Relationship between Postoperative Pain and Sociocultural Level in Major Orthopedic Surgery.

Background: Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are associated with moderate to severe postoperative pain (POP). POP is theoretically predictable and may be influenced by sociocultural differences. This study aimed to identify the relationship between POP and the sociocultural level of the patient undergoing THA or TKA. Methods: Prospective study, involving informed-consenting adults conducted through consulting patient's clinical processes, preoperative and postoperative questionnaires. Demographic and anthropometric data, type of surgery, ASA classification, sociocultural level of the patient, and POP were assessed. Results: 95 patients, all Caucasian and natural from the north of the Portugal, were included. Younger women undergoing TKA reported higher levels of POP. In females, the ASA 3 physical condition was also associated with higher mean pain intensity. Patients with preoperative chronic pain, without depression diagnosis, and unsatisfied with the current profession showed higher levels of reported POP. Retirees, with lower school degree, reported higher levels of minimal pain. Conclusions: Job satisfaction, type of surgery, body mass index, presence of chronic pain, and the absence of depression were identified as the main predictors of pain after THA or TKA.

Airway management in prone position: a case of knife injury in the posterior spine.

Airway management in prone position is a very challenging procedure, predicting a difficult airway situation. We present a case of an adult with knife injury in the posterior spine, needing surgical care. Because of possible dislodgment of the knife with life-threatening complications, supine and lateral decubitus positions were not considered for airway management. To get around this difficulty, we used a fiberoptic intubation through supraglottic device I-gel® in prone position, under general anesthesia, to secure the airway. This case shows the use of fiberoptic intubation through an I-gel® supraglottic device, in prone position, as a valid choice.

Anesthetic Approach in Ambulatory Vitrectomy: Peribulbar Block vs. Balanced General Anesthesia.

Background: Vitrectomy is one of the most common outpatient ophthalmic surgeries. The anesthetic technique used in outpatient surgery should contribute to a faster functional recovery, better pain control, and fewer complications. The aim of this study was to compare peribulbar block and balanced general anesthesia, in patients undergoing outpatient vitrectomy. Methods: A prospective cohort study was carried out, including adult patients undergoing ambulatory vitrectomy, between January and February 2018. Peribulbar block or balanced general anesthesia was the independent variable analyzed. Clinical and perioperative variables were evaluated, namely, postoperative pain, nausea, and vomiting in the postoperative period, intraoperative hypotension, patient satisfaction with the anesthetic technique, time to oral diet introduction and to hospital discharge, operating room occupancy time, and pharmacological costs. SPSS® 27 was used for statistical analyses. Results: Twenty-one patients were evaluated, 11 of whom underwent peribulbar block and 10 underwent balanced general anesthesia. Patients undergoing peribulbar block did not experience postoperative pain when compared to patients undergoing balanced general anesthesia (p=0.001). Intraoperative hypotension occurred in 18.2% of patients undergoing peribulbar block and in 70% of those undergoing balanced general anesthesia (p=0.03). Time to oral diet introduction (<1 hour vs. > 2 hours; p < 0.05), operating room occupancy time (70 vs. 90 minutes; p=0.027), time to hospital discharge (17 vs. 22.5 hours; p=0.004), and pharmacological costs (4.65 vs. 12.09 euros; p < 0.05) were lower in patients undergoing peribulbar block versus balanced general. Conclusions: Peribulbar block seems to meet the criteria of an ideal anesthetic technique in outpatient vitrectomy surgery.

Numerical-experimental analysis of the permeability-porosity relationship in triply periodic minimal surfaces scaffolds.

Bone Tissue Engineering has been focusing on improving the current methods for bone repair, being the use of scaffolds presented as an upgrade to traditional surgery techniques. Scaffolds are artificially porous matrices, meant to promote cell seeding and proliferation, being these properties influenced by the permeability of the structure. This work employed experimental pressure drop tests and Computational Fluid Dynamics models to assess permeability (and fluid streamlines) within different triply periodic minimal surfaces scaffold geometries (Schwarz D, Gyroid and Schwarz P). The pressure outputs from the computational analysis presented a good correlation with the experimental results, with R2 equal to 0.903; they have also shown that a lower porosity may not mean a lower permeability if the geometry is altered, such as the difference between 60% porous Gyroid scaffolds (8.1*10-9 mm2) and 70% porous Schwarz D scaffolds (7.1*10-9 mm2). Fluid streamlines revealed how the Gyroid geometries are the most appropriate design for most bone tissue engineering applications, due to their consistent fluid permeation, followed by Schwarz D. The Schwarz P geometries have shown flat streamlines and significant variation of the permeability with the porosity (an increase of 10% in their porosity lead to an increase in the permeability from 5.1*10-9 mm2 to 11.7*10-9 mm2), which would imply a poor environment for cell seeding and proliferation.

Construção e Validação de um Protocolo de Cuidados para Pacientes Críticos com Câncer em Delirium / Construction and Validation of a Care Protocol for Critical Patients with Cancer in Delirium / Construcción y Validación de un Protocolo de Atención al Paciente Crítico con Cáncer en Delirium

Introdução: A frequência de delirium em unidades de terapia intensiva oncológica é elevada. Objetivo: Construir um protocolo de cuidados para pacientes com câncer em delirium, internados em uma unidade de terapia intensiva e investigar sua validade de face e de conteúdo. Método: Estudo descritivo realizado em 2016 em um centro de assistência de alta complexidade em oncologia localizado na cidade do Rio de Janeiro, Brasil. Um comitê formado por 43 juízes apreciou as validades de face e de conteúdo do protocolo que foi construído a partir das recomendações constantes no Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium. Calcularam-se o índice de validade de conteúdo e as proporções de pertinência e de conformidade de cada item desse protocolo. Resultados: Todos os 19 itens obtiveram índice de validade de conteúdo >0,80 e proporções de conformidade superiores a 95%. A proporção de pertinência de cada item variou de 86% a 100%. Conclusão: O protocolo apresentou adequadas validades de face e de conteúdo, mostrando-se promissor no manejo do delirium em pacientes com câncer internados em unidade de terapia intensiva.

Introduction: The frequency of delirium in oncology intensive care units is high. Objective: To build a care protocol for cancer patients with deliriumadmitted to an intensive care unit and investigate its face and content validity. Method: Descriptive study conducted in 2016 in a high complexity care center in oncology located in the city of Rio de Janeiro, Brazil. A committee formed by 43 judges assessed the face and content validity of the protocol that was built from the recommendations contained in the Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium. The content validity index and the proportions of pertinence and compliance of each item of the protocol were calculated. Results: All 19 items had a content validity index >0.80 and proportions of compliance greater than 95%. The relevance ratio of each item ranged from 86% to 100%. Conclusion: The protocol presented adequate face and content validity, being promising for the management of delirium in cancer patients admitted to an intensive care unit.

Introducción: La frecuencia del delirium en las unidades de cuidados intensivos oncológicos es alta. Objetivo: Elaborar un protocolo de atención para pacientes oncológicos con delirium ingresados en unidad de cuidados intensivos e investigar su validez aparente y de contenido. Método: Estudio descriptivo realizado en 2016 en un centro de atención de alta complejidad en oncología ubicado en la ciudad de Río de Janeiro, Brasil. Un comité formado por 43 jueces evaluó la validez aparente y de contenido del protocolo que se construyó a partir de las recomendaciones contenidas em el Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium. Se calculó el índice de validez de contenido y las proporciones de pertinencia y cumplimiento de cada ítem del protocolo. Resultados: Los 19 ítems tenían un índice de validez de contenido >0,80 y proporciones de cumplimiento superiores al 95%. El índice de relevancia de cada ítem osciló entre el 86% y el 100%. Conclusión: El protocolo presentó una adecuada validez aparente y de contenido, y se mostró prometedor en el manejo del delirium en pacientes con cáncer ingresados en una unidad de cuidados intensivos.

On the permeability of TPMS scaffolds.

This study presents an experimental evaluation of permeability of triply periodic minimal surfaces (TPMS). Permeability is widely used to characterize scaffolds for Tissue Engineering (TE) applications as it gives information about the structure porosity, pore size, tortuosity and pore interconnectivity which have an important impact in cell seeding and proliferation. Three different TPMS structures were used: Schwartz Diamond (SD), Gyroid (SG) and Schwartz Primitive (SP), in four different porosity levels (50, 60, 70 and 80%). Overall, the SG scaffold type was determined to be the most permeable one while the SD was the least permeable. Furthermore, the presence of microscopic inertial pressure losses was verified and the Forchheimer's law proved to be a good mathematical tool as a Darcy's law expansion for the calculation of the structure's permeability while the weak-inertia regime was hard to detect or quantify.

Incidence of pressure injury in an oncological intensive care unit / Incidencia de úlcera por presión en unidad de cuidados intensivos oncológica / Incidência de lesão por pressão em unidade de terapia intensiva oncológica

ABSTRACT Objective: to investigate the incidence of pressure injury in cancer patients of an intensive care unit. Method: A longitudinal study with 105 patients admitted to an oncological intensive care unit. The incidence rate was calculated as the number of events per 100 patient-days. Cumulative incidence was calculated both globally and according to selected characteristics, and submitted to hypothesis tests. Results: incidence rate per 100 patient-days was 1.32, and global cumulative incidence was 29.5%. A higher incidence was observed in patients with chronic diseases who had at least one episode of diarrhea, received enteral nutrition, and took vasoactive or sedative drugs for a prolonged period of time. Regarding type of tumour and antineoplastic treatments, no differences in incidence were observed. Conclusion: A high cumulative global incidence of pressure lesion was reported in cancer patients admitted to the intensive care unit, although tumour characteristics and antineoplastic treatments did not affect incidence.

RESUMEN Objetivo: describir la incidencia de úlcera por presión en pacientes con cáncer hospitalizados en unidad de cuidados intensivos. Método: estudio longitudinal, en el cual participaron 105 pacientes hospitalizados en unidad de cuidados intensivos oncológica. Se calcularon la tasa de incidencia por 100 pacientes-día y de incidencia acumulada -total y según las características seleccionadas- y las sometió a test de hipótesis. Resultados: la tasa de incidencia fue igual a 1,32 por 100 pacientes-día y la de incidencia acumulada total fue un 29,5%. Se observó una mayor incidencia entre los portadores de enfermedades crónicas que tuvieron al menos un episodio de diarrea, que recibieron nutrición enteral y drogas vasoactivas y sedantes por tiempo prolongado. En cuanto al tipo de tumor y al tratamiento antineoplásico recibido, no se observaron diferencias en la incidencia. Conclusión: se describió la elevada incidencia acumulada total de úlcera por presión en pacientes con cáncer hospitalizados en unidad de cuidados intensivos, sin embargo las características del tumor y del tratamiento antineoplásico no presentaron diferencias en la incidencia.

RESUMO Objetivo: descrever a incidência de lesão por pressão em pacientes com câncer internados em unidade de terapia intensiva. Método: estudo longitudinal realizado com 105 pacientes internados em unidade de terapia intensiva oncológica. Calcularam-se taxa de incidência por 100 pacientes-dia e incidência acumulada - global e segundo caraterísticas selecionadas - submetendo-a a testes de hipótese. Resultados: taxa de incidência foi igual a 1,32 por 100 pacientes-dia e incidência acumulada global igual a 29,5%. Observou-se maior incidência entre portadores de doenças crônicas que apresentaram pelo menos um episódio de diarreia, que receberam nutrição enteral e drogas vasoativas e sedativas por tempo prolongado. Quanto ao tipo de tumor e ao tratamento antineoplásico recebido, não foram observadas diferenças na incidência. Conclusão: descreveu-se elevada incidência acumulada global de lesão por pressão em pacientes com câncer internados em unidade de terapia intensiva, embora características do tumor e do tratamento antineoplásico não tenham apresentado diferenças na incidência.

Delirium em pacientes com câncer internados em unidade de terapia intensiva: estudo retrospectivo / Delirium in cancer patients admitted to the intensive care unit: a retrospective study

RESUMO Objetivo: Descrever a ocorrência de delirium em pacientes com câncer internados em unidade de terapia intensiva, segundo características clínicas e demográficas. Métodos: Estudo retrospectivo realizado com 135 adultos internados na unidade de terapia intensiva de um hospital público especializado em oncologia, localizado na cidade do Rio de Janeiro, entre os meses de janeiro e março de 2016. Foram utilizados o teste exato de Fischer e o teste de associação linear para identificar diferenças estatisticamente significativas na ocorrência de delirium entre, respectivamente, variáveis categóricas e ordinais, considerando valor de p < 0,05. Resultados: A ocorrência global de delirium foi igual a 39,3%, sendo foi mais frequente entre pessoas com idade igual ou superior a 60 anos, com performance status que requeria grande assistência/acamado, internaram na unidade de terapia intensiva por problemas clínicos, em uso de drogas sedativas, submetidas à quimioterapia, e permaneceram 8 ou mais dias internados na unidade de terapia intensiva. Considerando apenas os pacientes sob ventilação mecânica, a ocorrência global de delirium foi de 64,6%, e apenas o tempo de permanência na unidade de terapia intensiva ≥ 8 dias mostrou diferença estatisticamente significativa. Conclusão: A ocorrência de delirium em pacientes críticos com câncer é elevada. Considerando apenas aqueles sob ventilação mecânica, a ocorrência desse fenômeno é ainda maior.

ABSTRACT Objective: To describe the occurrence of delirium in cancer patients admitted to the intensive care unit according to clinical and demographic characteristics. Methods: A retrospective study was conducted with 135 adults admitted to the intensive care unit of a public cancer hospital in the city of Rio de Janeiro, Brazil, between January and March 2016. Fisher's exact test and the linear association test were used to identify statistically significant associations between the occurrence of delirium and categorical and ordinal variables, respectively, considering a p-value < 0.05. Results: The overall occurrence of delirium was 39.3%. Delirium was more frequent among individuals aged 60 years or older and those who required extensive assistance or were bedbound, were admitted to the intensive care unit for clinical reasons, were using sedative drugs, were undergoing chemotherapy, and those who remained 8 or more days in the intensive care unit. Considering only patients on mechanical ventilation, the overall occurrence of delirium was 64.6%, and only a length of stay in the intensive care unit ≥ 8 days showed a statistically significant association with delirium. Conclusion: The occurrence of delirium in critically ill cancer patients is high. When only those on mechanical ventilation are considered, the occurrence of delirium is even greater.

Incidence of pressure injury in an oncological intensive care unit.

OBJECTIVE: to investigate the incidence of pressure injury in cancer patients of an intensive care unit. METHOD: A longitudinal study with 105 patients admitted to an oncological intensive care unit. The incidence rate was calculated as the number of events per 100 patient-days. Cumulative incidence was calculated both globally and according to selected characteristics, and submitted to hypothesis tests. RESULTS: incidence rate per 100 patient-days was 1.32, and global cumulative incidence was 29.5%. A higher incidence was observed in patients with chronic diseases who had at least one episode of diarrhea, received enteral nutrition, and took vasoactive or sedative drugs for a prolonged period of time. Regarding type of tumour and antineoplastic treatments, no differences in incidence were observed. CONCLUSION: A high cumulative global incidence of pressure lesion was reported in cancer patients admitted to the intensive care unit, although tumour characteristics and antineoplastic treatments did not affect incidence.

Delirium in cancer patients admitted to the intensive care unit: a retrospective study. / Delirium em pacientes com câncer internados em unidade de terapia intensiva: estudo retrospectivo.

OBJECTIVE: To describe the occurrence of delirium in cancer patients admitted to the intensive care unit according to clinical and demographic characteristics. METHODS: A retrospective study was conducted with 135 adults admitted to the intensive care unit of a public cancer hospital in the city of Rio de Janeiro, Brazil, between January and March 2016. Fisher's exact test and the linear association test were used to identify statistically significant associations between the occurrence of delirium and categorical and ordinal variables, respectively, considering a p-value < 0.05. RESULTS: The overall occurrence of delirium was 39.3%. Delirium was more frequent among individuals aged 60 years or older and those who required extensive assistance or were bedbound, were admitted to the intensive care unit for clinical reasons, were using sedative drugs, were undergoing chemotherapy, and those who remained 8 or more days in the intensive care unit. Considering only patients on mechanical ventilation, the overall occurrence of delirium was 64.6%, and only a length of stay in the intensive care unit ≥ 8 days showed a statistically significant association with delirium. CONCLUSION: The occurrence of delirium in critically ill cancer patients is high. When only those on mechanical ventilation are considered, the occurrence of delirium is even greater.

OBJETIVO: Descrever a ocorrência de delirium em pacientes com câncer internados em unidade de terapia intensiva, segundo características clínicas e demográficas. MÉTODOS: Estudo retrospectivo realizado com 135 adultos internados na unidade de terapia intensiva de um hospital público especializado em oncologia, localizado na cidade do Rio de Janeiro, entre os meses de janeiro e março de 2016. Foram utilizados o teste exato de Fischer e o teste de associação linear para identificar diferenças estatisticamente significativas na ocorrência de delirium entre, respectivamente, variáveis categóricas e ordinais, considerando valor de p < 0,05. RESULTADOS: A ocorrência global de delirium foi igual a 39,3%, sendo foi mais frequente entre pessoas com idade igual ou superior a 60 anos, com performance status que requeria grande assistência/acamado, internaram na unidade de terapia intensiva por problemas clínicos, em uso de drogas sedativas, submetidas à quimioterapia, e permaneceram 8 ou mais dias internados na unidade de terapia intensiva. Considerando apenas os pacientes sob ventilação mecânica, a ocorrência global de delirium foi de 64,6%, e apenas o tempo de permanência na unidade de terapia intensiva ≥ 8 dias mostrou diferença estatisticamente significativa. CONCLUSÃO: A ocorrência de delirium em pacientes críticos com câncer é elevada. Considerando apenas aqueles sob ventilação mecânica, a ocorrência desse fenômeno é ainda maior.

Manejo de delirium no paciente em unidade de terapia intensiva oncológica: elaboração de protocolos de diretrizes de cuidados / Delirium management in intensive cancer care unit patients: elaboration of care guidelines protocols

Objetivo: propor diretrizes de cuidado de manejo de delirium em uma unidade de cuidados intensivos oncológica, utilizando as recomendações do Clinical Practice Guidelines for Pain, Agitation, and Delirium (PAD). Método: estudo transversal para avaliar a frequência de delirium no período de três meses e para avaliar e validar diretrizes a partir do PAD em prontuários. Foi realizado com 43 profissionais na unidade de cuidados intensiva oncológica de um hospital especializado em oncologia da rede pública do Estado do Rio de Janeiro, que é um roteiro para o desenvolvimento integrado, com base em evidências, e para a prevenção e tratamento da dor, agitação e delirium em pacientes críticos. O instrumento preliminar proposto foi avaliado/validado através da metodologia Delphi, obedecendo consenso de 80% e Índice de Validade de Conteúdo (IVC) para análise do grau de importância de 0.78. Durante os meses de outubro a dezembro de 2016. Resultados: Cento e trinta e cinco prontuários de pacientes internados na UTI/UPO foram incluídos no estudo. A média de dias que precedeu a internação destes pacientes na unidade de cuidados intensivos oncológica foi de 10,3 dias. Encontrou-se uma frequência de 39,3% de pacientes com delirium no período pesquisado. Considerando apenas os pacientes sob ventilação mecânica, a frequência de delirium foi de 64,6%. O resultado do teste U indicou diferença significativa entre os grupos conforme o tempo de permanência na unidade de cuidados intensivos oncológica (p < 0,01). Pacientes internados por até sete dias tiveram tempo médio (M= 0,36; DP= 0,89) de duração de delirium (em dias) significativamente inferior aos de pacientes internados por oito dias ou mais (M = 4,58; DP = 4,80). Na análise ajustada foi identificado que os pacientes submetidos a traqueostomia (OR = 4,15; IC95% 1,33 ­ 12,94; p = 0,01) e ventilação mecânica (OR = 7,64; IC95% 2,41 ­ 24,25; p < 0,01) apresentaram maiores chances de delirium do que os pacientes que não foram submetidos a tais procedimentos. Sobre as diretrizes todos os 19 itens avaliados obtiveram a concordância maior de 80% e IVC maior de 0,78, a validação dos juízes na etapa Delphi 1, com consenso de 19 itens, foi um resultado considerado positivo, em especial, pela extensão do protocolo e diversidades de temáticas envolvidas com o manejo de delirium com pacientes oncológicos em UTI, o que poderia ter aumentado as chances de inadequações, apesar da análise dos resultados obtidos na 1ª de rodada da Técnica Delphi obterem índice de concordância mínimo de 80%, a análise dos comentários e das sugestões realizados pelos juízes determinou a realização de alterações no conteúdo dos itens, que foram submetidas à nova avaliação do grupo, no Delphi 2 utilizando Método de Pascali com valores percentuais superiores a 90%. Isso atesta que as diretrizes se encontram competente, quanto ao seu conteúdo, para avaliar o que se propõem: o manejo do delirium em paciente oncológico na UTI. Conclusão, aplicabilidade e impacto: a elaboração e validação das diretrizes revelou-se pertinente pela alta concordância dos pares visando uma melhor gestão do delirium para qualidade em cuidado e melhores desfechos, manejos e incidência do delirium

Fabrication of individual alginate-TCP scaffolds for bone tissue engineering by means of powder printing.

The development of polymer-calcium phosphate composite scaffolds with tailored architectures and properties has great potential for bone regeneration. Herein, we aimed to improve the functional performance of brittle ceramic scaffolds by developing a promising biopolymer-ceramic network. For this purpose, two strategies, namely, direct printing of a powder composition consisting of a 60:40 mixture of α/ß-tricalcium phosphate (TCP) powder and alginate powder or vacuum infiltration of printed TCP scaffolds with an alginate solution, were tracked. Results of structural characterization revealed that the scaffolds printed with 2.5 wt% alginate-modified TCP powders presented a uniformly distributed and interfusing alginate TCP network. Mechanical results indicated a significant increase in strength, energy to failure and reliability of powder-modified scaffolds with an alginate content in the educts of 2.5 wt% when compared to pure TCP, as well as to TCP scaffolds containing 5 wt% or 7.5 wt% in the educts, in both dry and wet states. Culture of human osteoblast cells on these scaffolds also demonstrated a great improvement of cell proliferation and cell viability. While in the case of powder-mixed alginate TCP scaffolds, isolated alginate gels were formed between the calcium phosphate crystals, the vacuum-infiltration strategy resulted in the covering of the surface and internal pores of the TCP scaffold with a thin alginate film. Furthermore, the prediction of the scaffolds' critical fracture conditions under more complex stress states by the applied Mohr fracture criterion confirmed the potential of the powder-modified scaffolds with 2.5 wt% alginate in the educts as structural biomaterial for bone tissue engineering.

Application of a 3D printed customized implant for canine cruciate ligament treatment by tibial tuberosity advancement.

Fabrication of customized implants based on patient bone defect characteristics is required for successful clinical application of bone tissue engineering. Recently a new surgical procedure, tibial tuberosity advancement (TTA), has been used to treat cranial cruciate ligament (CrCL) deficient stifle joints in dogs, which involves an osteotomy and the use of substitutes to restore the bone. However, limitations in the use of non-biodegradable implants have been reported. To overcome these limitations, this study presents the development of a bioceramic customized cage to treat a large domestic dog assigned for TTA treatment. A cage was designed using a suitable topology optimization methodology in order to maximize its permeability whilst maintaining the structural integrity, and was manufactured using low temperature 3D printing and implanted in a dog. The cage material and structure was adequately characterized prior to implantation and the in vivo response was carefully monitored regarding the biological response and patient limb function. The manufacturing process resulted in a cage composed of brushite, monetite and tricalcium phosphate, and a highly permeable porous morphology. An overall porosity of 59.2% was achieved by the combination of a microporosity of approximately 40% and a designed interconnected macropore network with pore sizes of 845 µm. The mechanical properties were in the range of the trabecular bone although limitations in the cage's reliability and capacity to absorb energy were identified. The dog's limb function was completely restored without patient lameness or any adverse complications and also the local biocompatibility and osteoconductivity were improved. Based on these observations it was possible to conclude that the successful design, fabrication and application of a customized cage for a dog CrCL treatment using a modified TTA technique is a promising method for the future fabrication of patient-specific bone implants, although clinical trials are required.

Fabrication of computationally designed scaffolds by low temperature 3D printing.

The development of artificial bone substitutes that mimic the properties of bone and simultaneously promote the desired tissue regeneration is a current issue in bone tissue engineering research. An approach to create scaffolds with such characteristics is based on the combination of novel design and additive manufacturing processes. The objective of this work is to characterize the microstructural and the mechanical properties of scaffolds developed by coupling both topology optimization and a low temperature 3D printing process. The scaffold design was obtained using a topology optimization approach to maximize the permeability with constraints on the mechanical properties. This procedure was studied to be suitable for the fabrication of a cage prototype for tibial tuberosity advancement application, which is one of the most recent and promising techniques to treat cruciate ligament rupture in dogs. The microstructural and mechanical properties of the scaffolds manufactured by reacting α/ß-tricalcium phosphate with diluted phosphoric acid were then assessed experimentally and the scaffolds strength reliability was determined. The results demonstrate that the low temperature 3D printing process is a reliable option to create synthetic scaffolds with tailored properties, and when coupled with topology optimization design it can be a powerful tool for the fabrication of patient-specific bone implants.

Menisco lateral discóide: avaliaçäo de 17 casos / Lateral discoid meniscus: evaluation of 17 cases

Os autores analisam série de 17 meniscos discóides encontrados em 1.000 artroscopias do joelho. Fazem consideraçoes a respeito da incidência e apresentaçao clínica. Relatam bons resultados com meniscoplastia da massa meniscal, como procedimento terapêutico, com seguimento médio de 25,5 meses.

Cifose de Scheuermann: resultados precoses com uso de colete de Milwaukee / Scheurmann's kyphosis: early results with use of Milwaukee's brace

Foram avaliados 23 pacientes que apresentavam cifose de Scheuermann, submetidos a tratamento conservador com colete de Milwaukee. A rotina de uso do colete consistiu em: uso integral (23 horas/dia) durante os seis primeiros meses e uso parcial (12 horas/dia) no período subseqüente de tratamento. O tempo total de uso do colete variou de 10 a 23 meses, com média de 14 meses. Quinze pacientes eram do sexo masculino e 8 do sexo feminino, cujas idades variaram de 9,3 a 14,6 anos. Os valores angulares iniciais das curvas estavam compreendidos entre 45 e 62 graus, com média de 51 graus. Após a descontinuaçäo do uso do colete de Milwaukee, os valores iniciais ao tratamento, variando de 29 a 42 graus, com média de 33 graus. O tempo de acompanhamento pós-colete variou de 2 a 27 meses. Baseados em nossos resultados, concluímos que o colete de Milwaukee proporcionou, a curto prazo excelentes resultados no tratamento da cifose de Scheuermann