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1.
Bone Joint J ; 102-B(7): 933-940, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32600149

RESUMO

AIMS: The aim was to compare long-term patient-reported outcome measures (PROMs) after operative and nonoperative treatment of acute Achilles tendon rupture in the context of a randomized controlled trial. METHODS: PROMs including the Short Musculoskeletal Function Assessment (SMFA), Achilles Tendon Total Rupture Score (ATRS), EuroQol five-dimension (EQ-5D), satisfaction, net promoter score and data regarding re-rupture, and venous thromboembolic rates were collected for patients randomized to receive either operative or nonoperative treatment for acute Achilles tendon rupture in a previous study. Of the 80 patients originally randomized, 64 (33 treated surgically, 31 nonoperatively) patients were followed up at a mean of 15.7 years (13.4 to 17.7). RESULTS: There was no statistically significant difference between operatively and nonoperatively treated patients, in SMFA Dysfunction Index (median 1.56 (interquartile range (IQR) 0 to 5.51) vs 1.47 (IQR 0 to 5.15); p = 0.289), SMFA Bother Index (2.08 (IQR 0 to 12.50) vs 0.00 (IQR 0 to 6.25); p = 0.074), ATRS (94 (IQR 86 to 100) vs 95 (IQR 81 to 100); p = 0.313), EQ-5D-5L (1 (IQR 0.75 to 1) vs 1 (IQR 0.84 to 1); p = 0.137) or EQ-5D health today visual analogue score (85 (IQR 72.5 to 95) vs 85 (IQR 8 to 95); p = 0.367). There was no statistically significant difference between operative and nonoperative groups in terms of satisfaction (84% vs 100%; p = 0.119) or willingness to recommend treatment to friends or family (79% vs 87%; p = 0.255). Four nonoperative patients and two in the operative group sustained a re-rupture (p = 0.306). CONCLUSION: Both patient groups reported good results at long-term follow-up. The findings give no evidence of superior long-term patient reported outcomes (as measured by the SMFA) for surgical treatment over nonoperative treatment. There was no demonstrable difference in other patient reported outcome measures, satisfaction, or re-rupture rates at long-term follow-up. Cite this article: Bone Joint J 2020;102-B(7):933-940.


Assuntos
Tendão do Calcâneo/lesões , Medidas de Resultados Relatados pelo Paciente , Traumatismos dos Tendões/terapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Ruptura , Traumatismos dos Tendões/cirurgia
2.
Medicine (Baltimore) ; 99(27): e21047, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629730

RESUMO

Repair of medial meniscus posterior root tear (MMPRT) is considered as an effective early intervention strategy for osteoarthritis. We aimed at evaluating whether or not single-photon emission computed tomography/computed tomography (SPECT/CT) could predict the treatment outcome.Eleven patients with MMPRT who underwent preoperative SPECT/CT were retrospectively enrolled. Clinical symptoms were evaluated based on the knee injury and osteoarthritis outcome score (KOOS) and visual analogue scale (VAS) for pain. The uptake pattern of the medial tibial plateau (MTP) on SPECT/CT was visually assessed. Additionally, the maximum lesion-to-cortical counts ratio (LCRmax) for the anterior and posterior aspects of MTP and anterior-posterior MTP ratio (APR) were quantitatively assessed. Spearman correlation analyses were performed between the change in clinical symptom scores and preoperative SPECT/CT patterns.All patients showed increased radiotracer uptake in MTP. Among them, 8 (73%) showed dominant uptake in the anterior aspect of MTP. The rest 3 (27%) showed posterior-dominant uptake. Patients with anterior-dominant patterns tended to show better outcomes in terms of the postoperative KOOS score (P = .07). Anterior MTP LCRmax showed a negative correlation with the change in VAS (ρ = -0.664, P < .03). APR showed a correlation with the change in the KOOS score (ρ = 0.655, P < .03).Patients with MMPRT with relatively higher uptake in the anterior aspect of MTP could have better clinical outcomes after the repair. The preoperative SPECT/CT pattern may have a predictive value in selecting patients with good postoperative outcomes.


Assuntos
Meniscos Tibiais/patologia , Osteoartrite/cirurgia , Ruptura/cirurgia , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único/métodos , Idoso , Osso e Ossos/diagnóstico por imagem , Feminino , Humanos , Traumatismos do Joelho/cirurgia , Articulação do Joelho/diagnóstico por imagem , Meniscectomia/métodos , Pessoa de Meia-Idade , Período Pós-Operatório , Valor Preditivo dos Testes , Período Pré-Operatório , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Escala Visual Analógica
3.
Medicine (Baltimore) ; 99(27): e21134, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629748

RESUMO

Implant ruptures may be diagnosed by physical examination, ultrasound (US), and magnetic resonance imaging (MRI). The absence of standard guidelines to approach to implant ruptures may cause unnecessary surgical revisions in the absence of radiological confirmation of prosthetic damages.The purpose of this study was to analyze the diagnostic procedures applied to patients with suspected prosthetic rupture and surgeon choices to perform a revision or to plan a clinical and radiological follow-up.We conducted a retrospective study on 62 women submitted to revision surgery due to radiological diagnosis of suspected implant rupture, following mastectomy or aesthetic reconstruction, and admitted to a Plastic Surgery Department between 2008 and 2018.Seventy-three implants, believed to be ruptured, were explanted. One-third of these were intact and unnecessarily explanted. US associated with MRI evaluation resulted in the most helpful diagnostical method.A standardized clinical and radiological approach is essential to manage breast implant ruptures successfully. An innovative protocol is proposed in order to: ensure the appropriate management of implant ruptures and prevent unnecessary surgical revisions; reduce the risk of claims for medical malpractice in cases of unsatisfactory final aesthetic results or worse than before.


Assuntos
Implantes de Mama/efeitos adversos , Comportamento de Escolha/fisiologia , Mastectomia/efeitos adversos , Cirurgia Plástica/efeitos adversos , Feminino , Hospitalização , Humanos , Responsabilidade Legal/economia , Imagem por Ressonância Magnética/métodos , Imperícia/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Ruptura/complicações , Ruptura/diagnóstico por imagem , Ruptura/cirurgia , Cirurgiões/psicologia , Ultrassonografia/métodos
4.
Medicine (Baltimore) ; 99(27): e21139, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629749

RESUMO

INTRODUCTION: Most symptomatic large-to-massive rotator cuff tears (RCTs) should be operated, but the surgical reparability depended on the degree of rotator cuff muscle atrophy or fatty infiltration. The orthopedic surgeons will decide whether the teared stump is reparable during the surgery, but preoperative evaluation can be done by some assessment tools. Magnetic resonance imaging (MRI) was used in recent studies to predict the reparability of large-to-massive RCTs, but the clinical availability was not as good as ultrasound. We hypothesize that the ultrasound elastography can predict the reparability of large-to-massive RCTs. METHODS: This is a prospective observational study and participants with large-to-massive RCTs who are going to have surgeries will be included. Out investigators will evaluate the shoulder passive range of motion (ROM) and strength of all participants. Participants' degree of shoulder pain and activities of daily living (ADLs) will be assessed by American Shoulder and Elbow Surgeons (ASES) score. The ultrasound elastography will be used to evaluate the tissue quality of supraspinatus muscle and infraspinatus muscle. To test the reliability of the ultrasound elastography, two physicians will perform the ultrasound elastography independently and twenty participants will be selected for the reliability test. Besides, MRI will be used to evaluate the size of tear, the degree of tendon retraction, fatty infiltration of rotator cuff muscles, and muscle atrophy. Finally, the orthopedic surgeons will perform surgeries and decide whether the teared stump can be completely repaired intraoperatively. The primary analysis is the predictive validity of ultrasound elastography for the reparability of large-to-massive RCTs. Before the predictive validity of ultrasound elastography is measured, our investigators will assess the reliability of ultrasound elastography when administered to cases with large-to-massive RCTs, and we will check the correlations between the findings of ultrasound elastography and MRI. DISCUSSION: The outcome will provide the evidence of ultrasound elastography for preoperative evaluation of large-to-massive RCTs. The relationships between the findings of ultrasound elastography and MRI will also be examined for further analysis. TRIAL REGISTRATION: Clinicaltrials.gov NCT03682679. Date of Registration: 25 September 2018, https://clinicaltrials.gov/ct2/show/NCT03682679?cond=rotator+cuff&cntry=TW&draw=2&rank=1.


Assuntos
Lesões do Manguito Rotador/diagnóstico por imagem , Ruptura/cirurgia , Ombro/fisiopatologia , Atividades Cotidianas , Tecido Adiposo/patologia , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Atrofia Muscular/patologia , Valor Preditivo dos Testes , Período Pré-Operatório , Estudos Prospectivos , Amplitude de Movimento Articular/fisiologia , Reprodutibilidade dos Testes , Manguito Rotador/patologia , Lesões do Manguito Rotador/patologia
5.
Orv Hetil ; 161(25): 1063-1068, 2020 06.
Artigo em Húngaro | MEDLINE | ID: mdl-32516125

RESUMO

Tracheobronchial injury is an uncommon, but often life-threatening condition. It is mostly caused by blunt thoracic or neck trauma, difficult or prolonged intubation associated with nasogastric tube insertion. An early diagnosis and treatment can be lifesaver. The diagnosis is often late because of atypical symptoms and unspecific radiological signs, and due to the presence of severe coexistent injuries. Generally, the classic hallmark during physical examination is a progressive, extensive surgical emphysema. Radiological signs are often atypical, which makes the diagnosis more difficult. The most frequent signs found on computed tomography are also unspecific, mostly surgical emphysema, pneumomediastinum or pneumothorax may be noted. We present three patients suffering from airway laceration caused by car accident, difficult intubation, and prolonged utilization of nasogastric and endotracheal tube. All the patients had an overdistended endotracheal balloon herniated outside the extratracheal space along the rupture of the tracheal wall. These external balloons were all detected on radiography. This is a direct and pathognomic sign of airway injury, suggesting complete rupture in the tracheal wall. In our report, we would like to highlight the diagnostic role of an overinflated cuff. Orv Hetil. 2020; 161(25): 1063-1068.


Assuntos
Intubação Intratraqueal , Pneumotórax , Tomografia Computadorizada por Raios X/métodos , Traqueia/lesões , Humanos , Radiografia , Ruptura , Traqueia/diagnóstico por imagem
6.
Orthop Clin North Am ; 51(3): 391-402, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32498958

RESUMO

Achilles tendon rupture is an increasingly common problem with an aging population participating in high-level physical activities. Appropriate treatment has been debated for decades, but good outcomes have been reported after conservative and surgical management. The development of minimally invasive surgical techniques for Achilles repair has reduced the incidence of complications and maintained the high level of function reported after open surgery. The Achilles Midsubstance SpeedBridge repair is a newer minimally invasive technique that has demonstrated promising results and is the authors' preferred treatment of Achilles tendon rupture in athletes and active patients.


Assuntos
Tendão do Calcâneo/cirurgia , Procedimentos Cirúrgicos Operatórios/métodos , Traumatismos dos Tendões/cirurgia , Tendão do Calcâneo/lesões , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Ruptura , Técnicas de Sutura
7.
Arthroscopy ; 36(6): 1702-1705, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32503779

RESUMO

We are united as an orthopaedic community in trying to improve the outcomes of anterior cruciate ligament (ACL) reconstruction. Graft rupture rates of 10% to 28% are reported in high-risk populations, reoperation for non-graft rupture-related indications are reported in 18% to 26%, and only 50% to 65% of recreational athletes return to their preinjury level of sports. Numerous groups across the world have published studies providing evidence demonstrating significant clinical efficacy of lateral extra-articular tenodesis in improving the outcomes of ACL surgery. Finally, the reductions in ACL graft rupture rates augmented with anterolateral ligament or a modified Lemaire reconstruction appear to be broadly comparable. In our hands, anterolateral ligament may result in fewer adverse events.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Tenodese , Humanos , Articulação do Joelho/cirurgia , Ruptura
8.
Am J Vet Res ; 81(7): 565-571, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32584181

RESUMO

OBJECTIVE: To determine whether luteinizing hormone receptors (LHRs) are expressed in canine femoral head subchondral bone (FHSB), hip joint round ligament (RL), cranial cruciate ligament (CCL), and femorotibial joint synovium (FJS) specimens. SAMPLE: 1 specimen each of the FHSB, RL, CCL, and FJS obtained from the left hind limbs of 19 fresh canine cadavers. PROCEDURES: 1 section of each FHSB, RL, CCL, and FJS specimen was processed with rabbit polyclonal IgG anti-human LHR antibody, and 1 section was treated with negative control reagents. Percentage immunoexpression of LHRs in FHSB and FJS sections was analyzed by assessment of 100 bone marrow cells or synoviocytes in 3 adjacent hpf (400×). In each RL and CCL section, immunoexpression of LHRs in fibrocytes was semiquantitatively analyzed on the basis of the mean of the product of percentage staining score (from 0 [no staining] to 3 [> 50% of cells stained]) and staining intensity score (from 0 [no staining] to 2 [moderate to strong staining]) for 3 adjacent hpf. RESULTS: All tissues examined had variable LHR expression. Expression of LHRs in FHSB, CCL, or FJS specimens did not differ between sexes or between sexually intact and gonadectomized dogs. However, RL specimens from female dogs had significantly greater LHR expression scores, compared with findings for male dogs. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that LHRs are expressed in structural support tissues of canine hip and femorotibial joints. Further research is required to determine the LHRs' function, mechanism of action, and potential contribution to the pathogenesis of hip dysplasia or CCL rupture in dogs.


Assuntos
Lesões do Ligamento Cruzado Anterior/veterinária , Doenças do Cão , Animais , Ligamento Cruzado Anterior , Cães , Feminino , Masculino , Coelhos , Receptores do LH , Ruptura/veterinária
9.
Clin Sports Med ; 39(3): 549-563, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32446574

RESUMO

Common flexor-pronator tendon injuries and medial epicondylitis can be successfully treated nonoperatively in most cases. Operative treatment is reserved for patients with continued symptoms despite adequate nonoperative treatment or in high-level athletes with complete rupture of the common flexor-pronator tendon. The physical examination and workup of patients with flexor-pronator tendon injuries should focus on related or concomitant pathologies of the medial elbow. The gold standard for surgical treatment of flexor-pronator tendon ruptures or medial epicondylitis includes tendon debridement and reattachment.


Assuntos
Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/terapia , Cotovelo/lesões , Traumatismos dos Tendões/diagnóstico , Traumatismos dos Tendões/terapia , Traumatismos em Atletas/cirurgia , Desbridamento , Cotovelo/anatomia & histologia , Cotovelo/cirurgia , Tendinopatia do Cotovelo/diagnóstico , Tendinopatia do Cotovelo/cirurgia , Tendinopatia do Cotovelo/terapia , Humanos , Exame Físico , Ruptura , Traumatismos dos Tendões/cirurgia
10.
Clin Sports Med ; 39(3): 565-574, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32446575

RESUMO

Medial ulnar collateral ligament (MUCL) insufficiency is becoming common in younger, nonprofessional athletes. In contrast to elite athletes who develop valgus extension overload syndrome and associated chronic pathologic changes in the MUCL, younger patients present with sprains and partial tears that can often be managed non-operatively with successful outcome and rapid return to play. In the younger throwing athlete with medial-sided elbow pain, a hinged elbow brace and rehabilitation of dysfunctional muscles often lead to successful recovery and return to play within 1-2 months. In more severe injuries, direct repair of the partial tear with or without added internal bracing supplementation allows restoration of stability with a return to play with 4 to 6 months.


Assuntos
Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/terapia , Ligamento Colateral Ulnar/lesões , Ruptura/diagnóstico , Ruptura/terapia , Entorses e Distensões/diagnóstico , Entorses e Distensões/terapia , Traumatismos em Atletas/cirurgia , Braquetes , Ligamento Colateral Ulnar/cirurgia , Humanos , Volta ao Esporte , Ruptura/cirurgia , Entorses e Distensões/cirurgia , Reconstrução do Ligamento Colateral Ulnar/métodos
11.
Clin Sports Med ; 39(3): 661-672, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32446582

RESUMO

Distal biceps tendon injuries typically occur from forced eccentric contraction against a heavy load and are more common in males than females. Most patients who rupture their distal biceps tendon undergo operative repair to minimize strength loss and fatigue. Single-incision and two-incision techniques have been developed in recent decades and achieve satisfactory outcomes. Cortical button and bone tunnel fixation demonstrate superior strength relative to suture anchors and interference screws for acute repairs. Patients who present late or who undergo surgery greater than 4 to 6 weeks from their injury are deemed chronic ruptures and may require autograft or allograft reconstruction.


Assuntos
Músculo Esquelético/lesões , Músculo Esquelético/cirurgia , Procedimentos Ortopédicos/métodos , Traumatismos dos Tendões/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ruptura/diagnóstico , Ruptura/cirurgia , Âncoras de Sutura , Traumatismos dos Tendões/diagnóstico , Tendões/transplante , Transplante Autólogo
12.
Clin Sports Med ; 39(3): 673-685, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32446583

RESUMO

Distal triceps ruptures are uncommon, usually caused by a fall on an outstretched hand or a direct blow. Factors linked to injury include eccentric loading of a contracting triceps, anabolic steroid use, weightlifting, and traumatic laceration. Risk factors include local steroid injection, hyperparathyroidism, and olecranon bursitis. Initial diagnosis can be complicated by pain and swelling, and a palpable defect is not always present. Plain radiographs can be helpful. MRI confirms the diagnosis and directs treatment. Incomplete tears can be treated nonsurgically; complete tears are best managed surgically. Good to excellent restoration of function has been shown with surgical repair.


Assuntos
Traumatismos em Atletas/diagnóstico por imagem , Traumatismos em Atletas/terapia , Ruptura/diagnóstico por imagem , Ruptura/terapia , Traumatismos dos Tendões/diagnóstico por imagem , Traumatismos dos Tendões/terapia , Traumatismos em Atletas/etiologia , Traumatismos em Atletas/cirurgia , Humanos , Imagem por Ressonância Magnética , Músculo Esquelético/lesões , Radiografia , Fatores de Risco , Ruptura/etiologia , Ruptura/cirurgia , Traumatismos dos Tendões/etiologia , Traumatismos dos Tendões/cirurgia
13.
Arthroscopy ; 36(5): 1308-1310, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32370893

RESUMO

Proximal hamstring tendon injuries are uncommon injuries, and there are few high-quality studies of surgical procedures in the literature. Increasing standardization of outcome measures with the use of validated, injury-specific, patient-reported outcome measures will improve research in this area. This will allow better assessment of novel surgical techniques.


Assuntos
Músculos Isquiossurais , Tendões dos Músculos Isquiotibiais , Traumatismos dos Tendões , Humanos , Avaliação de Resultados em Cuidados de Saúde , Ruptura
14.
Medicine (Baltimore) ; 99(19): e20126, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384492

RESUMO

INTRODUCTION: Rupture of the radial collateral ligament (RCL) of the index metacarpophalangeal (MCP) joint is mostly related to acute local mechanical causes, which severely affect the stability of the MCP joint. However, few cases of chronic bilateral job-related RCL injury have been reported in the literature. There is no consensus on the knowledge of the disease to date. Here, we present an extremely rare case of chronic bilateral RCL injury. PATIENT CONCERNS: A 58-year-old female shoemaker presented with chief complaints of swelling and pain in the radial aspect of the MCP joint of bilateral index fingers since 2 years. There was no history of acute RCL injury. The persistent pain was aggravated while gripping, pulling, buttoning, and twisting. DIAGNOSIS: Based on the combination of physical examination, X-ray, and ultrasonic and magnetic resonance imaging, the patient was diagnosed with bilateral tear of the RCLs and joint dislocation of the index MCP joint. Eventually, intra-operative findings confirmed the diagnosis. INTERVENTION: The patient underwent bilateral index MCP joint fusion followed by immobilization for 6 weeks. Functional therapy was started after immobilization. OUTCOMES: The patient's chief complaints were significantly alleviated after the operation. At the 12-month follow-up, the patient returned to a full level of activity as a shoemaker without any complications. CONCLUSION: Compared to acute RCL rupture of the index MCP joint, occupation may play an important role in the diagnosis of chronic RCL rupture of the index MCP joint. Our report will provide more diagnostic and treatment experience to deal with this type of injury.


Assuntos
Ligamentos Colaterais/lesões , Ligamentos Colaterais/patologia , Articulação Metacarpofalângica/patologia , Ruptura/patologia , Doença Crônica , Ligamentos Colaterais/diagnóstico por imagem , Feminino , Humanos , Articulação Metacarpofalângica/diagnóstico por imagem , Pessoa de Meia-Idade , Ruptura/diagnóstico por imagem , Ruptura/terapia
15.
Medicine (Baltimore) ; 99(20): e20167, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443333

RESUMO

The purpose of this study is to analyze the risk factors of sporadic renal hamartoma and establish a risk scoring system, and to intervene in patients with high-risk sporadic renal hamartoma who are prone to rupture and bleeding as soon as possible.Retrospective univariate and multivariate logistic analyzes were conducted for clinical data of 332 sporadic renal hamartoma patients to screen out independent risk factors of tumor rupture. Score of each independent risk factor was calculated. (Calculation formula: the risk coefficient of each factor = the beta regression coefficient of each factor/the minimum value of the beta regression coefficient of all factors, the value of the smallest beta regression coefficient corresponding to all the factors was assigned 1 point. The score of each factor was equal to the risk coefficient of each variable was taken as an integer value by rounding.) The total score was equal to the sum of all factors. Then the area under the receiver operating characteristics (AUC) curve was compared between high risk factors and scoring system. Finally, the scoring system was evaluated by the area under the curve (AUC) and the Hosmer-Lemeshow method in an independent cohort of 130 patients.Factors such as symptoms at presentation, tumor size, tumor blood supply, and tumor growth pattern were significant predictors of sporadic renal angiomyolipoma rupture in both the univariate and multivariate analyses; these predictors were included in the scoring system to predict sporadic renal angiomyolipoma rupture. There were no significant differences in AUCs between high risk factors and scoring system (z = 0.6434, P = .583, AUC = 0.913, and 0.903 for high risk factors and scoring system, respectively). The sporadic renal angiomyolipoma patients who scored >6 points were prone to rupture. AUROC of the scoring system in the validation set was 0.854(95%CI:0.779, 0.928). Using the Hosmer-Lemeshow method, the value of X was 2.916, P = .893, suggesting the scoring system fitted well.A scoring system based on clinical features is simple and effective in predicting sporadic angiolipoma rupture and hemorrhage. When the score is higher than 6 points, the probability of hamartoma rupture and hemorrhage is significantly increased and early intervention is needed.


Assuntos
Angiomiolipoma/complicações , Hamartoma/complicações , Hemorragia/diagnóstico , Neoplasias Renais/patologia , Ruptura/diagnóstico , Adulto , China/epidemiologia , Regras de Decisão Clínica , Feminino , Hemorragia/etiologia , Humanos , Neoplasias Renais/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Projetos de Pesquisa/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Ruptura/etiologia , Carga Tumoral/fisiologia
16.
Medwave ; 20(2): e7831, 2020 Mar 03.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-32225130

RESUMO

Introduction: Macular hemorrhages result in a sudden and profound loss of vision. The primary treatment modalities include observation, intravitreal injection of antiangiogenic drugs, neodymium-doped yttrium aluminum garnet hialoidotomy, intravitreal injection of gas with or without tissue plasminogen activator, as monotherapy or combined with surgery. In this paper, we report four cases of macular hemorrhages of different causes treated with different approaches, and we review the literature in this regard. Case presentation: All four patients presented different causes of macular hemorrhage. The first case had a preretinal hemorrhage due to a Valsalva retinopathy and was treated with surgery. Case 2 had a multilevel macular hemorrhage due to a rupture of a retinal arteriolar macroaneurysm and was treated with pneumatic displacement, laser, and intravitreal ranibizumab. Case 3 presented an extensive subretinal hemorrhage due to a choroidal rupture after high-energy ocular trauma that was also successfully treated with surgery. The last case was a preretinal hemorrhage due to diabetic retinopathy managed with neodymium-doped yttrium aluminum garnet laser. Different treatment approaches were successfully performed in all cases with good outcomes. Conclusion: There is an extensive range of options available for the management of macular hemorrhages, and the best option depends on the characteristics of each particular case. Proper and timely management of these diseases can achieve an excellent visual outcome, especially if the location of the hemorrhage is preretinal.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Terapia a Laser , Hemorragia Retiniana/terapia , Corioide/patologia , Retinopatia Diabética/complicações , Humanos , Injeções Intravítreas , Hemorragia Retiniana/etiologia , Ruptura , Ativador de Plasminogênio Tecidual
17.
Clin Orthop Surg ; 12(1): 1-8, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32117532

RESUMO

There is no clear consensus on the optimal treatment of acute Achilles tendon rupture. Recently, studies have demonstrated the critical role of functional rehabilitation in the treatment of ruptured Achilles tendons. Hence, conservative treatment is preferred by a growing number of surgeons seeking to treat the condition without the risk of complications from surgery. However, operative treatment is still considered as a more reliable treatment option for acute Achilles tendon rupture. In this review article, we provide an overview of recent treatment strategies for acute rupture of the Achilles tendon.


Assuntos
Tendão do Calcâneo/cirurgia , Ruptura/reabilitação , Ruptura/cirurgia , Traumatismos dos Tendões/reabilitação , Traumatismos dos Tendões/cirurgia , Humanos , Resultado do Tratamento
18.
Medicine (Baltimore) ; 99(12): e19579, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32195972

RESUMO

BACKGROUND: Numerous quantitatively based studies measuring the accuracy of MRI and MRA for the diagnosis of rotator cuff tears remain inconclusive. In order to compare the accuracy of MRI with MRA in detection of rotator cuff tears a meta-analysis was performed systematically. METHODS: PubMed/Medline and Embase were utilized to retrieve articles comparing the diagnostic performance of MRI and MRA for use in detecting rotator cuff tears. After screening and diluting out the articles that met inclusion criteria to be used for statistical analysis the pooled evaluation indexes including sensitivity and specificity as well as hierarchical summary receiver operating characteristic (HSROC) curves with 95% confidence interval (CI) were calculated. RESULTS: Screening determined that 12 studies involving a total of 1030 patients and 1032 shoulders were deemed viable for inclusion in the meta-analysis. The results of the analysis showed that MRA has a higher sensitivity and specificity than MRI for the detection of any tear; similar results were observed in the detection of full-thickness tears. However, for the detection of partial-thickness tear, MRI has similar performance with MRA. CONCLUSION: MRI is recommended to be a first-choice imaging modality for the detection of rotator cuff tears. Although MRA have a higher sensitivity and specificity, it cannot replace MRI after the comprehensive consideration of accuracy and practicality.


Assuntos
Artrografia/métodos , Imagem por Ressonância Magnética/métodos , Lesões do Manguito Rotador/diagnóstico por imagem , Manguito Rotador/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrografia/estatística & dados numéricos , Feminino , Humanos , Lacerações/diagnóstico por imagem , Lacerações/patologia , Imagem por Ressonância Magnética/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Manguito Rotador/patologia , Ruptura/diagnóstico por imagem , Ruptura/patologia , Sensibilidade e Especificidade , Adulto Jovem
19.
Bone Joint J ; 102-B(3): 388-393, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32114818

RESUMO

AIMS: To validate the Sydney Hamstring Origin Rupture Evaluation (SHORE), a hamstring-specific clinical assessment tool to evaluate patient outcomes following surgical treatment. METHODS: A prospective study of 70 unilateral hamstring surgical repairs, with a mean age of 47.3 years (15 to 73). Patients completed the SHORE preoperatively and at six months post-surgery, and then completed both the SHORE and Perth Hamstring Assessment Tool (PHAT) at three years post-surgery. The SHORE questionnaire was validated through the evaluation of its psychometric properties, including; internal consistency, reproducibility, reliability, sensitivity to change, and ceiling effect. Construct validity was assessed using Pearson's correlation analysis to examine the strength of association between the SHORE and the PHAT. RESULTS: The SHORE demonstrated an excellent completion rate (100%), high internal consistency (Cronbach's alpha 0.78), and good reproducibility (intraclass correlation coefficient (ICC) 0.82). The SHORE had a high correlation with the validated PHAT score. It was more sensitive in detecting clinical change compared to the PHAT. A ceiling effect was not present in the SHORE at six months; however, a ceiling effect was identified in both scores at three years post-surgery. CONCLUSION: This study has validated the SHORE patient reported outcome measure (PROM) as a short, practical, reliable, valid, and responsive tool that can be used to assess symptom and function following hamstring injury and surgical repair. Cite this article: Bone Joint J 2020;102-B(3):388-393.


Assuntos
Tendões dos Músculos Isquiotibiais/lesões , Procedimentos Ortopédicos/métodos , Medidas de Resultados Relatados pelo Paciente , Traumatismos dos Tendões/cirurgia , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Tendões dos Músculos Isquiotibiais/diagnóstico por imagem , Tendões dos Músculos Isquiotibiais/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Reprodutibilidade dos Testes , Ruptura , Inquéritos e Questionários , Traumatismos dos Tendões/diagnóstico , Fatores de Tempo , Adulto Jovem
20.
S D Med ; 73(3): 102-105, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32142227

RESUMO

INTRODUCTION: Gallbladder trauma is an uncommon occurrence, most commonly found incidentally at the time of laparotomy for associated injuries following abdominal trauma. It is even more rare in blunt abdominal trauma, with one of the rarest forms being an isolated injury to the gallbladder. Awareness for this type of injury should not be forgotten by emergency personal when evaluating someone with a history of recent trauma. CASE DESCRIPTION: A 44-year-old male who works as a construction worker fell from a roof, landing on his right side. Upon evaluation by the emergency department, emergency personnel combined the history, abnormal laboratory values and imaging including ultrasound (U/S) and computed tomography (CT) to assess and diagnose a concern for gallbladder perforation. He was treated with a diagnostic laparoscopy, laparoscopic cholecystectomy, and intraoperative choleangiogram. The patient tolerated the procedure well and discharged home on postoperative day 1. DISCUSSION: Gallbladder trauma can be seen in all population types. As the gallbladder is fairly protected, it is rare to have an isolated injury. A detailed history as described can tip off practitioners to the diagnosis, but is also missed or delayed due to occasionally vague symptoms. Imaging studies can be used adjunctively to assist in diagnosis and may include CT, U/S, color Doppler, or HIDA scans. These can also fail to give a diagnosis leading to a missed injury and further morbidity and mortality. Perforated gallbladders can safely be treated laparoscopically as well as other options depicted. CONCLUSION: Awareness of isolated and rare injuries in trauma, such as those to the gallbladder, enables many types of emergency personnel to recognize and treat patients and consequently prevent the morbidity and mortality of a missed injury.


Assuntos
Traumatismos Abdominais , Vesícula Biliar , Ferimentos não Penetrantes , Traumatismos Abdominais/complicações , Adulto , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/lesões , Vesícula Biliar/cirurgia , Humanos , Masculino , Ruptura , Ultrassonografia
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