Results Of Minimally Invasive Vats Thymectomy In Miastenia Gravis Patients Compared With More Invasive Approaches - 10-Year Experience In A Single Center.

INTRODUCTION: Myasthenia gravis (MG) is an autoimmune, neurologic disease that causes a wide range of symptoms. While the transsternal, transcervical and thoracotomy approaches are accepted as effective, there is still debate regarding the VATS approach. MATERIALS AND METHODS: We analyzed our center's surgical experience with thymectomy for myasthenia gravis, comparing the results of patients operated on using VATS and more invasive approaches, over a period of 10 years. A search of the department's surgical database for myasthenia gravis cases between January 2010 and January 2021, revealed a total of 40 cases. Twenty-four patients were included in the final analysis and were distributed into two groups: the VATS procedure group (group A) and the open procedure group (group B). The latter included sternotomy, thoracotomy, transcervical and hemiclamshell approaches. Only radical thymectomies were included. The established outcomes were clinical improvement defined as asymptomatic remission, reduction, or discontinuation of the medication necessary to achieve optimal symptom control. RESULTS: The median follow-up time was 27 months (ranging from 4 to 75 months). Videothoracoscopy radical thymectomy was performed on 12 patients. Complete remission with no medication was achieved in 1 case (8.3%), while 2 patients (16.7%) became asymptomatic with reduced medication. An improvement (reduced symptoms or decreased medication) was observed in 8 cases (66.6%). No change in clinical outcome was noted in 1 patient (8.3%). None of the patients reported worsening symptoms. Open thymectomy was performed on 12 patients. Complete remission with no medication was achieved in 1 case (8.3%), while 2 patients (16.7%) became asymptomatic with reduced medication. An improvement was noted in 6 cases (50%). No change in clinical outcome was observed in 3 patients (25%) whereas 2 of them (16.7%) experienced slightly better symptom control but with a significant increase in medication. One patient (8.3%) described the clinical results as without any significant change. None of the patients reported worsening symptoms. CONCLUSION: The videotoracoscopic approach in the treatment of myasthenia gravis is non-inferior compared to the open approach and effective in a long-term follow-up, offering all the additional benefits of less invasive surgery.

First record of Oligobregma Kudenov & Blake, 1975 (Annelida: Polychaeta: Scalibregmatidae Malmgren, 1867) from Brazil with the description of three new species.

Oligobregma represents the most speciose genus of Scalibregmatidae with 17 valid species. Most of them occur at great depths and are found living on soft bottoms. Here, we present the descriptions of O. nonatoi sp. nov., O. cruzae sp. nov., and O. bakkeni sp. nov., sampled from the Brazilian continental shelf and slope, and a key to all species of Oligobregma. O. nonatoi sp. nov. differs from its congeners by the presence of a triangular prostomium with short rounded horns, acicular spines on notopodia of chaetigers 14 and on neuropodia of chaetigers 13. Oligobregma cruzae sp. nov. can be distinguished by the presence of a quadrangular prostomium with two short, rounded horns, acicular spines on chaetigers 14, and lyrate chaetae from chaetiger 5. Finally, O. bakkeni sp. nov. is unique among its congeners by the presence of acicular spines with rounded tips. This is the first record of this genus along the Brazilian coast and the specimens were collected on Esprito Santo, Campos and Santos sedimentary basins, both located in Brazilian southeast region. The sampling campaigns were carried out in scientific expeditions related to two research projects: Santos Project Santos Basin Environmental Characterization and Ambes Project Esprito Santo Basin Assessment Project, both coordinated by CENPES/PETROBRAS.

New species of Pseudoscalibregma Ashworth, 1901 (Annelida: Scalibregmatidae Malmgren, 1867) from Brazil.

Pseudoscalibregma Ashworth, 1901 is a small genus of the family Scalibregmatidae Malmgren, 1867. Currently, a total of eight valid species are accepted. Of these, the majority are found at great depths. This work contains the first report of Pseudoscalibregma to the Brazilian coast, with the description of three new species: Pseuscalibregma ermindae sp. nov., P. magalhaesi sp. nov. and P. parapari sp. nov. The material was sampled from the Brazilian southeast region, on Campos and Santos sedimentary basins, during scientific expeditions called Santos ProjectSantos Basin Environmental Characterization and Ambes ProjectEsprito Santo Basin Assessment Project, both coordinated by PETROBRAS/CENPES. We also include an identification key to Pseudoscalibregma species.

An Unusual Location for a Lymph Node.

We report a case of a 67-years old non-smoking female diagnosed with hypertension when 24-years-old and complicated with chronic kidney and hypertensive heart diseases. On CT-Chest an incidental discovery of a lesion (16x14x23mm) adjacent to the abdominal aorta was made. Initially suspected to be paraganglioma, a hypothesis which the subsequent MRI did not exclude. Urine analysis showed normal Metanephrine with slightly elevated Chromogranin-A levels. During VATs-procedure "bulging" below the adventitial layer of the descending aorta at the level of the diaphragmatic gutter was identified. By opening the adventitia, a lipomatous lesion with a nodular, consistent center was identified and excised. Final histopathological report confirmed the diagnosis of lymph node not suggestive of neoplasia. Currently, 12 months after the surgery, the patient's condition is good being under surveillance in the Thoracosurgical Outpatient Clinic. Despite not having identified any neuroendocrine component, the patient had clinical signs of clear improvement of arterial hypertension.

Unravelling the diversity of Scalibregma Rathke, 1843 (Annelida: Polychaeta: Scalibregmatidae) from southeast Brazilian coast.

Scalibregmatidae Malmgren, 1867 is a relatively small family of annelids, with only two taxa reported to Brazil. In this work, we expand the scientific knowledge of this group by presenting two new Scalibregma Rathke, 1843 species. The new species S. lanai sp. nov. and S. cinthyae sp. nov. were collected during an expedition to the Campos and Santos oceanographic basins. Scalibregma cinthyae sp. nov. is unique among its congeners by the presence of two rows of paired lobes on the mouths upper and lower lips, whereas S. lanai sp. nov. is unique among its congeners by the presence of two rows of paired lobes on the mouths lower lip, branchiae from chaetigers 35, and lyrate chaetae with equal tynes. We provide an identification key to all Scalibregma species.

Innovative 3d-Printed Prosthesis In A Rare Case Of A Huge Mass Of Anterior Thoracic Wall - Low Grade Fibromyxoid Sarcoma (Lgfms).

The need for complete resection of chest wall tumors creates a huge challenge in terms of reconstructing the complex dynamics of the thorax. We are reporting a case of a low-grade fibromyxoid sarcoma (LGFMS) diagnosed in a young male, where the complete resection of the mass, sternum and parcially the pericardium was performed. Subsequently, a composite porous high-density polyethylene StarPore® prosthesis of the sternum and costal arches was used and the latissimus dorsi muscle free flap with skin graft was implanted over the sternum.

Enhancing the biological properties of zinc complexes with bis(indolyl)methane groups: Synthesis, characterization, DNA interaction, and biocide activity.

The unprecedented mononucleated ligand (6,6-di(1H-indol-3-yl)-N,N-bis(pyridin-2-ylmethyl)hexan-1-amine (LC5) with an N3-donor set and its complexes [Zn(LC5)Cl2] • 2CH3OH (1) and [Zn(LC5)2](ClO4)2 (2), were successfully prepared. All compounds were fully characterized by a suite of physicochemical methods. Fluid 1H and 13C NMR spectroscopy, as well as DFT and TD-DFT calculations, were carried out to propose a viable structural arrangement for both complexes. The interaction between these compounds and DNA was monitored in the UV region where binding constants (Kb) were estimated (2 > 1 > LC5). These data were corroborated by DNA cleavage assays using groove binders, circular dichroism, and docking studies. Both complexes confirmed their biocide activity against selected microorganisms: Gram-positive (S. aureus) and Gram-negative (E. coli) bacteria, the filamentous fungi A. fumigatus and S. cerevisiae. Finally, the cytotoxic activities of 1 and 2 were tested against the erythroleukemia K562 cell line. For all biological studies, it was probed that the presence of the indole moieties and the zinc atoms in the chemical composition of the complexes studied could increase the magnitude of the activity following the order: 2 > 1 > LC5, where a linear relationship between the biological activity upon K562 cells (IC50) and DNA binding studies (Kb) was found.

Versatile Electrochemical Synthesis of Selenylbenzo[b]Furan Derivatives Through the Cyclization of 2-Alkynylphenols.

We report an electrochemical oxidative intramolecular cyclization reaction between 2-alkynylphenol derivatives and different diselenides species to generate a wide variety of substituted-benzo[b]furans. Driven by the galvanostatic electrolysis assembled in an undivided cell, it provided efficient transformation into oxidant-, base-, and metal-free conditions in an open system at room temperature. With satisfactory functional group compatibility, the products were obtained in good to excellent yields.

Rare case of low-grade fibromyxoid sarcoma of the thoracic wall with complete sternum reconstruction.

An 18-year-old boy presented with a giant midline mass with 9 years of evolution. The tumor was excised, and reconstruction made with a customized sternum implant and a free latissimus dorsi muscle flap with skin graft. Histological analysis was compatible with low-grade fibromyxoid sarcoma (LGFMS).

LYMPH NODE UPSTAGING AFTER SURGERY IN PATIENTS WITH NEGATIVE MEDIASTINAL STAGING BY EBUS.

INTRODUCTION: Mediastinal staging is a hot topic in thoracic oncology. According to the guidelines, and besides other criteria, in the presence of a primary lung cancer with increased mediastinal lymph node uptake on PET-CT, a negative result after lymph node sampling by Endobronchial Ultrasound (EBUS) is not enough to rule out mediastinal lymph node involve- ment, demanding a cervical mediastinoscopy to vouch for the results. METHODS AND OBJECTIVES: In order to study the percentage of lymph node surgical upstaging in patients with neg- ative mediastinal node staging by EBUS and evaluate the role of mediastinoscopy in these patients, we conducted a search in our department's database using the key-word EBUS in the period concerned between January 2014 and August 2020. A total of 302 patients were found. After applying defined criteria, we obtained 42 cases. RESULTS: Lymph node surgical upstaging occurred in 11 (26%) patients, of which 8 were upstaged to N2 and 3 to N1. Most of the cases were single station. Only in 5 (12% of the total) of the 11 patients, the upstaging was related to lymph node stations previously sampled by EBUS. Upstaging was more frequent among males and lower lobe tumours. DISCUSSION AND CONCLUSIONS: Regarding the 8 upstage cases for N2, 5 were single station. Of these 8 cases, only 5 would be approachable by cervical mediastinoscopy. Furthermore, 2 of them were single station, eligible for upfront surgery. Then, only in 3 (7%) of the 42 cases cervical mediastinoscopy would be of foremost importance.

Triathlete with Multiple Stress Fractures in the Lower Limbs: Case Report and Literature Review.

Recurrent stress fractures rarely affect the same athlete. We present the case of a female triathlete who suffered multiple stress fractures in both tibias, the right fibula, and the left femoral neck. Conservative treatment was instituted in all episodes, with rest, reduced training load, and physical therapy rehabilitation. The relative energy deficiency in sport syndrome, along with an eating disorder, training overload, and osteopenia, was identified as a risk factor. Although rare, multiple stress fractures can occur in female triathletes. These patients must be screened for risk factors associated with biomechanics, nutrition, and training to develop an effective prevention and treatment program.

Triathlete with Multiple Stress Fractures in the Lower Limbs: Case Report and Literature Review / Triatleta com múltiplas fraturas por estresse nos membros inferiores: Relato de um caso e revisão da literatura

Abstract Recurrent stress fractures rarely affect the same athlete. We present the case of a female triathlete who suffered multiple stress fractures in both tibias, the right fibula, and the left femoral neck. Conservative treatment was instituted in all episodes, with rest, reduced training load, and physical therapy rehabilitation. The relative energy deficiency in sport syndrome, along with an eating disorder, training overload, and osteopenia, was identified as a risk factor. Although rare, multiple stress fractures can occur in female triathletes. These patients must be screened for risk factors associated with biomechanics, nutrition, and training to develop an effective prevention and treatment program.

Resumo Fraturas por estresse recorrentes num mesmo atleta são raras. Apresentamos o caso de uma triatleta que sofreu múltiplas fraturas por estresse na tíbia bilateral, na fíbula direita e no colo femoral esquerdo. O tratamento conservador foi instituído em todos os episódios, com repouso, redução da carga de treino e reabilitação fisioterápica. Foi identificada como fator de risco a síndrome da deficiência energética relativa no esporte, com distúrbio alimentar, sobrecarga de treino e osteopenia. Mesmo que seja raro, múltiplas fraturas por estresse podem ocorrer em mulheres triatletas, nas quais é importante avaliar os fatores de risco associados à biomecânica, nutrição e ao treinamento para arquitetar um programa de prevenção e tratamento efetivos.

Aberrant Pleural Plaques.

Male, 71 years old, active smoker. Referred to our outpatient clinic due to right upper lobe nodule with 4 year follow-up, which increased in size and metabolic uptake during the last year. CT scan also revealed multiple pleural plaques with a diffuse pattern. The patient underwent a right upper VATS lobectomy and mediastinal lymphadenectomy after intraoperative pathology consultation was positive for malignancy. Intraoperative with evidence of multiple hyline pleural plaques and aberrant neoformative lesions, mimicking teeth, on the diaphragm and parietal costal pleura, probably related to asbestos exposure.

Unusual Behavior of a Lung Inflammatory Myofibroblastic Tumor: Case Report.

INTRODUCTION: 55 years old, male patient. History of heavy smoking (65 UMA) and COPD. Admitted to hospital due to a left pneumonia. Thoracic CT and PET-Scan, showed left lower lobe mass measuring 92x89 mm (SUVmax 49). Several mediastinal node groups presented increased uptake of FDG. A fiberoptic bronchoscopy was performed. Citology of the bronchoalveolar lavage suggested a squamous carcinoma. EBUS of node stations 4R, 4L e 7 without evidence of malignancy. METHODS: The case was taken to a multidisciplinary meeting staged as IIIA (T3N2M0). Neoadjuvant therapy (four cycles cysplatine and gemcitabine) was decided based on station 5, suspected disease. A left lower lobectomy was performed after a cervical mediastinoscopy excluded metastasis of node stations 4R and 4L. Histology of the specimen was compatible with inflammatory myofibroblastic tumor (IMT). No lymph node involvement was reported. It was restaged as IIB (ypT3N0M0). RESULTS: Three months after surgery one de novo nodule in the lingula with 12,7 of SUVmax was reported. The nodule was removed confirming a IMT metastasis. Four months after the nodule ressection a CT showed new lung and liver nodules. A total oclusion of the left main bronchus was documented and bronchoscopic debulking of the endobronchial mass again revealed IMT. Paliative radiotherapy was decided in the multidisciplinar group targeting the left main bronchus (five sessions of radiotherapy on a dose of 20Gy in 4Gy daily fractions). Ten months after surgery due to the onset of back pain, a CT revealed a sacrum lesion whose needle biopsy was suspicious for multiple myeloma. The patient was referred to another oncological center where previous non-surgical cases had been sent in the past. The patient is now proposed for histology reassessment and discussion by the hematology and pneumology medical teams. CONCLUSION: Inflammatory myofibrobastic tumors are considered benign or low-grade malignant tumors. The size of the tumour (cut-off of 3 cm) and secure surgical resection with free margins are the major determinants for recurrence and survival. There are some cases reported in the literature of distant metastasis and sarcomatous transformation after multiple recurrences. In our patient, the lesion was bigger than 3 cm and he underwent a complete resection. Nothing could foresee this aggressive metastatic behavior, especially when the recurrence did not show a sarcomatous transformation.

Contribuições para a assistência farmacêutica: relato de uma experiência no Programa PET-Saúde / Contributions to the pharmaceutical assistance: report of an experience in the PET-Health Program

Introdução: o medicamento é um insumo fundamental para a promoção da saúde da população, tornando-se necessária a organização adequada da Assistência Farmacêutica (AF). Objetivos: o objetivo com o presente artigo foi descrever a experiência de formulação de propostas para a melhoria das condições da AF em uma Unidade Básica de Saúde (UBS) integrante do Programa PET-Saúde, incluindo a descrição das condições de armazenamento de medicamentos. Métodos: o artigo é composto de dois componentes: um relato de experiência e uma descrição das condições dearmazenamento dos medicamentos. O relato da experiência consistiu na descrição do processo de formulação de propostas de contribuições para a AF no período de setembro de 2012 a setembro de 2013. A avaliação do armazenamento ocorreu em setembro de 2013 e foi realizada por meio da observação direta com o emprego de um formulário estruturado. Resultados: os estudantes do PET-Saúde realizaram observações de todas as atividades desenvolvidas na UBS e adquiriram vivência paraformular uma proposta de contribuição para a AF da unidade, transformada em um projeto de extensão articulado à pesquisa. As condições de armazenamento apresentaram-se adequadas em relação à maioria das recomendações da Organização Mundial de Saúde e da Portaria 344/98 do Ministério da Saúde. Conclusão: o programa PET-Saúde proporcionou aos estudantes a possibilidade de formulação de propostas que podem contribuir para a melhoria das condições de AF e para a promoção dasaúde da população adscrita à UBS.

Introduction: medicines are fundamental items for the promotion of the population?s health and thus the proper organization of Pharmaceutical Assistance (AF) is necessary. Objectives: this article described the experience of formulating proposals for the AF improvement in a Basic Health Unit (BHU,) member of PET-Health Program, including the description of the medications? storage conditions. Methods: the article is composed of two components: a case study and a description of the medications? storage conditions. The case study consisted in the description of the process of formulating proposals for contributions to AF in the period between September of 2012 and September of 2013. The assessment of storage conditions occurred in September of 2013 and was carried out through direct observation using a structured form. Results: the PET-Health students conducted observations of all activities developed at the UBS and acquired experience to formulate a proposal for the contribution to the unit?s AF, which was transformed into an extension project linked to research. The storage conditions were appropriate and complied to most of the World Health Organization recommendations and Ordinance 344/98 from the Ministry of Health. Conclusion: the PET-Health program providedstudents with the possibility of formulating proposals that could contribute to the improvement of AF and promotion of health in the population assigned to UBS.

Posterior cruciate ligament injury: characteristics and associations of most frequent injuries / Lesoes do ligamento cruzado posterior: caracteristicas e associacoes mais frequentes

OBJECTIVE: To investigate the prevalence and combinations of PCL injuries and their correlations with the mechanism, the occurrence of evident dislocation and associated fracture. METHOD: A retrospective study of 85 lesions of PCL operated between 2003 and 2010. Diagnosis by physical examination and dynamic radiography, compared with surgical findings. RESULTS: Injuries involving the PCL were more prevalent in men (78.8%) with a mean age of 33 years. The main cause was traffic accidents (73.80%), and (49.4%) motorcycle. Isolated PCL injury occurred in (15.3%) cases, and combined (84.7%). Among the isolated lesions, bone avulsions were nine (10.6%). The most associated PCL injuries were the ACL (48.2%), followed by LCL PCL/PLC (22.4%). Fractures were more associated with combining PCL + LCL/PLC injuries and did not appear in the PCL + MCL/PMC. Complications beyond fractures: peripheral nerve injury (4.8%) and vascular (1.2%). Evident dislocation in primary care (16.7%) was more prevalent in combined ACL + PCL + MCL/PMC (44.4%). Half the patients were operated during the acute phase. There was a statistically significant difference (p < 0.05) comparing each combination of ligament injuries with the presence of fracture, dislocation or clear mechanism of injury. CONCLUSION: Surgical treatment of PCL injuries in a center for orthopedic trauma care was mostly multiligament and mainly involving the ACL. A significant association was seen between the type of injury with mechanism of injury, presentation of the knee, if dislocated or reduced, and the presence of associated fracture. .

OBJETIVO: Pesquisar a prevalência das lesões do ligamento cruzado posterior (LCP) e suas combinações e correlações com o mecanismo e a ocorrência de luxação evidente e fratura associada. MÉTODO: Estudo retrospectivo de 85 lesões do LCP operadas entre 2003 e 2010. Diagnóstico por meio do exame físico e da radiografia dinâmica, confrontados com achados cirúrgicos. RESULTADOS: Lesões que envolveram o LCP foram mais prevalentes nos homens (78,8%) com média de idade de 33 anos. A causa principal foi o acidente de trânsito (73,80%), dos quais 49,4% de motocicleta. Lesão isolada do LCP ocorreu em 15,3% dos casos e combinada em 84,7%. Dentre as lesões isoladas, nove foram avulsões ósseas (10,6%). O ligamento mais associado às lesões do LCP foi o cruzado anterior (48,2%), seguido da lesão combinada do LCP com o ligamento colateral lateral/canto póstero-lateral (22,4%). Fraturas estiveram mais associadas à combinação LCP + LCL/CPL e não apareceram nas lesões do LCP + ligamento colateral medial/canto póstero-medial. Complicações além de fraturas: lesão de nervo periférico (4,8%) e vascular (1,2%). Luxação evidente no primeiro atendimento (16,7%), mais prevalente na combinação LCP + LCA + LCM/CPM (44,4%). Metade dos pacientes foi operada na fase aguda. Houve diferença estatística significativa (p < 0,05) na comparação de cada combinação de lesões de ligamentos com a presença de fratura, luxação evidente ou mecanismo do trauma. CONCLUSÃO: Lesões do LCP submetidas a tratamento cirúrgico em centro de atenção ao trauma ortopédico foram na sua maioria multiligamentares e envolveram principalmente o LCA. Houve associação significativa entre o tipo ...

A selenium-based ionic liquid as a recyclable solvent for the catalyst-free synthesis of 3-selenylindoles.

The ionic liquid 1-butyl-3-methylimidazolium methylselenite, [bmim][SeO2(OCH3)], was successfully used as solvent in the catalyst-free preparation of 3-arylselenylindoles by the reaction of indole with ArSeCl at room temperature. The products were obtained selectively in good yields without the need of any additive and the solvent was easily reused for several cycles with good results.

Posterior cruciate ligament injury: characteristics and associations of most frequent injuries.

OBJECTIVE: To investigate the prevalence and combinations of PCL injuries and their correlations with the mechanism, the occurrence of evident dislocation and associated fracture. METHOD: A retrospective study of 85 lesions of PCL operated between 2003 and 2010. Diagnosis by physical examination and dynamic radiography, compared with surgical findings. RESULTS: Injuries involving the PCL were more prevalent in men (78.8%) with a mean age of 33 years. The main cause was traffic accidents (73.80%), and (49.4%) motorcycle. Isolated PCL injury occurred in (15.3%) cases, and combined (84.7%). Among the isolated lesions, bone avulsions were nine (10.6%). The most associated PCL injuries were the ACL (48.2%), followed by LCL PCL/PLC (22.4%). Fractures were more associated with combining PCL + LCL/PLC injuries and did not appear in the PCL + MCL/PMC. Complications beyond fractures: peripheral nerve injury (4.8%) and vascular (1.2%). Evident dislocation in primary care (16.7%) was more prevalent in combined ACL + PCL + MCL/PMC (44.4%). Half the patients were operated during the acute phase. There was a statistically significant difference (p < 0.05) comparing each combination of ligament injuries with the presence of fracture, dislocation or clear mechanism of injury. CONCLUSION: Surgical treatment of PCL injuries in a center for orthopedic trauma care was mostly multiligament and mainly involving the ACL. A significant association was seen between the type of injury with mechanism of injury, presentation of the knee, if dislocated or reduced, and the presence of associated fracture.

OBJETIVO: Pesquisar a prevalência das lesões do ligamento cruzado posterior (LCP) e suas combinações e correlações com o mecanismo e a ocorrência de luxação evidente e fratura associada. MÉTODO: Estudo retrospectivo de 85 lesões do LCP operadas entre 2003 e 2010. Diagnóstico por meio do exame físico e da radiografia dinâmica, confrontados com achados cirúrgicos. RESULTADOS: Lesões que envolveram o LCP foram mais prevalentes nos homens (78,8%) com média de idade de 33 anos. A causa principal foi o acidente de trânsito (73,80%), dos quais 49,4% de motocicleta. Lesão isolada do LCP ocorreu em 15,3% dos casos e combinada em 84,7%. Dentre as lesões isoladas, nove foram avulsões ósseas (10,6%). O ligamento mais associado às lesões do LCP foi o cruzado anterior (48,2%), seguido da lesão combinada do LCP com o ligamento colateral lateral/canto póstero-lateral (22,4%). Fraturas estiveram mais associadas à combinação LCP + LCL/CPL e não apareceram nas lesões do LCP + ligamento colateral medial/canto póstero-medial. Complicações além de fraturas: lesão de nervo periférico (4,8%) e vascular (1,2%). Luxação evidente no primeiro atendimento (16,7%), mais prevalente na combinação LCP + LCA + LCM/CPM (44,4%). Metade dos pacientes foi operada na fase aguda. Houve diferença estatística significativa (p < 0,05) na comparação de cada combinação de lesões de ligamentos com a presença de fratura, luxação evidente ou mecanismo do trauma. CONCLUSÃO: Lesões do LCP submetidas a tratamento cirúrgico em centro de atenção ao trauma ortopédico foram na sua maioria multiligamentares e envolveram principalmente o LCA. Houve associação significativa entre o tipo de lesão com o mecanismo de trauma, a forma de apresentação do joelho, se luxado ou reduzido, e a presença de fratura associada.

Impact of intraoperative transesophageal echocardiography in cardiac surgery: retrospective analysis of a series of 850 examinations.

OBJECTIVE: To evaluate the impact of intraoperative transesophageal echocardiography (TEE) on surgical decisions patients undergoing cardiac surger in a Portuguese hospital. METHODS: The authors retrospectively analyzed a series of 850 examinations performed between 2003 and 2009 in patients who underwent different cardiac surgical procedures. Medical records and TEE reports were reviewed to determine whether new information was found and whether this changed the surgical plan. RESULTS: Intraoperative TEE revealed new information in 32% of the study population and had surgical impact in 29% of all patients. TEE had the greatest impact in class I indications, but its use in class II indications also had a significant impact. No cases of morbidity or mortality were found. CONCLUSIONS: Our findings suggest that intraoperative TEE should be used routinely in all patients undergoing cardiac surgery.