OR = 3.52, 95% CI 0.4, 31.24, p = 0.26), interstitial volume doubling or all-cause ESRD (OR = 7.04, 95% CI 0.66, 74.87, p = 0.11), and was not associated with the conventional endpoint of doubling serum creatinine, all-cause ESRD, or death (OR = 0.89, 95% CI 0.21, 3.71, p = 0.87). These results suggest that the current practice of liberal fluid intake may not be beneficial in low risk and mostly Caucasian transplant recipients.


Assuntos
Comportamento de Ingestão de Líquido/fisiologia , Ingestão de Líquidos/fisiologia , Falência Renal Crônica/cirurgia , Transplante de Rim , Adulto , Idoso , Feminino , Seguimentos , Taxa de Filtração Glomerular , Sobrevivência de Enxerto , Humanos , Falência Renal Crônica/fisiopatologia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Recidiva , Resultado do Tratamento , Urina
5.
Med Teach ; 37(8): 747-754, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25301039

RESUMO

Medical leadership and management (MLM) skills are essential in preventing failings of healthcare; it is unknown how these attitudes can be developed during undergraduate medical education. This paper aims to quantify interest in MLM and recommends preferred methods of teaching and assessment at UK medical schools. Two questionnaires were developed, one sent to all UK medical school faculties, to assess executed and planned curriculum changes, and the other sent to medical students nationally to assess their preferences for teaching and assessment. Forty-eight percent of UK medical schools and 260 individual student responses were recorded. Student responses represented 60% of UK medical schools. 65% of schools valued or highly valued the importance of teaching MLM topics, compared with 93.2% of students. Students' favoured teaching methods were seminars or lectures (89.4%) and audit and quality improvement (QI) projects (77.8%). Medical schools preferred portfolio entries (55%) and presentations (35%) as assessment methods, whilst simulation exercises (76%) and audit reports (61%) were preferred by students. Preferred methods encompass experiential learning or simulation and a greater emphasis should be placed on encouraging student audit and QI projects. The curriculum changes necessary could be achieved via further integration into future editions of Tomorrow's Doctors.

6.
Am J Transplant ; 13(11): 2924-34, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24011252

RESUMO

Live donation benefits recipients, but the long-term consequences for donors remain uncertain. Renal and Lung Living Donors Evaluation Study surveyed kidney donors (N = 2455; 61% women; mean age 58, aged 24-94; mean time from donation 17 years, range 5-48 years) using the Short Form-36 Health Survey (SF-36). The 95% confidence intervals for White and African-American donors included or exceeded SF-36 norms. Over 80% of donors reported average or above average health for their age and sex (p < 0.0001). Donors' age-sex adjusted physical component summary (PCS) scores declined by half a point each decade after donation (p = 0.0027); there was no decline in mental component summary (MCS) scores. White donors' PCS scores were three points higher (p = 0.0004) than non-Whites'; this difference remained constant over time. Nine percent of donors had impaired health (PCS or MCS score >1 SD below norm). Obesity, history of psychiatric difficulties and non-White race were risk factors for impaired physical health; history of psychiatric difficulties was a risk factor for impaired mental health. Education, older donation age and a first-degree relation to the recipient were protective factors. One percent reported that donation affected their health very negatively. Enhanced predonation evaluation and counseling may be warranted, along with ongoing monitoring for overweight donors.


Assuntos
Transplante de Rim , Doadores Vivos/psicologia , Complicações Pós-Operatórias , Qualidade de Vida , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Prontuários Médicos , Pessoa de Meia-Idade , Nefrectomia , Obesidade , Grupos Raciais , Fatores de Risco , Fatores de Tempo , Adulto Jovem
7.
Am J Transplant ; 13(2): 390-8, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23137211

RESUMO

While cautious criteria for selection of living kidney donors are credited for favorable outcomes, recent practice changes may include acceptance of less than ideal donors. To characterize trends in donor acceptance, the Renal and Lung Living Donors Evaluation (RELIVE) Study evaluated 8,951 kidney donors who donated between 1963 and 2007 at three major U.S. transplant centers. Over the study interval, there was an increase in the percentage of donors >40 years old from 38% to 51%; donors >60 years varied between 1% and 4%. The proportion of donors with obesity increased from 8% to 26% and with glucose intolerance from 9% to 25%. The percentage of hypertensive donors was consistent (5-8%). Accepted donors ≥60 years old were more likely to have obesity, glucose intolerance, and/or hypertension compared to younger donors (p<0.0001). Our results demonstrate important trends in acceptance of older and more obese donors. The fraction of older donors accepted with glucose intolerance or hypertension remains small and for the majority includes mild elevations in glucose or blood pressure that were previously classified as within normal limits.


Assuntos
Pressão Sanguínea , Transplante de Rim/métodos , Doadores Vivos/estatística & dados numéricos , Insuficiência Renal/terapia , Adulto , Idoso , Feminino , Intolerância à Glucose/complicações , Intolerância à Glucose/fisiopatologia , Humanos , Hipertensão/complicações , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Obesidade/complicações , Obesidade/fisiopatologia , Sistema de Registros , Resultado do Tratamento
10.
Eye (Lond) ; 37(5): 947-952, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-35105935

RESUMO

BACKGROUND: Ocular medulloepithelioma (diktyoma) is a rare and potentially malignant paediatric tumour of the non-pigmented ciliary epithelium. Adjuvant chemotherapy can be given in advanced cases, but the indications and regimens remain to be defined. The aim was to identify whether adjuvant chemotherapy offers treatment benefit in advanced ocular medulloepithelioma. METHODS: This was a retrospective case series of subjects referred to a single specialist ocular oncology centre for advanced ocular medulloepithelioma subsequently treated with enucleation, including those needing adjuvant systemic vincristine, etoposide and carboplatin. A case-note review was performed for included subjects meeting referral criteria. The outcomes were histopathology characteristics, recurrence, metastases and survival. RESULTS: Between March 2010 and June 2017, four male patients (mean age 31 months) underwent enucleation for ocular medulloepithelioma. Adjuvant chemotherapy was commenced in 3 patients (75%) due to malignant histopathological features. With a mean follow-up time of 81.5 months (median 71 months, range 49-135 months) none of the patients have had recurrence, metastases or death from the tumour. CONCLUSIONS: This series is unique in reporting the management of advanced malignant ocular medulloepithelioma with adjuvant systemic vincristine, etoposide and carboplatin for advanced tumours with malignant features. This regimen appears to be safe and may be effective in preventing metastatic spread.


Assuntos
Tumores Neuroectodérmicos Primitivos , Criança , Humanos , Masculino , Pré-Escolar , Estudos Retrospectivos , Carboplatina/uso terapêutico , Etoposídeo/uso terapêutico , Vincristina/uso terapêutico , Enucleação Ocular , Quimioterapia Adjuvante , Tumores Neuroectodérmicos Primitivos/tratamento farmacológico , Tumores Neuroectodérmicos Primitivos/patologia , Tumores Neuroectodérmicos Primitivos/cirurgia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico
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