RESUMO
BACKGROUND: While traditional surgical repair of the anterior cruciate ligament is able to restore anterior-posterior knee stability, laxity in the transverse plane remains. Double-bundle reconstruction has demonstrated greater rotational restraint than the single-bundle technique under passive loading conditions; however, no comparison has been made under physiological weight-bearing conditions. The purpose of this study was to determine differences in rotational knee kinematics during a dynamic task in patients who had received either a single- or double-bundle reconstruction. METHODS: Twenty-two patients exhibiting isolated anterior cruciate ligament rupture were randomly allocated either a single or double-bundle reconstruction. Three-dimensional knee kinematics were measured during a dynamic cutting activity prior to and following surgery. Functional range of rotation was compared between groups pre- and post-operatively and kinematics were assessed against uninjured control subjects. FINDINGS: No difference in overall range of rotation was found under physiological loading conditions. However, a significant interaction of the midpoint of the range of movement was observed; a greater external rotational shift in the single-bundle group followed reconstruction, while the kinematics of the double-bundle patient group shifted closer to those of the control group. INTERPRETATION: The double-bundle reconstruction demonstrated superior outcome in rotational kinematics to the single-bundle technique.
Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior/métodos , Traumatismos do Joelho/cirurgia , Articulação do Joelho/fisiopatologia , Procedimentos de Cirurgia Plástica/métodos , Tendões/cirurgia , Adulto , Fenômenos Biomecânicos , Feminino , Marcha/fisiologia , Humanos , Traumatismos do Joelho/fisiopatologia , Masculino , Rotação , Suporte de Carga , Adulto JovemRESUMO
BACKGROUND: Anterior cruciate ligament (ACL) ruptures are considered the most severe injury sustained in sports. Although various intrinsic and extrinsic risk factors have been identified, the exact aetiology of the injury is not yet fully understood. Recently, the gene encoding for the alpha1 chain of type I collagen (COL1A1) has been shown to be associated with cruciate ligament ruptures and shoulder dislocations. OBJECTIVE: To determine whether the functional Sp1 binding site polymorphism within intron 1 of the COL1A1 gene is associated specifically with ACL ruptures in an independent population. METHODS: 117 Caucasian participants with surgically diagnosed ACL ruptures, and 130 Caucasian physically active controls without any history of previous ligament or tendon injuries were recruited for this case-control genetic association study. All participants were genotyped for the COL1A1 Sp1 binding site polymorphism (G/T; rs1800012). RESULTS: The rare TT genotype was significantly (p = 0.031, OR = 0.08, 95% CI <0.01 to 1.46) under-represented in the ACL group (0 out of 117, 0%), compared with the controls (6 out of 130, 4.6%). CONCLUSION: The TT genotype of the COL1A1 Sp1 binding site polymorphism was significantly under-represented in South African participants with ACL ruptures. We propose that this sequence variant be the first specific genetic element to be included in multifactorial models developed to understand the aetiology and risk factors for ACL rupture.
Assuntos
Lesões do Ligamento Cruzado Anterior , Traumatismos em Atletas/genética , Proteínas de Fusão Oncogênica/genética , Polimorfismo de Nucleotídeo Único/genética , Adulto , Análise de Variância , Sítios de Ligação/genética , Estudos de Casos e Controles , DNA/análise , Feminino , Frequência do Gene , Genótipo , Humanos , Íntrons/genética , Masculino , Linhagem , Fatores de Risco , Ruptura/genéticaRESUMO
INTRODUCTION: Percutaneous endoscopic gastrostomy (PEG) has been performed on children since 1979. The indications for a PEG are wide ranging and while there are well-established benefits, it remains a procedure with recognised complications. GOALS AND OBJECTIVES: The goal of this study was to review our experience with this procedure at a South African paediatric tertiary referral hospital over a 5-year period. The objectives were to review PEGs with regard to patient characteristics, indications, anaesthesia time required and complications. METHODS: The study was a retrospective case record review. RESULTS: A total of 70 PEGs were performed. Patients had a mean age of 4 years and 3 months, and a mean weight of 12.2 kg at the time of performing the procedure. The mean anaesthetic time required for performing a PEG was 27 minutes. Fifty-four PEGs (77%) were performed for inability to swallow, 15 (21%) to improve caloric intake, and 1 (1%) for continuous enteral feeding. There were no deaths, 5 patients had major complications (6%), and 12 patients (17%) needed antireflux surgery subsequent to the placement of a PEG. DISCUSSION: There is an increasing demand for PEGs at our institution. The indications for a PEG in this series are similar to those reported in other series, although we may be underutilising PEGs to improve caloric intake. Our complication rates compare favourably with those reported in other series. We have, however, identified post-PEG gastrooesophageal reflux disease as a complication we would like to reduce, and suggest a practical approach to do so.
Assuntos
Transtornos de Deglutição/cirurgia , Nutrição Enteral/métodos , Gastroscopia/métodos , Gastrostomia/métodos , Adolescente , Criança , Pré-Escolar , Perfuração Esofágica/etiologia , Migração de Corpo Estranho/etiologia , Refluxo Gastroesofágico/etiologia , Refluxo Gastroesofágico/cirurgia , Gastroscopia/efeitos adversos , Gastrostomia/efeitos adversos , Humanos , Lactente , Recém-Nascido , Enfisema Mediastínico/etiologia , Distúrbios Nutricionais/prevenção & controle , Estudos Retrospectivos , Sepse/etiologia , Resultado do TratamentoRESUMO
The purpose of the present paper is to review the indications, results, clinical correlation and implications for management of a modified CT peritoneography (CTP) technique in the evaluation of continuous ambulatory peritoneal dialysis (CAPD) patients. Forty CTP in 33 patients were reviewed by two observers blinded to clinical history or outcome. The CTP technique included 100 mL non-ionic intraperitoneal contrast, 1 h of ambulation and prone positioning during the CT. No precontrast or delayed examinations were performed. A CAPD-related complication was diagnosed in 33 of 40 (82%) CTP. Twenty-nine CTP were performed for evaluation of suspected dialysate leaks. In this group there were 18 leaks, a total of seven umbilical hernias (five as isolated findings) and five normal studies. Nine of 18 (50%) leaks resolved with conservative management and six of nine patients (67%) of the remainder continued CAPD after appropriate surgery. Seven patients were evaluated for scrotal swelling (one bilateral), and there were five communicating hydroceles (all with inguinal fat herniation and all surgically confirmed) and three non-communicating hydroceles (none of which progressed). Umbilical hernias were present in nine of 33 patients (27%). No false positive or false negative studies were identified. The CTP technique described provides accurate diagnostic information in the management of common CAPD-related complications, particularly dialysate leak, genital swelling, abdominal wall hernias and peritoneal adhesions. Computed tomography peritoneography directs appropriate conservative or surgical management.
Assuntos
Cavidade Peritoneal/diagnóstico por imagem , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Soluções para Diálise , Extravasamento de Materiais Terapêuticos e Diagnósticos/diagnóstico por imagem , Feminino , Hérnia Inguinal/diagnóstico por imagem , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Peritonite/diagnóstico por imagem , Escroto/diagnóstico por imagem , Hidrocele Testicular/diagnóstico por imagemRESUMO
Peri-operative cardiac events are the leading cause of death following anaesthesia and surgery. We attempt to put into perspective the various methods of pre-operative assessment of patients at risk, and suggest a logical sequence for the use of potentially costly investigations such as 12-lead ECG, exercise stress ECG, ambulatory ECG monitoring, myocardial perfusion imaging, radionuclide ejection fraction, and coronary angiography. Important principles are given for the management of patients at risk of peri-operative cardiac incidents if the decision is made to proceed with non-cardiac surgery despite the potential risk or because of inoperable coronary disease.
Assuntos
Doença das Coronárias/diagnóstico , Isquemia Miocárdica/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios , Procedimentos Cirúrgicos Operatórios , Eletrocardiografia , HumanosAssuntos
Atitude do Pessoal de Saúde , Fumar , Feminino , Humanos , Masculino , Controle Social Formal , África do Sul , Estudantes de MedicinaRESUMO
We report on three episodes of acute renal failure due to the haemolytic uraemic syndrome in two elderly men with disseminated prostatic carcinoma. Two of the three episodes were treated with plasmapheresis and antiplatelet agents and all three episodes resolved before treatment for the prostatic carcinoma was undertaken. There are only two previous reports in the literature of untreated malignancy presenting with the haemolytic uraemic syndrome, one of which was a case of prostatic carcinoma.
Assuntos
Síndrome Hemolítico-Urêmica/etiologia , Neoplasias da Próstata/complicações , Adenocarcinoma/complicações , Adenocarcinoma/secundário , Idoso , Síndrome Hemolítico-Urêmica/terapia , Humanos , Masculino , Pessoa de Meia-Idade , PrognósticoRESUMO
The changes in total serum calcium, ionized calcium, total serum protein, albumin and phosphate levels during cardiopulmonary bypass were measured. The possible causes of the changes in these parameters are discussed. The effect of the presence of heparin on serum ionized calcium is evaluated. The metabolic and clinical significance of the changes in blood components measured are discussed, special attention being paid to the use of calcium as an inotropic agent at the termination of cardiopulmonary bypass.