Surgical treatment results for dupuytren's disease.

OBJECTIVE: To present the results of our cases of Dupuytren's disease treated with regional selective fasciectomy in light of the literature. METHODS: Patients diagnosed with Dupuytren's contracture and surgically treated with regional selective fasciectomy at our institution with adequate follow-up data were included in the study. All patients were routinely followed after surgery to assess results and complications. QuickDASH scoring was used to evaluate the patients and recurrences and complications were recorded. RESULTS: Twenty-one hands of 19 patients (13 males, 6 females) who underwent surgery and received adequate follow-up were retrospectively evaluated. Mean patient age was 65.8 (range: 41 to 86) and the mean follow-up period was 48.2 months (range: 24 to 86). Fourteen (66.6%) hands had excellent results, five (23%) hands had good results and two (9.4%) had fair results. The mean QuickDASH score for the patients at the final follow-up was 6.58 (range: 0 to 20.4). CONCLUSION: Our study results demonstrated that regional selective fasciectomy is a reliable and efficient method to treat Dupuytren's disease with low rates of complications and recurrence and the technique can be considered the gold standard. Level of Evidence IV, Case Series.

OBJETIVO: Apresentar os resultados de nossos casos de doença de Dupuytren tratados com fasciotomia seletiva regional, à luz da literatura. MÉTODOS: Os pacientes diagnosticados com contratura de Dupuytren e tratados cirurgicamente com fasciotomia seletiva regional em nossa instituição que tinham dados de acompanhamento adequados foram incluídos no estudo. Todos os pacientes foram rotineiramente acompanhados após a cirurgia para avaliação dos resultados e das complicações. Foi utilizada a pontuação QuickDASH na avaliação dos pacientes e as recorrências e complicações foram registradas. RESULTADOS: Foram avaliadas retrospectivamente vinte e uma mãos de 19 pacientes (13 homens, 6 mulheres) submetidos à cirurgia e acompanhados adequadamente. A média de idade dos pacientes foi de 65,8 (intervalo: 41 a 86) e o período médio de seguimento foi 48,2 meses (intervalo: 24 a 86). Quatorze (66,6%) mãos tiveram excelentes resultados, enquanto cinco (23%) mãos tiveram bons e duas (9,4%) tiveram resultados moderados. A pontuação média no QuickDASH dos pacientes no seguimento final foi de 6,58 (intervalo: 0 a 20,4). CONCLUSÃO: Os resultados do nosso estudo demonstraram que a fasciotomia seletiva regional é um método confiável e eficiente, com baixas taxas de complicação e recorrência no tratamento da doença de Dupuytren e a técnica pode ser considerada o padrão-ouro. Nível de Evidência IV, Série de Casos.

Neuraxial anesthesia after local anesthesia for management of percutaneous vertebroplasty complication during vertebroplasty.

Percutaneous vertebroplasty is a relatively safe, simple and commonly performed interventional procedure for the management of vertebral compression fractures. However, serious complications are rarely reported in the procedure. Those are pulmonary embolism, severe infection, paraplegia and an occurrence of a new fracture in an adjacent vertebra after vertebroplasty. Acute complications are generally associated with the procedure. We present the case of neuraxial anesthesia, developed after local anesthesia with 8mL of 2% prilocaine, in a 68-year-old woman who underwent percutaneous vertebroplasty after an osteoporotic collapsed fracture in the L1 vertebra due to trauma. To our knowledge, this is the first case in the literature.

[Neuraxial anesthesia after local anesthesia for management of percutaneous vertebroplasty complication during vertebroplasty]. / Bloqueio neuroaxial após anestesia local para manejo de complicação de vertebroplastia percutânea durante vertebroplastia.

Percutaneous vertebroplasty is a relatively safe, simple and commonly performed interventional procedure for the management of vertebral compression fractures. However, serious complications are rarely reported in the procedure. Those are pulmonary embolism, severe infection, paraplegia and an occurrence of a new fracture in an adjacent vertebra after vertebroplasty. Acute complications are generally associated with the procedure. We present the case of neuraxial anesthesia, developed after local anesthesia with 8mL of 2% prilocaine, in a 68-year-old woman who underwent percutaneous vertebroplasty after an osteoporotic collapsed fracture in the L1 vertebra due to trauma. To our knowledge, this is the first case in the literature.

Comparison of the i-gelTM and the Laryngeal Mask Airway ClassicTM in terms of clinical performance / Comparação da máscara laríngea i-gel (i-gelTM) com a máscara laríngea clássica (LMA-ClassicTM) em relação ao desempenho clínico

ABSTRACTPURPOSE: The i-gelTM is one of the second generation supraglottic airway devices. Our study was designed to compare the i-gel and the Laryngeal Mask Airway ClassicTM with respect to the clinical performance.METHODS: We compared the performance of the i-gel with that of the Laryngeal Mask Airway Classic in 120 patients undergoing urologic surgery during general anesthesia without muscle relaxant with respect to the number of attempts for successful insertion, insertion time, peak airway pressure, incidence of regurgitation, fiberoptic glottic view and postoperative complications. Second generation supraglottic airway devices were inserted by the same anesthesiologist, experienced in use of both devices (>200 uses and first time failure rate <5%). Methylene blue method was used to detect gastric regurgitation.RESULTS: There was no statistical difference between the two groups regarding the success of insertion of second generation supraglottic airway device (p = 0.951). The laryngeal mask insertion time for the i-gel group was significantly shorter than that for the Laryngeal Mask Airway Classic group (11.6 ± 2.4 s versus 13.1 ± 1.8 s [p = 0.001]). The fiberoptic glottic view scores for the i-gel group was significantly better than that for the ones for the Laryngeal Mask Airway Classic group (p = 0.001). On fiberoptic view, there was no sign of methylene blue dye at any time point in either group. In addition, there was no difference between the groups in patient response regarding the presence of a sore throat when questioned 24 h after the procedure (p = 0.752).CONCLUSION: Both devices had good performance with low postoperative complications and without occurrence of regurgitation. The i-gel provided a shorter insertion time and a better fiberoptic view than the Laryngeal Mask Airway Classic.

RESUMOJUSTIFICATIVA E OBJETIVO: A i-gel é um dos dispositivos supraglóticos de segunda geração para o manejo das vias aéreas. Nosso estudo foi projetado para comparar a i-gelTM e a máscara laríngea clássica (Laryngeal Mask Airway ClassicTM, LMA-C) em relação ao desempenho clínico.MÉTODOS: Avaliamos os desempenhos de i-gel e LMA-C em 120 pacientes submetidos à cirurgia urológica sob anestesia geral sem relaxante muscular. Comparamos o número de tentativas de inserção bem-sucedidas, o tempo de inserção, a pressão de pico das vias aéreas, a incidência de regurgitação, a visibilidade da glote com o uso de fibra óptica e as complicações no pós-operatório. Os dispositivos supraglóticos de segunda geração foram inseridos pelo mesmo anestesiologista com experiência na aplicação de ambos os dispositivos (> 200 aplicações e taxa de falha na primeira tentativa < 5%). O corante azul de metileno foi usado para detectar regurgitação gástrica.RESULTADOS: Não houve diferença estatística entre os dois grupos em relação ao sucesso da inserção do dispositivo supraglótico de segunda geração (p = 0,951). O tempo de inserção da máscara laríngea no grupo i-gel foi significativamente menor do que no grupo LMA-C (11,6 ± 2,4 segundos vs. 13,1 ± 1,8 segundos, p = 0,001). O escore de visibilidade da glote via fibra óptica do grupo i-gel foi significativamente melhor do que o do grupo LMA-C (p = 0,001). Na visão via fibra ótica, sinais do corante azul de metileno não foram observados em qualquer momento em ambos os grupos. Além disso, não houve diferença entre as respostas dos grupos quando perguntados sobre a presença de dor de garganta 24 horas após o procedimento (p = 0,752).CONCLUSÃO: Ambos os dispositivos apresentaram bom desempenho, com poucas complicações no pós-operatório e sem ocorrência de regurgitação. A máscara laríngea i-gel proporcionou um tempo de inserção mais curto e uma visão via fibra óptica melhor do que a LMA-C.

[Comparison of the i-gel™ and the Laryngeal Mask Airway Classic™ in terms of clinical performance]. / Comparação da máscara laríngea i-gel (i-gel™) com a máscara laríngea clássica (LMA-Classic™) em relação ao desempenho clínico.

PURPOSE: The i-gel™ is one of the second generation supraglottic airway devices. Our study was designed to compare the i-gel and the Laryngeal Mask Airway Classic™ with respect to the clinical performance. METHODS: We compared the performance of the i-gel with that of the Laryngeal Mask Airway Classic in 120 patients undergoing urologic surgery during general anesthesia without muscle relaxant with respect to the number of attempts for successful insertion, insertion time, peak airway pressure, incidence of regurgitation, fiberoptic glottic view and postoperative complications. Second generation supraglottic airway devices were inserted by the same anesthesiologist, experienced in use of both devices (>200 uses and first time failure rate <5%). Methylene blue method was used to detect gastric regurgitation. RESULTS: There was no statistical difference between the two groups regarding the success of insertion of second generation supraglottic airway device (p=0.951). The laryngeal mask insertion time for the i-gel group was significantly shorter than that for the Laryngeal Mask Airway Classic group (11.6±2.4s versus 13.1±1.8s [p=0.001]). The fiberoptic glottic view scores for the i-gel group was significantly better than that for the ones for the Laryngeal Mask Airway Classic group (p=0.001). On fiberoptic view, there was no sign of methylene blue dye at any time point in either group. In addition, there was no difference between the groups in patient response regarding the presence of a sore throat when questioned 24h after the procedure (p=0.752). CONCLUSION: Both devices had good performance with low postoperative complications and without occurrence of regurgitation. The i-gel provided a shorter insertion time and a better fiberoptic view than the Laryngeal Mask Airway Classic.

Comparison of the i-gel™ and the Laryngeal Mask Airway Classic™ in terms of clinical performance.

PURPOSE: The i-gel™ is one of the second generation supraglottic airway devices. Our study was designed to compare the i-gel and the Laryngeal Mask Airway Classic™ with respect to the clinical performance. METHODS: We compared the performance of the i-gel with that of the Laryngeal Mask Airway Classic in 120 patients undergoing urologic surgery during general anesthesia without muscle relaxant with respect to the number of attempts for successful insertion, insertion time, peak airway pressure, incidence of regurgitation, fiberoptic glottic view and postoperative complications. Second generation supraglottic airway devices were inserted by the same anesthesiologist, experienced in use of both devices (>200 uses and first time failure rate <5%). Methylene blue method was used to detect gastric regurgitation. RESULTS: There was no statistical difference between the two groups regarding the success of insertion of second generation supraglottic airway device (p=0.951). The laryngeal mask insertion time for the i-gel group was significantly shorter than that for the Laryngeal Mask Airway Classic group (11.6±2.4s versus 13.1±1.8s [p=0.001]). The fiberoptic glottic view scores for the i-gel group was significantly better than that for the ones for the Laryngeal Mask Airway Classic group (p=0.001). On fiberoptic view, there was no sign of methylene blue dye at any time point in either group. In addition, there was no difference between the groups in patient response regarding the presence of a sore throat when questioned 24h after the procedure (p=0.752). CONCLUSION: Both devices had good performance with low postoperative complications and without occurrence of regurgitation. The i-gel provided a shorter insertion time and a better fiberoptic view than the Laryngeal Mask Airway Classic.