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1.
J Med Life ; 9(3): 316-320, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27974942

RESUMO

Hand fractures are one of the most common causes for presenting to the emergency room. Metacarpal fractures count about 18 to 44% of all hand fractures, and are most often standalone closed injuries, without misplacement, not needing operative treatment. We present a case in which osteosynthesis with plates and screws was used to reduce two metacarpal fractures in order to allow an early motion recovery, despite the fact that a small portion of the periosteum needed to be removed. The type of fractures were misclassified according to the radiological findings, therefore the correct diagnosis was established during surgery. The results according to the radiological aspects and to the DASH score were excellent with 95% function recovery at twelve months. In this case, the use of osteosynthesis with plates and screws led to a good fracture healing without any major complications. However, there are a series of complications related to this method that should be taken into consideration. Being misled by the radiological aspects of the fractures, the most certain way to classify a metacarpal shaft fracture is through exploratory surgery, even if in most of the cases the three radiological views are enough to establish the diagnosis. Abbreviations: DASH score = Disability of Arm, Shoulder and Hand score, TAM = Total Active Motion, MCP = metacarpal phalangeal joint, PIP = proximal inter phalangeal joint.


Assuntos
Placas Ósseas , Parafusos Ósseos , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Ossos Metacarpais/lesões , Periósteo/cirurgia , Adulto , Falanges dos Dedos da Mão/cirurgia , Consolidação da Fratura , Fraturas Ósseas/diagnóstico por imagem , Humanos , Masculino , Ossos Metacarpais/diagnóstico por imagem
2.
Cleft Palate Craniofac J ; 53(1): 47-56, 2016 01.
Artigo em Inglês | MEDLINE | ID: mdl-25950239

RESUMO

OBJECTIVES: This cross-sectional study sought to assess bone formation and spontaneous tooth eruption in a cohort of 25 consecutive patients aged 6 to 11 years who underwent primary gingivoperiosteoplasty by the Collares technique. DESIGN: Cross-sectional study assessing bone formation in the cleft area using a within-group time series design. SETTING: Hospital de Clínicas de Porto Alegre (HCPA), a tertiary hospital in Brazil. PATIENTS: Twenty-five patients with nonsyndromic, complete unilateral cleft lip and palate, no comorbidities, and unerupted permanent canines. INTERVENTION: Cheiloplasty was performed by means of the Millard II technique, with the addition of a triangle at the mucocutaneous junction, vomer flap nasal floor closure, and wide subperiosteal elevation, followed by gingivoperiosteoplasty by the Collares technique. MAIN OUTCOME MEASURES: Cone-beam computed tomography was used to assess treatment effect. In a novel method, software was used to obtain two three-dimensional reconstructions, one each of the cleft and noncleft sides, enabling quantitative comparison of bone presence in the alveolar defect area. RESULTS: Of the 25 patients, 24 achieved bone bridge formation. The cleft side had 75.1% (67.9%-82.3%) of the bone volume, 70.5% (53.1%-87.9%) of the height, and 63.3% (44.1%-82.5%) of the width of the noncleft side. Bone formation was 17.28% lower in patients with lateral incisor agenesis. CONCLUSION: Collares gingivoperiosteoplasty performed well as a technique for alveolar repair in patients with cleft lip and palate, allowing spontaneous eruption of deciduous and permanent lateral incisors through the bone bridge created.


Assuntos
Processo Alveolar/diagnóstico por imagem , Processo Alveolar/cirurgia , Fenda Labial/diagnóstico por imagem , Fenda Labial/cirurgia , Fissura Palatina/diagnóstico por imagem , Fissura Palatina/cirurgia , Tomografia Computadorizada de Feixe Cônico , Gengivoplastia/métodos , Periósteo/cirurgia , Brasil , Criança , Estudos Transversais , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Imageamento Tridimensional , Masculino , Osteogênese , Retalhos Cirúrgicos , Erupção Dentária , Resultado do Tratamento
3.
Dent Mater J ; 29(6): 673-81, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21099156

RESUMO

To date, there has been no study on the development of novel regimens based on the following tissue engineering principles: seeding and culturing mesenchymal stem cells (MSCs) on a scaffold before surgery or injecting cultured MSCs into a scaffold during surgery. The purpose of this study was to assess the in vivo osteogenic ability of scaffold/MSCs implanted beneath the periosteum of the cranial bone of rats in three different sample groups: one in which MSCs were pre-seeded and cultured on a scaffold to produce the 3-D woven fabric scaffold/MSC composite using osteo-lineage induction medium, one in which cultured MSCs produced by osteo-lineage induction in cell cultivation flasks were injected into a scaffold during surgery and a control group, in which only the 3-D woven fabric scaffold was implanted. The results indicate that pre-seeding MSCs on a scaffold leads to a higher osteogenic ability than injecting cultured MSCs into a scaffold during surgery.


Assuntos
Regeneração Óssea/fisiologia , Transplante de Células-Tronco Mesenquimais/métodos , Osteogênese/fisiologia , Periósteo/cirurgia , Crânio/cirurgia , Alicerces Teciduais , Implantes Absorvíveis , Animais , Células da Medula Óssea/fisiologia , Contagem de Células , Técnicas de Cultura de Células , Diferenciação Celular/fisiologia , Linhagem da Célula , Proliferação de Células , Forma Celular , Humanos , Ácido Láctico/química , Masculino , Células-Tronco Mesenquimais/fisiologia , Osteoblastos/fisiologia , Plasma Rico em Plaquetas/fisiologia , Poliésteres , Polímeros/química , Desenho de Prótese , Ratos , Ratos Endogâmicos F344 , Ratos Nus , Engenharia Tecidual
5.
Ann Fr Anesth Reanim ; 28(9): 735-42, 2009 Sep.
Artigo em Francês | MEDLINE | ID: mdl-19713066

RESUMO

OBJECTIVE: To determine the level of satisfaction in terms of pain relief and comfort among patients receiving different postoperative analgesia protocols after hand surgery under regional anaesthesia in a day care unit. METHODS: Cohort study among patients after hand surgery under regional anaesthesia during two consecutive three months time periods, with patient stratification according to the expected pain level with different balanced analgesia protocols (group A: carpal tunnel, group B: other surgery without bone involvement, group C: bone surgery). A telephone survey, scoring analgesia and comfort, each with a numerical (0-10) scale was conducted on days 1 and 7. During the first period analgesia for groups A and B was the same (acetaminophen-dextropropoxyphene or acetaminophen-codeine) and group C patients were treated with acetaminophen-ketoprofen-tramadol. In the second period analgesia was reduced for group A (acetaminophen alone) and increased for group B (acetaminophen-ketoprofen-tramadol) and group C (duration increased from 3 to 7 days). RESULTS: For carpal tunnel surgery, analgesia with acetaminophen alone was efficient, (Pain scale [PS] d0=2[0-10], PS d1=1 [0-10] and PS d2-d4=0,5 [0-10]). This surgery does not elicit important pain, there is no benefit in adding other analgesics. For group B, a significant improvement in postoperative pain was observed (postoperative d1 p<0.03) with a major increase in side effects (2/57 vs 17/48 p<0.001). For group C, therapeutic changes were ineffective (PS d0=2 vs 3.5 et PS d1=3 vs 5 [NS]) and we noticed an increase in side effects (p<0.05). One third of all patients are totally satisfied on day 7, logistic regression showing the role of inefficient analgesia in late postoperative period (PS>2 between d2-d4). Between day 1 and day 7, 20% of the patients change their point of view, those who feel less satisfied on day 7 complained of a more severe postoperative pain between day 2 and 4 (p<0.001) and between day 5-7 (p<0.01). CONCLUSION: For hand surgery on day case, quality of late postoperative analgesia (day 2-day 7) is strongly related to patient's satisfaction on day 7.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Analgésicos não Narcóticos/uso terapêutico , Analgésicos Opioides/uso terapêutico , Mãos/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Satisfação do Paciente , Acetaminofen/administração & dosagem , Acetaminofen/uso terapêutico , Adulto , Idoso , Analgésicos não Narcóticos/administração & dosagem , Analgésicos Opioides/administração & dosagem , Anestesia Local , Síndrome do Túnel Carpal/cirurgia , Codeína/administração & dosagem , Codeína/uso terapêutico , Estudos de Coortes , Dextropropoxifeno/administração & dosagem , Dextropropoxifeno/uso terapêutico , Quimioterapia Combinada , Feminino , Humanos , Cetoprofeno/administração & dosagem , Cetoprofeno/uso terapêutico , Masculino , Pessoa de Meia-Idade , Periósteo/cirurgia , Garantia da Qualidade dos Cuidados de Saúde , Fatores de Tempo , Tramadol/administração & dosagem , Tramadol/uso terapêutico
6.
Acta Orthop Belg ; 74(6): 823-30, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19205331

RESUMO

Corticotomy and periosteal elevation as a surgical procedure for management of chronic critical limb ischaemia is a relatively new technique. The current study aimed at assessing its safety, efficiency and cost/benefit ratio. The procedure was performed in 36patients. Preoperative documentation for age, sex, co-morbidities, ankle systolic pressure, and magnetic resonance contrast angiography was obtained. Early results included evaluation of skin perfusion. Late results involved assessment of wound healing, which was documented with photographs and was graded (healed, healing, resistant, recurrent), pain (intermittent claudication and pain at rest), Kelkar score, procedure morbidity, patient satisfaction and quality of life. Mean age was 68.03 +/- 5.5 years; 23 patients were males (63.9%) and 13 females (36.1%). Twenty (55.6%) patients had ankle systolic pressure < 50 mmHg and 29 (80.5%) had infra-inguinal vascular disease. Skin perfusion improved in 33/36 patients (91.7%). At final follow-up, 34 patients (94.1%) achieved complete wound healing. Relief from ischaemic rest pain and intermittent claudication was achieved in 86.1% and 55.6% respectively, with 20 (55.6%) patients having an excellent Kelkar score. Only one patient required a major amputation. Morbidity was noted in 17.7% of cases. Patient satisfaction scores at 12 months and at final follow-up were 7.1 +/- 1.3, and 8.7 +/- 1.7 respectively, on a scale from 0 to 10. Quality of life was markedly improved as compared to the preoperative status (overall score: p = 0.05, mental health scale: p <0.05 and pain/anxiety domain: p < 0.001). The procedure appears to represent an interesting tool, which should be evaluated in randomised studies. Our findings support the postulated angiogenic effect of the fracture haematoma.


Assuntos
Isquemia/cirurgia , Tíbia/cirurgia , Idoso , Doença Crônica , Hormônio Liberador da Corticotropina/análogos & derivados , Análise Custo-Benefício , Feminino , Humanos , Claudicação Intermitente/terapia , Isquemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Periósteo/cirurgia , Qualidade de Vida
7.
J Craniofac Surg ; 17(3): 468-73, 2006 May.
Artigo em Inglês | MEDLINE | ID: mdl-16770182

RESUMO

The effects of alveolar grafting on the development of the craniofacial complex have been reported by numerous investigators. The reported results vary in the literature from significant to very little impediment of maxillary growth. The present work evaluates and compares facial form at age six years in complete unilateral cleft lip and palate patients treated with presurgical orthopedic correction and primary reconstruction with (1) primary bone grafts (n = 14), (2) gingivoperiosteoplasty (n = II), or (3) without alveolar grafting procedures at the time of lip repair (n = 13). The cohort groups were analyzed with a one-way analysis of variance (ANOV A). Statistical analysis revealed significant differences between the three groups for only one of the 12 parameters analyzed. The primary bone grafted group demonstrated less vertical descent-of the anterior maxilla compared to the gingivoperiosteoplasty and non-grafted groups (P = .0027).


Assuntos
Transplante Ósseo , Fenda Labial/terapia , Fissura Palatina/terapia , Gengivoplastia , Obturadores Palatinos , Periósteo/cirurgia , Alveoloplastia , Cefalometria , Criança , Pré-Escolar , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Estudos de Coortes , Face , Feminino , Seguimentos , Humanos , Processamento de Imagem Assistida por Computador , Lábio/cirurgia , Masculino , Maxila/cirurgia , Dimensão Vertical
8.
J Hand Surg Am ; 30(2): 400-3, 2005 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15781366

RESUMO

The pincer-nail deformity is characterized by an excessively curved and distorted nail across the transverse dimension. Forty-nine sides (paronychial folds) were dissected off the distal phalanx periosteum with scissors and/or a small elevator. The dermis was placed between the paronychial fold and the plalanx to flatten the germinal and sterile matrix. Direct comparison of autograft dermis to homograft dermis did not show any significant differences in postcorrection appearance of the nail or relief of symptoms. Surgical time averaged 22 minutes less in those patients having reconstruction on both sides of one nail with homograft dermis.


Assuntos
Unhas Malformadas/cirurgia , Transplante de Pele/métodos , Humanos , Periósteo/cirurgia , Transplante de Pele/economia , Transplante Autólogo/economia , Transplante Homólogo/economia
10.
Cleft Palate Craniofac J ; 39(1): 26-9, 2002 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-11772166

RESUMO

OBJECTIVE: The purpose of this study was to compare the financial impact of two treatment approaches to the unilateral cleft alveolus. The recently advocated nasoalveolar molding (NAM; and gingivoperiosteoplasty (GPP; at the time of lip repair were compared with the traditional approach of secondary alveolar bone graft. DESIGN: The records of all patients (n = 30) with unilateral cleft lip and alveolus treated by a single surgeon during 1985 through 1988 were examined retrospectively. The patients were divided into two groups: group 1 patients (n = 14) were treated by lip repair, primary nasal repair, and secondary alveolar bone graft prior to eruption of permanent dentition; group 2 patients (n = 16) were treated by NAM, GPP, lip repair, and primary nasal repair. Patients who required secondary alveolar bone graft after GPP were noted. The cost of treatment by each protocol was calculated in 1998 dollars. RESULTS: The average cost of treatment for a patient treated by lip repair, primary nasal repair, and secondary alveolar bone graft prior to eruption of permanent dentition was $22,744. Of the 16 patients treated by NAM, GPP, lip repair, and primary nasal repair, 10 required no further treatment of the unilateral cleft alveolus; six patients required secondary alveolar bone graft. The average per-patient treatment cost in this group was $19,745. The average cost savings of NAM and GPP, compared with alveolar bone graft is $2999. CONCLUSIONS: The treatment of unilateral cleft alveolus by nasoalveolar molding and gingivoperiosteoplasty results in substantial cost savings, compared with treatment by secondary alveolar bone graft.


Assuntos
Processo Alveolar/patologia , Alveoloplastia/métodos , Transplante Ósseo/métodos , Fissura Palatina/cirurgia , Gengivoplastia/métodos , Nariz/patologia , Obturadores Palatinos , Periósteo/cirurgia , Anestesiologia/economia , Transplante Ósseo/economia , Fenda Labial/cirurgia , Fenda Labial/terapia , Fissura Palatina/reabilitação , Protocolos Clínicos , Redução de Custos , Honorários Médicos , Cirurgia Geral/economia , Gengivoplastia/economia , Custos de Cuidados de Saúde , Hospitalização/economia , Humanos , Salas Cirúrgicas/economia , Ortodontia/economia , Obturadores Palatinos/economia , Sala de Recuperação/economia , Estudos Retrospectivos , Fatores de Tempo , Erupção Dentária , Resultado do Tratamento
11.
J Am Vet Med Assoc ; 207(6): 746-50, 1995 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-7657575

RESUMO

Racing records of 199 Thoroughbred foals with angular limb deformities surgically treated by hemicircumferential periosteal transection and elevation (HCPT) from 1987 through 1989 (principals) were compared with records of their 1,017 siblings (controls) for starting status; 2-, 3-, and 4-year-old starts; earnings and earnings per start; and starts percentile ranking number (SPR). Principals had a slightly lower percentage of horses starting a race (45 vs 55%), fewer 2-year-old starts (1.06 vs 1.72), and lower SPR (33.49 vs 49.18), compared with those of controls (P < 0.05). Starting status was significantly (P < 0.05) affected by surgery and the horse's sex, but not by anatomic site treated. Fillies were 1.74 times less likely to start than were colts, regardless of surgery, whereas principal fillies were 2.63 times less likely to start than were control colts. Difference was not detected between principals and controls in 3- or 4-year-old starts; 2-, 3-, or 4-year-old earnings, or earnings per start. Horses treated with distal metacarpal/metatarsal HCPT had fewer 2-year-old starts (1.09 vs 2.19), but did not have a significantly different SPR or lower starting percentage, compared with values for controls. Horses treated with distal radial HCPT had lower starting percentage (48 vs 55%), fewer 2-year-old starts (1.22 vs 1.70), and lower SPR (32.53 vs 53.32), compared with those of controls.(ABSTRACT TRUNCATED AT 250 WORDS)


Assuntos
Cavalos/anormalidades , Deformidades Congênitas dos Membros , Periósteo/cirurgia , Condicionamento Físico Animal , Animais , Anormalidades Congênitas/economia , Anormalidades Congênitas/cirurgia , Anormalidades Congênitas/veterinária , Extremidades/cirurgia , Feminino , Cavalos/cirurgia , Modelos Logísticos , Masculino , Estudos Retrospectivos , Esportes
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