Damage control for subclavian artery injury.

Mortality from penetrating traumas involving the subclavian vessels can be as high as 60% in pre-hospital settings. Operating room mortality is in the range of 5-30%. This paper presents a case in which a strategy for damage control was employed for a patient with an injury to the origin of the left subclavian artery, using subclavian ligation, with no need for any other intervention, and maintaining viability of the left upper limb via collateral circulation. The authors also review surgical approaches and treatment strategies with a focus on damage control in subclavian vessel injuries.

EXTRA-ARTICULAR RECONSTRUCTION ASSOCIATED WITH THE ANTERIOR CRUCIATE LIGAMENT IN BRAZIL.

OBJECTIVE: To assess the knowledge and technical preferences of Brazilian knee surgeons in relation to the treatment of Anterior Cruciate Ligament (ACL) injuries using intra-articular reconstruction in combination with extra-articular reconstruction. METHODS: A questionnaire consisting of 16 questions about intra-articular ACL reconstruction in combination with extra-articular procedures and about the Anterolateral Ligament (ALL) was applied at the 48th Brazilian Congress of Orthopedics. RESULTS: One hundred thirty-seven surgeons answered the questionnaire. Most surgeons perform 10-30 ACL reconstructions per year, with the transtibial technique appearing as the most common. Most surgeons find some percentage of residual pivot-shift after reconstructions, but the minority performs extra-articular procedures on a routine basis. The main indications for extra-articular reconstruction are revision and profuse pivot-shift cases. Most surgeons consider the ALL a true ligament, but 46.7% with less biomechanical importance and 32.3% with greater importance in knee stability. However, 91.4% had a positive perception of the reconstruction of this structure. CONCLUSION: Although the preferred technique is still the transtibial procedure, combined anatomical reconstructions already make up more than 50% of cases. Extra-articular reconstructions associated with the ACL are still performed by the minority of Brazilian surgeons, but 91.4% of them report having had a positive perception with their reconstruction. Level of Evidence III, Descriptive Study.

OBJETIVO: Avaliar o conhecimento e as preferências técnicas entre os cirurgiões de joelho brasileiros no tratamento das lesões do ligamento cruzado anterior, com reconstrução intra-articular associada à reconstrução extra-articular. MÉTODOS: Foi aplicado questionário de 16 perguntas no 48° Congresso Brasileiro de Ortopedia acerca de reconstrução intra-articular do ligamento cruzado anterior associada a procedimentos extra-articulares e sobre o ligamento anterolateral. RESULTADOS: Responderam o questionário 137 cirurgiões. A maioria faz entre 10 e 30 reconstruções de ligamento cruzado anterior por ano, sendo a técnica transtibial a mais realizada. A maioria encontrou alguma porcentagem de pivot-shift residual após as reconstruções, mas a minoria realizou procedimento extra-articular de rotina. As indicações principais de reconstrução extra-articular foram casos de revisão e pivot-shift exuberante. A maioria considera o ligamento anterolateral um ligamento verdadeiro, porém 46,7% o caraterizou com importância biomecânica menor e 32,3% com importância maior na estabilidade do joelho, mas 91,4% tiveram percepção positiva em relação à reconstrução dessa estrutura. CONCLUSÃO: Apesar da técnica de preferência ainda ser a transtibial, as reconstruções anatômicas combinadas já são mais de 50% dos casos. As reconstruções extra-articulares associadas ao ligamento cruzado anterior ainda são feitas pela minoria dos cirurgiões brasileiros, mas 91,4% deles referem ter tido uma percepção positiva com sua reconstrução. Nível de Evidência III, Estudo Descritivo.

Why Do Authors Differ With Regard to the Femoral and Meniscal Anatomic Parameters of the Knee Anterolateral Ligament?: Dissection by Layers and a Description of Its Superficial and Deep Layers.

BACKGROUND: No consensus exists regarding the anatomic characteristics of the knee anterolateral ligament (ALL). A critical analysis of the dissections described in previous studies allows the division of the ALL into 2 groups with similar characteristics. The presence of considerable variability suggests that the authors may not be referring to the same structure. PURPOSE/HYPOTHESIS: To perform a lateral anatomic dissection, by layers, seeking to characterize the 2 variants described for the ALL on the same knee. We hypothesized that we would identify the 2 variants described for the ALL and that these variants would have distinct characteristics. STUDY DESIGN: Descriptive laboratory study. METHODS: Thirteen unpaired cadaveric knees were used in this study. The dissection protocol followed the parameters described in previous studies. Immediately below the iliotibial tract, we isolated a structure designated as the superficial ALL, whereas between this structure and the articular capsule, we isolated a structure designated as the deep ALL. The 2 structures were measured for length at full extension and at 90° of flexion and for distance from the tibial insertion relative to the Gerdy tubercle. Potential contact with the lateral meniscus was also evaluated. After measurements were obtained, the 2 dissected structures underwent histologic analysis. RESULTS: The superficial ALL presented a posterior and proximal origin to the center of the lateral epicondyle, its length increased on knee extension, and it exhibited no contact with the lateral meniscus. The deep ALL was located in the center of the lateral epicondyle, its length increased on knee flexion, and it presented a meniscal insertion. Both structures had a similar tibial insertion site; however, the insertion site of the deep ALL was located more posteriorly. The analysis of the histological sections for both structures indicated the presence of dense and well-organized collagen fibers. CONCLUSION: This anatomic study clearly identified 2 structures, described as the superficial and deep ALL, which were consistent with previous but conflicting descriptions of the ALL. CLINICAL RELEVANCE: This study clarifies numerous controversies encountered in anatomic studies of the ALL. Knowledge regarding the existence of 2 distinct structures in the anterolateral knee will allow more accurate evaluation of their functions and characteristics.

Rangelia vitalii: changes in the enzymes ALT, CK and AST during the acute phase of experimental infection in dogs.

Rangelia vitalii is a protozoon that causes diseases in dogs, and anemia is the most common laboratory finding. However, few studies on the biochemical changes in dogs infected with this protozoon exist. Thus, this study aimed to investigate the biochemical changes in dogs experimentally infected with R. vitalii, during the acute phase of the infection. For this study, 12 female dogs (aged 6-12 months and weighing between 4 and 7 kg) were used, divided in two groups. Group A was composed of healthy dogs (n = 5); and group B consisted of infected animals (n = 7). Blood samples were collected on days 0, 10, 20 and 30 after infection, using tubes without anticoagulant to obtain serum and analyze the biochemical parameters. An increase in alanine aminotransferase (ALT) on day 20 (P < 0.05) was observed. Also, increased creatine kinase (CK) and aspartate aminotransferase (AST) levels were observed throughout the experimental period (P < 0.05). No changes in the serum gamma-glutamyltransferase, urea and creatinine levels were observed. Thus, is possible to conclude that experimental infection with R. vitalii in dogs causes changes to the biochemical profile, with increased ALT, AST and CK enzyme levels.

Influence of Rangelia vitalii (Apicomplexa: Piroplasmorida) on copper, iron, and zinc bloodstream levels in experimentally infected dogs.

The aim of this study was to evaluate the concentrations of copper, iron, and zinc in blood serum of dogs experimentally infected with Rangelia vitalii (n  =  7) compared with uninfected controls (n  =  5). Serum metal levels were determined in blood samples collected at days 0, 10, 15, and 20 post-infection (PI). Inductively coupled plasma optical emission spectrometry was used to measure the levels of copper, iron, and zinc. Significant differences (P < 0.05) were observed among groups PI. Increased levels of copper and decreased levels of iron and zinc were observed in the infected animals. The infection by R. vitalii may, therefore, alter the serum metal levels, resulting in metabolic disorders in dogs. These metals are directly involved in many enzymatic systems; accordingly, alterations in their blood concentrations may also influence the pathogenesis of disease.

Design of a complex bioimpedance spectrometer using DFT and undersampling for neural networks diagnostics.

Electrical impedance spectroscopy offers many applications in the medical field due the fast response, non-invasiveness and low cost. One promising area is the use of this method for diagnostics. This paper describes the design and experimental evaluation of a multifrequencial complex bioimpedance analyzer. Impedance amplitude and phase were calculated using Discrete Fourier Transform (DFT) and high frequency signals were measured with undersampling. The prototype was able to measure values from 1 Ω to 50 kΩ (frequency range from 50 Hz to 500 kHz). The accuracy of the technique was compared with a commercial equipment. The analysis of passive components resulted in a mean error of 2.9% for the magnitude and 0.69 degrees for the phase. Besides, an initial study for head and neck cancer detection through neural networks is shown. One used bioimpedance values as well as gender, age and body mass index as inputs. The network used 120 training and 40 validation data and was able to simulate 77.5% of the two types of diagnostic correctly.

Current development in non-invasive glucose monitoring.

Painless control of blood glycemic levels could improve life quality of diabetes patients, enabling a better regulation of hyper- and hypoglycaemia episodes and thereby avoiding physiological complications. Although research groups have been trying for decades to separate non-invasive glucose information from interference compounds, none of the available commercial devices offers enough precision to replace lancet approaches. Many reviews have already been published on this topic, but the great amount of information available and the fast development of technologies require a continuous update in the research status. Besides the description of current in-vivo methods and the analysis of devices available commercially, one also explains treatment algorithms useful for multivariate analysis.