RESUMEN
The introduction of the new generation of thumb carpometacarpal (CMC I) joint implants for the treatment of CMC I osteoarthritis has significantly broadened the scope of hand surgery in recent years. However, the technical demands of the procedure and the many details that need to be considered require appropriate training and a learning curve. To share experiences with the Touch CMC I prosthesis, we held the first German-speaking CMC I joint prosthetics user meeting in Zurich. After some basic introductory lectures on biomechanics and the principles of prosthetic fitting of the CMC I joint, the various challenges associated with CMC I joint prosthetics were discussed in interactive expert panels. Subsequently, cases were discussed in small groups under expert guidance and the respective conclusions were discussed in plenary. The main results of this symposium are summarised in this manuscript.
Asunto(s)
Articulaciones Carpometacarpianas , Prótesis Articulares , Osteoartritis , Diseño de Prótesis , Pulgar , Humanos , Masculino , Fenómenos Biomecánicos , Articulaciones Carpometacarpianas/cirugía , Osteoartritis/cirugía , Ajuste de Prótesis , Pulgar/cirugíaAsunto(s)
Traumatismos de la Mano , Lepra , Esguinces y Distensiones , Traumatismos de la Muñeca/cirugía , Humanos , MuñecaRESUMEN
Superior vena cava (SVC) clamping can be required during thoracic surgery for SVC replacement or repair. In such cases, bypass techniques can be necessary to avoid hemodynamic instability, cerebral venous hypertension and hypoperfusion. Here, we report a novel and simple SVC bypass technique which does not require full systemic heparinization, specialized cannulation techniques or pumping devices and which can be applied percutaneously in the preoperative phase or intraoperatively. The preoperative shunt consisted in two Swan-Ganz catheters inserted in the jugular and femoral veins and connected by perfusion tubing with a three way stopcock. The intraoperative shunt consisted of a Pruitt(®)-catheter inserted in the left innominate vein and connected to a femoral Swan-Ganz catheter by perfusion tubing. We validated our system in seven patients undergoing SVC reconstruction. We monitored the systemic arterial blood pressures, the heart rate and vasoactive peptide requirements throughout the procedure. We also determined the neurological status and the in-hospital morbidity and mortality for each patient. Using this bypass, SVC clamping caused no hemodynamic instability, no neurological impairments and no in-hospital complications or deaths. This simple temporary SVC bypass procedure is safe and avoids hemodynamic instability and cerebral venous hypertension.
Asunto(s)
Venas Braquiocefálicas , Cateterismo Periférico , Vena Femoral , Procedimientos Quirúrgicos Vasculares , Vena Cava Superior/cirugía , Cateterismo Periférico/efectos adversos , Cateterismo Periférico/instrumentación , Cateterismo Periférico/mortalidad , Cateterismo de Swan-Ganz/instrumentación , Catéteres , Trastornos Cerebrovasculares/etiología , Constricción , Diseño de Equipo , Femenino , Hemodinámica , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/etiología , Suiza , Factores de Tiempo , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/efectos adversos , Procedimientos Quirúrgicos Vasculares/instrumentación , Procedimientos Quirúrgicos Vasculares/mortalidadRESUMEN
The systemic treatment of kidney cancers is promising regarding the first results of the inhibiting molecules of the angiogenesis. Projections in research are encouraging for more specific and sensitive markers of the prostate cancer. For this last the intermittent hormonotherapy improves the quality of life of the patients. The overweight control in infertility allows greater chances of giving birth. The morbidity of the kidney percutaneous surgery is decreased by the use of smaller tools. Reduction rate of reobstruction thanks to new manufactoring stents. The botulinic toxin for the hyperactive bladder refunded by the health insurances.