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2.
Int J Med Educ ; 10: 62-67, 2019 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-30927542

RESUMO

Objectives: To assess the correlation between perception of the learning environment and the approach to learning adopted by anesthesiology residents throughout training in an academic institution in the United States. Methods: This is a cross-sectional study involving forty-one anesthesiology residents who completed electronic forms of the Revised Two-Factor Study Process Questionnaire to assess learning approaches, and the Dundee Ready Educational Environment Measure questionnaire to assess learning environment. Convenience sampling was used with the current anesthesiology residents. Learning approaches were analyzed with a multiple regression model for correlation between total score, domains, and training level. Analysis of variance was used to assess differences in perception of the learning environment based on training level. Multivariate logistic regression was used to assess the correlation between domains of learning the environment and approaches questionnaires. Cronbach α was used to evaluate the internal consistency of responses within each domain of both questionnaires. Results: Forty-one residents completed the questionnaires. Cronbach α varied between 0.604 and 0.76 among the domains in the Study Process Questionnaire and was greater than 0.60 for the Dundee questionnaire. There was a moderate correlation between total deep approach scores and the total subjective perception of teachers scores (R2= - 0.507, p <0.01). There was no significant association between specific domains of Dundee and study process questionnaires and resident year of training. Conclusions: The learning approaches adopted by anesthesiology residents and the perception of the educational environment are not correlated with years of training. The DREEM and R-SPQ-2F questionnaires should not be recommended for evaluation of anesthesiology residents.


Assuntos
Anestesiologia/educação , Atitude do Pessoal de Saúde , Avaliação Educacional , Internato e Residência/métodos , Aprendizagem/fisiologia , Meio Social , Estudantes de Medicina , Adulto , Anestesiologia/métodos , Anestesiologia/organização & administração , Anestesiologia/normas , Estudos Transversais , Avaliação Educacional/métodos , Avaliação Educacional/normas , Feminino , Humanos , Internato e Residência/tendências , Masculino , Pessoa de Meia-Idade , Percepção/fisiologia , Estudantes de Medicina/psicologia , Estudantes de Medicina/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos/epidemiologia
3.
Minerva Anestesiol ; 85(4): 376-383, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30482003

RESUMO

BACKGROUND: Labor epidural analgesia success depends on precise needle position placement within the epidural space, with reported failure rates to be as high as 32%. In this study, we describe a novel technique employing color Doppler to aid in the confirmation of the correct position of the epidural needle tip. METHODS: Retrospective evaluation of 35 patients who received labor combined spinal-epidural (CSE) with confirmation of epidural needle position with color flow Doppler (CFD) ultrasonography. Demographic data, intervertebral level of insertion and dermatome sensory level were extracted. Video and image evaluation of CFD patterns were used to confirm epidural needle tip and catheter position. CFD was used to visualize intrathecal injection of local anesthetic in two patients. RESULTS: Three different color flow patterns were visualized after the loss of resistance technique: visualization of a red and blue mosaic adjacent to the posterior complex, a mosaic pattern enveloping the trajectory of the epidural needle, and a linear deeper mosaic color pattern during spinal injection in relation to the posterior complex. Identification of epidural needle tip and epidural catheter tip occurred in 77% and 37.1% of patients, respectively. CONCLUSIONS: CFD is a novel and useful technique to confirm the precise position of the epidural needle tip in the context of labor analgesia. Identification of the epidural catheter with CFD is difficult despite an adequate CSE technique.

4.
Ann Med Surg (Lond) ; 36: 129-134, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30455878

RESUMO

Aim: To evaluate maternal, neonatal and anesthetic outcomes according to BMI in women undergoing cesarean section. Background: Increased incidence rates of obesity and morbid obesity have been reported in the United States. Pregnant obese patients are at increased risk of maternal and fetal complications, and obstetric and anesthetic management of these patients is especially challenging. Methods: A retrospective chart review of patients who underwent cesarean section in a single center between 2015 and 2016 was conducted. Anesthetic, obstetric and neonatal outcomes were analyzed in relation to levels of BMI. Results: Seven hundred and seventy one patients underwent cesarean section during the study period. The number of patients with normal BMI, obesity and morbid obesity was 213 (27.6%), 365 (47.3%) and 193 (25%), respectively. Sixty-one percent of the patients in morbidly obese group had at least one comorbidity (p < 0.01). We found no significant differences with respect to perioperative obstetric complications. Intraoperative blood loss was significantly higher in the morbidly obese group. Conclusion: Increasing BMI is associated with comorbidities such as hypertension and diabetes mellitus, and with increased intraoperative blood loss. We were unable to detect differences in other obstetric, anesthetic and neonatal outcomes.

5.
Bull Hosp Jt Dis (2013) ; 73(1): 25-36, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26516998

RESUMO

Intraoperative monitoring (IOM) of spinal cord and nerve root injury through somatosensory evoked potentials (SSEP), transcranial motor evoked potentials (TcMEP), spontaneous electromyography (sEMG), and triggered electromyography (tEMG) modalities is vital during spinal surgery. However, there are currently no practice guidelines or practice patterns for the utilization of unimodal and multimodal IOM for specific surgeries. This study reviews IOM modalities and documents practice patterns of spine surgeons at our single-center tertiary hospital about their use of various IOM modalities on 23 spinal procedures. As different intraoperative monitoring modalities have shown to have different sensitivities and specificities, devising practice guidelines for IOM utilization in specific spinal procedures should be considered.


Assuntos
Monitorização Neurofisiológica Intraoperatória/estatística & dados numéricos , Procedimentos Ortopédicos , Padrões de Prática Médica , Medula Espinal/cirurgia , Raízes Nervosas Espinhais/cirurgia , Centros de Atenção Terciária , Eletroencefalografia/estatística & dados numéricos , Eletromiografia/estatística & dados numéricos , Potencial Evocado Motor , Potenciais Somatossensoriais Evocados , Pesquisas sobre Serviços de Saúde , Humanos , Monitorização Neurofisiológica Intraoperatória/métodos , Procedimentos Ortopédicos/efeitos adversos , Valor Preditivo dos Testes , Reflexo , Medula Espinal/fisiopatologia , Raízes Nervosas Espinhais/fisiopatologia , Estimulação Transcraniana por Corrente Contínua/estatística & dados numéricos
6.
Spine J ; 15(12): 2564-73, 2015 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-26431997

RESUMO

BACKGROUND CONTEXT: Numerous studies have demonstrated poorer outcomes in patients with Workers' compensation (WC) when compared with those without WC following treatment of various of health conditions, including spine disorders. It is thus important to consider compensation status when assessing treatment outcomes in spine surgery. However, reported strengths of association have varied significantly (1.31-7.22). PURPOSE: The objective of this study was to evaluate the association of unsatisfactory outcomes on compensation status in spine surgery patients. STUDY DESIGN/SETTING: A meta-analysis was performed. PATIENT SAMPLE: Patient sample is not applicable in this study. OUTCOME MEASURE: Demographics, type of surgery, country, follow-up time, patient satisfaction, return to work and non-union events were the outcome measures. METHODS: Both prospective and retrospective studies that compared outcomes between compensated and non-compensated patients in spine surgery were included. Two independent investigators extracted outcome data. The meta-analysis was performed using Revman software. Random effects model was used to calculate risk ratio (RR, 95% confidence interval [CI]) for dichotomous variables. RESULTS: Thirty-one studies (13 prospective; 18 retrospective) with a total of 3,567 patients were included in the analysis. Follow-up time varied from 4 months to 10 years. Twelve studies involved only decompression; the rest were fusion. Overall RR of an unsatisfactory outcome was 2.12 [1.74, 2.58; p<.001] in patients with WC when compared with those without WC after surgery. The RR of an unsatisfactory outcome in patients with WC, compared with those without, was 2.09 [1.38, 3.17]; p<.01 among studies from Europe and Australia, and 2.14 [1.48, 2.60]; p<.01 among US studies. The RR of decompression-only procedures was 2.53 [1.85, 3.47]; p<.01,and 1.79 [1.45, 2.21]; p<.01 for fusion. Forty-three percent (209 of 491) of patients with WC did not return to work versus 17% (214 of 1250) of those without WC (RR 2.07 [1.43, 2.98]; p<.001). Twenty-five percent (74 of 292) and 13.5% (39 of 287) of patients had non-union in the compensated and non-compensated groups, respectively. This was not statistically significant (RR 1.33 [0.92, 1.91]; p=.07). CONCLUSIONS: Workers' compensation patients have a two-fold increased risk of an unsatisfactory outcome compared with non-compensated patients after surgery. This association was consistent when studies were grouped by country or procedure. Compensation status must be considered in all surgical intervention studies.


Assuntos
Descompressão Cirúrgica/economia , Coluna Vertebral/cirurgia , Indenização aos Trabalhadores , Adulto , Descompressão Cirúrgica/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
7.
Plast Reconstr Surg Glob Open ; 3(6): e434, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26180735

RESUMO

We report 3 cases of breast pyoderma gangrenosum in patients undergoing total mastectomy with immediate reconstruction. All three received systemic corticosteroid treatment, resulting in resolution of symptoms. As experience grew, early diagnosis in the third patient helped prosthesis salvage and timely return to the original course of reconstruction. This represents the first report of prosthesis salvage from post breast reconstruction pyoderma gangrenosum, and it demonstrates that implant removal is not always necessary during management of this rare condition.

8.
Int J Spine Surg ; 9: 19, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26114088

RESUMO

BACKGROUND: Unplanned hospital readmissions result in significant clinical and financial burdens to patients and the healthcare system. Readmission rates and causes have been investigated using large administrative databases which have certain limitations in data reporting and coding. The objective of this study was to provide a description of 90 day post-discharge readmissions following surgery for common degenerative cervical spine pathologies at a large-volume tertiary hospital. The study also compared the readmission rates of patients who underwent anterior- and posterior-approach procedures. METHODS: The administrative records from a single-center, high-volume tertiary institution were queried using ICD-9 codes for common cervical pathology over a three year period to determine the rate and causes of readmissions within the 90 days following the index surgery. RESULTS: A total of 768 patients underwent degenerative cervical spine surgery during the three year study period. Within 90 days of discharge, 24 (3.13%) patients were readmitted; 16 (2.06%) readmissions were planned for lumbar surgery; 8 (1.04%) readmissions were unplanned. 640 patients underwent procedures involving an anterior approach and 128 patients underwent procedures involving a posterior approach. There were 14 (2.17%) planned readmissions in the anterior group and 2 (1.5%) in the posterior group. The unplanned readmission rate was 0.63% (4 patients) and 3.13% (4 patients) in the anterior and posterior groups, respectively. (p=0.0343). CONCLUSION: The 90 day post-discharge unplanned readmission rate that followed elective degenerative cervical spine surgery was 1.04%. The unplanned readmission rate associated with posterior-approach procedures (3.13%) was significantly higher than that of anterior-approach procedures (0.63%). LEVEL OF EVIDENCE: IV.

9.
Spine (Phila Pa 1976) ; 40(8): E443-9, 2015 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-25868100

RESUMO

STUDY DESIGN: This is a prospective, randomized, double-blinded comparison of tranexamic acid (TXA), epsilon aminocaproic acid (EACA), and placebo used intraoperatively in patients with adult spinal deformity. OBJECTIVE: The purpose of this study was to provide high-quality evidence regarding the comparative efficacies of TXA, EACA, and placebo in reducing blood loss and transfusion requirements in patients undergoing posterior spinal fusion surgery. SUMMARY OF BACKGROUND DATA: Spine deformity surgery usually involves substantial blood loss. The antifibrinolytics TXA and EACA have been shown to improve hemostasis in large blood loss surgical procedures. METHODS: Fifty-one patients undergoing posterior spinal fusion of at least 5 levels for correction of adult spinal deformity were randomized to 1 of 3 treatment groups. Primary outcome measures included intraoperative estimated blood loss, total loss, (estimated blood loss + postoperative blood loss), and transfusion rates. RESULTS: Patients received TXA (n = 19), EACA (n = 19), or placebo (n = 13) in the operating room (mean ages: 60, 47, and 43 yr, respectively); TXA patients were significantly older and had larger estimated blood volumes than both other groups. Total losses were significantly reduced for EACA versus control, and there was a demonstrable but nonsignificant trend toward reduced intraoperative blood loss in both antifibrinolytic arms versus control. EACA had significant reductions in postoperative blood transfusions versus TXA. CONCLUSION: The findings in this study support the use of antifibrinolytics to reduce blood loss in posterior adult spinal deformity surgery. LEVEL OF EVIDENCE: 1.


Assuntos
Ácido Aminocaproico/uso terapêutico , Antifibrinolíticos/uso terapêutico , Perda Sanguínea Cirúrgica/prevenção & controle , Coluna Vertebral/cirurgia , Ácido Tranexâmico/uso terapêutico , Adulto , Transfusão de Sangue , Volume Sanguíneo , Método Duplo-Cego , Feminino , Hematócrito , Humanos , Cuidados Intraoperatórios , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fusão Vertebral , Coluna Vertebral/anormalidades
10.
Spine (Phila Pa 1976) ; 40(6): 423-8, 2015 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-25774465

RESUMO

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To assess the rate and causes of unplanned readmissions after surgical treatment of common degenerative lumbar pathologies within 90 days. SUMMARY OF BACKGROUND DATA: With pay-for performance and bundled payment compensation models being implemented; there is a growing emphasis to decrease the number of unplanned readmissions after surgery. Reports on degenerative lumbar spine pathology readmission rates are often obtained from national databases that lack clinical detail. Less published are the results from single-center institutions. METHODS: Hospital administrative database from a single-tertiary institution was queried to identify patients who underwent surgery for 6 common lumbar pathologies during a period from 2011 to 2013. All readmissions within 90 days of discharge were reviewed for cause and rate of unplanned readmissions was calculated. RESULTS: A total of 1306 patients were identified who underwent surgery for various lumbar pathologies during a 2-year time period. There were a total of 70 readmissions captured in the database that included 14 planned, 43 unplanned readmissions, and 13 coding errors. The unplanned readmission rate varied between 2.1% and 7.1% depending on pathology, with an overall rate of 3.3% within 90 days of discharge. Index length of stay, discharge disposition, severity of illness scores, and surgical approach were associated with readmission. The addition of fusion to decompression procedures did not seem to increase readmission rates. Surgical site infections and wound complications were the 2 most common reasons for readmissions accounting for 72% of all readmissions during the 90-day postdischarge period. CONCLUSION: The rate of readmission after surgery for common lumbar degenerative pathologies is relatively low. Surgical site infections and wound complications were the most common cause of readmission in this patient cohort. LEVEL OF EVIDENCE: 4.


Assuntos
Vértebras Lombares/cirurgia , Readmissão do Paciente/estatística & dados numéricos , Doenças da Coluna Vertebral/cirurgia , Adulto , Idoso , Feminino , Humanos , Laminectomia/efeitos adversos , Laminectomia/estatística & dados numéricos , Região Lombossacral/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Fusão Vertebral/estatística & dados numéricos , Infecção da Ferida Cirúrgica/etiologia
11.
Spine J ; 15(4): 752-61, 2015 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-25617507

RESUMO

BACKGROUND CONTEXT: Spine surgery is usually associated with large amount of blood loss, necessitating blood transfusions. Blood loss-associated morbidity can be because of direct risks, such as hypotension and organ damage, or as a result of blood transfusions. The antifibrinolytic, tranexamic acid (TXA), is a lysine analog that inhibits activation of plasminogen and has shown to be beneficial in reducing surgical blood loss. PURPOSE: To consolidate the findings of randomized controlled trials (RCTs) investigating the use of TXA on surgical bleeding in spine surgery. STUDY DESIGN: A metaanalysis. STUDY SAMPLE: Randomized controlled trials investigating the effectiveness of intravenous TXA in reducing blood loss in spine surgery, compared with a placebo/no treatment group. METHODS: MEDLINE, Embase, Cochrane controlled trials register, and Google Scholar were used to identify RCTs published before January 2014 that examined the effectiveness of intravenous TXA on reduction of blood loss and blood transfusions, compared with a placebo/no treatment group in spine surgery. Metaanalysis was performed using RevMan 5. Weighted mean difference with 95% confidence intervals was used to summarize the findings across the trials for continuous outcomes. Dichotomous data were expressed as risk ratios with 95% confidence intervals. A p<.05 was considered statistically significant. RESULTS: Eleven RCTs were included for TXA (644 total patients). Tranexamic acid reduced intraoperative, postoperative, and total blood loss by an average of 219 mL ([-322, -116], p<.05), 119 mL ([-141, -98], p<.05), and 202 mL ([-299, -105], p<.05), respectively. Tranexamic acid led to a reduction in proportion of patients who received a blood transfusion (risk ratio 0.67 [0.54, 0.83], p<.05) relative to placebo. There was one myocardial infarction (MI) in the TXA group and one deep vein thrombosis (DVT) in placebo. CONCLUSIONS: Tranexamic acid reduces surgical bleeding and transfusion requirements in patients undergoing spine surgery. Tranexamic acid does not appear to be associated with an increased incidence of pulmonary embolism, DVT, or MI.


Assuntos
Antifibrinolíticos/uso terapêutico , Perda Sanguínea Cirúrgica/prevenção & controle , Procedimentos Ortopédicos/efeitos adversos , Coluna Vertebral/cirurgia , Ácido Tranexâmico/uso terapêutico , Humanos , Resultado do Tratamento
12.
Plast Reconstr Surg ; 133(6): 1365-8, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24867719

RESUMO

Autologous fat grafting has been widely used in reconstructive and cosmetic surgery. Harvesting techniques play a key role in graft viability and outcomes. The authors investigated the effect of harvest pressure on adipocyte survival and viability of the surviving cells. Abdominal lipoaspiration was performed at high pressure (-760 mmHg) and low pressure (-250 mmHg) on three patients. Adipocyte survival and cell viability were measured. Adipocyte count immediately after harvest was 47 percent higher when aspirated at low pressure compared with high pressure. In addition, the cell viability was significantly higher at day 7 with low-pressure aspiration. The authors also describe a simple technique for aspirating at low pressures to obtain a controlled, consistent, reproducible, and good quality graft.


Assuntos
Adipócitos/fisiologia , Tecido Adiposo/transplante , Coleta de Tecidos e Órgãos/métodos , Adipócitos/citologia , Tecido Adiposo/citologia , Autoenxertos , Sobrevivência Celular , Humanos , Pressão
13.
Am J Orthop (Belle Mead NJ) ; 43(5): 227-9, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24839629

RESUMO

The anconeus epitrochlearis (AE) muscle is a common anatomical variation in the cubital tunnel retinaculum of the elbow with an incidence of up to 28%; it is one cause of compressive ulnar neuropathy. In this study, we report the significance of preoperative recognition of AE-associated cubital tunnel syndrome, based on the grade of velocity drop of the compressed ulnar nerve in electrophysiological studies. Twenty-two cases with idiopathic cubital tunnel compression (CTC) were retrospectively analyzed; AE was present in 6 cases. Velocity drop of the ulnar nerve was calculated by dividing the difference in velocity (m/s) by distance (cm); the results were classified into the following grades: + (0-2.99 m/s per cm) and ++ (< 3.00 m/s per cm). Categorical data were compared using Fisher's exact test; the Mann-Whitney U test was used to determine statistical significance of ordinal data. In patients with AE-associated CTC, 3 of the 6 (50%) cases had grade ++ velocity drop. In comparison, only 1 patient of the 16 non-AE cases (6%) had grade ++ velocity drop (P = .046). Preoperative nerve velocity conduction studies that show grade ++ velocity drop (< 3.00 m/s per cm) in ulnar nerve are highly suggestive of the presence of AE.


Assuntos
Síndrome do Túnel Ulnar/etiologia , Músculo Esquelético/fisiopatologia , Síndromes de Compressão do Nervo Ulnar/fisiopatologia , Nervo Ulnar/fisiopatologia , Adulto , Idoso , Eletrodiagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/anatomia & histologia , Estudos Retrospectivos , Síndromes de Compressão do Nervo Ulnar/diagnóstico , Síndromes de Compressão do Nervo Ulnar/cirurgia , Adulto Jovem
14.
Acta Biomater ; 9(3): 5751-8, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23174700

RESUMO

The objective was to evaluate the presence and distribution of the lubricating and anti-adhesion glycoprotein lubricin and cells containing the contractile isoform smooth muscle α-actin (SMA) in pseudomembranes around loose hip prostheses. Periprosthetic tissue was obtained at revision arthroplasty of eight aseptic, loose hip implants, and for comparison three loose knee prostheses. Immunohistochemical analysis was performed in 3 zones: zone 1, within 300µm of the edge of the implant-tissue interface; zone 2, between zones 1 and 3; zone 3, within 300µm of the resected/trimmed edge. The presence of lubricin was extensive in all samples: (1) as a discrete layer at the implant-tissue interface; (2) within the extracellular matrix (ECM); (3) intracellularly. There was significantly more high grade (>50%) lubricin surface staining at the implant-tissue interface compared with the resected edge. While there was also a significant effect of location of high grade ECM lubricin staining, there was no significant effect of implant type (i.e. hip versus knee). All but two hip pseudomembrane samples showed the presence of many SMA-containing cells. There was a significant effect of location on the number of SMA-expressing cells, but not of implant type. These findings might explain why the management of loose prosthesis is so challenging.


Assuntos
Actinas/metabolismo , Glicoproteínas/metabolismo , Prótese de Quadril , Prótese do Joelho , Miofibroblastos/metabolismo , Miofibroblastos/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Matriz Extracelular/metabolismo , Humanos , Imuno-Histoquímica , Implantes Experimentais , Membranas/metabolismo , Membranas/patologia , Pessoa de Meia-Idade , Coloração e Rotulagem
15.
Orthop Clin North Am ; 43(4): 439-47, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23026459

RESUMO

Treatment failure and complications are encountered in 1% to 25% of all carpal tunnel releases. Besides hematoma, infection, skin necrosis, and intraoperative iatrogenic injuries, persistence and recurrence should be included in this discussion. Persistence is often related to incomplete release. Similar symptoms recurring after a symptom-free interval of 6 months are considered recurrent and may be caused by intraneural or perineural scarring. Adequate diagnosis and treatment of these failures can be challenging. Operative release is the main treatment consisting of complete decompression of the median nerve. In some circumstances, coverage of the median nerve may be necessary.


Assuntos
Síndrome do Túnel Carpal , Descompressão Cirúrgica , Complicações Intraoperatórias , Complicações Pós-Operatórias , Vasos Sanguíneos/lesões , Síndrome do Túnel Carpal/diagnóstico , Síndrome do Túnel Carpal/fisiopatologia , Síndrome do Túnel Carpal/cirurgia , Terapia Combinada , Descompressão Cirúrgica/efeitos adversos , Descompressão Cirúrgica/métodos , Descompressão Cirúrgica/reabilitação , Progressão da Doença , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/fisiopatologia , Complicações Intraoperatórias/terapia , Nervo Mediano/lesões , Nervo Mediano/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Recidiva , Reoperação/métodos , Avaliação de Sintomas , Fatores de Tempo , Falha de Tratamento , Nervo Ulnar/lesões , Nervo Ulnar/cirurgia
16.
J Biomed Mater Res B Appl Biomater ; 100(7): 1961-9, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22865664

RESUMO

Capsular contraction is the most common complication of breast reconstruction surgery. While presence of the contractile protein alpha smooth muscle actin (α-SMA) is considered among the causes of capsular contraction, the exact etiology and pathophysiology is not fully understood. The objective of this study was to investigate the possible role of lubricin in capsular formation and contraction by determining the presence and distribution of the lubricating protein lubricin in human breast tissue expander capsules. Related aims were to evaluate select histopathologic features of the capsules, and the percentage of cells expressing α-SMA, which reflects the myofibroblast phenotype. Capsules from tissue expanders were obtained from eight patients. Lubricin, at the tissue-implant interface, in the extracellular matrix, and in cells, and α-SMA-containing cells were evaluated immunohistochemically. The notable finding was that lubricin was identified in all tissue expander capsules: as a discrete layer at the tissue-implant interface, extracellular, and intracellular. There was a greater amount of lubricin in the extracellular matrix in the intimal-subintimal zone when compared with the tissue away from the implant. Varying degrees of synovial metaplasia were seen at the tissue-implant interface. α-SMA-containing cells were also seen in all but one patient. The findings might help us better understand factors involved in capsule formation.


Assuntos
Actinas/metabolismo , Implantes de Mama/efeitos adversos , Matriz Extracelular/metabolismo , Glicoproteínas/metabolismo , Miofibroblastos/metabolismo , Adulto , Idoso , Implante Mamário , Matriz Extracelular/patologia , Feminino , Humanos , Imuno-Histoquímica , Metaplasia/metabolismo , Metaplasia/patologia , Pessoa de Meia-Idade , Miofibroblastos/patologia
17.
Cartilage ; 3(2): 165-72, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26069629

RESUMO

OBJECTIVE: Lubricin is the principal boundary lubricant on articular cartilage. We aimed to describe the distribution of lubricin in the other articulating structures in the human knee and hip-menisci and labra-and to relate this distribution to the degree of tissue degeneration. METHODS: Eighteen menisci and 6 labra were obtained from patients with osteoarthritis undergoing total knee and total hip replacements, respectively. Macroscopically intact specimens were fixed in formalin and processed for H&E staining and immunohistochemical evaluation with an antilubricin monoclonal antibody. RESULTS: Lubricin was found in all tissues as a discrete layer on the tissue surface, within the extracellular matrix, and intracellularly, indicating that it plays a role in the tribology of these tissues in human subjects, and can be synthesized by cells within the tissues. While none of the samples displayed macroscopic tears, approximately 40% of the surface of the menisci and 80% of the surface of the labra displayed microscopic fibrillations and slight fraying. There was no effect of the degenerative changes on the distribution of lubricin. CONCLUSIONS: Lubricin coats nearly the entirety of the surfaces of menisci and labra, including microfibrillations and tears, with possible implications towards the tribology of the tissues and healing of tissue damage.

19.
Mol Vis ; 17: 3055-61, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-22162624

RESUMO

PURPOSE: Lubricin is a principal boundary lubricating and anti-adhesion protein found in synovial fluid and several musculoskeletal tissues. This study investigates the presence of lubricin in the meibomian gland, lacrimal gland and ocular surface of healthy rabbits; prompted by the hypothesis that lubricin acts as boundary lubricant and anti-adhesive protein in the eye. METHODS: Thirty six eyelids were resected from ten cadaveric New Zealand White rabbits and two eyeballs and two lacrimal glands from two of them. Thirty two samples from 8 animals were processed for immunohistochemical localization of lubricin using a purified monoclonal antibody and quantification of the lubricin-containing meibocytes. Confirmatory western blot analysis was performed on four eyelids from 2 animals. RESULTS: Lubricin-positive meibomian cells were seen in the glands in all eight animals evaluated immunohistochemically. The percentage of lubricin-positive cells ranged from was 8%-50% in the upper and 3%-50% in the lower eyelid, with no significant difference between the upper and lower eyelid. Western blot analysis confirmed the presence of lubricin ranging from 10 to 40 ng in four eyelids from the other two rabbits. Occasional staining was seen in the epithelium of the hair follicles of the eyelid. No lubricin was evident on the ocular surface or in the lacrimal gland. CONCLUSIONS: Lubricin is secreted by the meibomian gland. The results provide a basis for the hypothesis that lubricin plays a role in boundary lubrication and in preventing adhesions in the eye, as well as in contributing to other functions of the meibomian gland. Moreover, if lubricin functions to decrease the friction between the eyelid and ocular surface, this study provides a rationale to supplement the amount of lubricin in cases of compromised meibomian gland function and other conditions.


Assuntos
Glicoproteínas/biossíntese , Glândulas Tarsais/metabolismo , Animais , Western Blotting , Feminino , Glicoproteínas/metabolismo , Imuno-Histoquímica , Aparelho Lacrimal/fisiologia , Masculino , Coelhos , Líquido Sinovial/fisiologia
20.
Cell Tissue Res ; 346(2): 255-62, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22009294

RESUMO

Lubricin, a lubricating glycoprotein that facilitates tendon gliding, is upregulated by mechanical as well as biochemical stimuli, prompting this study of its induction by extracorporeal shockwave therapy (ESWT). The objective of this study was to characterize and quantify the effect of ESWT on lubricin expression in tendons and septa in a rat model. Hindlimbs of six rats were treated with low-dose ESWT and those of another six with high-dose ESWT, using contralateral limbs as controls. After 4 days, resected samples were processed for immunolocalization of lubricin using a purified monoclonal antibody. ESWT was found to increase lubricin expression in both low-dose and high-dose ESWT-treated tendons and also in septa. Lubricin expression generally increased with increasing dose of ESWT. Increased lubricin expression may contribute to the beneficial effects of ESWT in providing pain and symptom relief in musculoskeletal disorders by decreasing erosive wear.


Assuntos
Glicoproteínas/metabolismo , Ondas de Choque de Alta Energia , Membro Posterior/anatomia & histologia , Tendões/metabolismo , Animais , Matriz Extracelular/metabolismo , Membro Posterior/citologia , Membro Posterior/metabolismo , Espaço Intracelular/metabolismo , Masculino , Ratos , Ratos Sprague-Dawley , Coloração e Rotulagem , Tendões/citologia
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