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1.
Ann Vasc Surg ; 2020 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-32173472

RESUMO

BACKGROUND: Endovascular techniques have become an essential tool for treatment of thoracic aortic pathology (TEVAR). The objetive of this study is to analyze indications and results of TEVAR in Vascular Surgery Units, through a retrospective and multicentric national registry called Regis-TEVAR. METHODS: From 2012 to 2016, a total of 287 patients from 11 Vascular Surgery Units, treated urgently and electively, were recruited consecutively. The primary variables analyzed are mortality, survival and reintervention rate. The indications for TEVAR were also analyzed: aortic dissections, thoracic aneurysms, traumatisms and intramural hematomas or penetrating ulcers, as well as results and postoperative complications according to each indication. RESULTS: Of the 287 TEVAR performed (239 males, mean age 64.1 ± 14.1 years), 155 were due to aortic aneurysm (54%), 90 type B aortic dissection (31.4%), 36 traumatic aortic rupture (12. 5%) and 6 penetrating ulcers or intramural hematomas (2.1%). Overall mortality at 30 days was 11.5% (18.5% in urgent and 5.3% in elective), being higher in dissections (13.3%). The median actuarial survival was 73% at 4 years. The stroke rate was 3.1% and the rate of spinal cord ischemia 4.9%. Aortic reoperations were necessary in 23 patients (8.1%). CONCLUSIONS: This registry provides complete and reliable information on real clinical practice of TEVAR in Spain, with results similar to international series of open surgery. According to these data, TEVAR can be performed with acceptable morbidity and mortality and with low rates of postoperative complications.

2.
Surg Innov ; 27(2): 160-164, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31854238

RESUMO

Introduction. The high incidence of lactose intolerance leads us to consider that many of our patients could suffer from this alteration. Therefore, as its main sign (even when asymptomatic) is increased intestinal gas, patients recovering from a Nissen fundoplication have a significant probability of suffering from gas bloat syndrome. Materials and Methods. This prospective study was conducted from November 2012 to January 2017, we included all the patients who had been treated by the Nissen technique for gastroesophageal reflux disease with gas bloat syndrome detected during follow-up and tested positive for lactose intolerance. The study participants were then prescribed a lactose-poor diet to be followed for 3 months. The patients were asked to complete quality of life and symptomatology questionnaires before and after diet. The pre- and post-diet results were then compared. Results. The pre- and post-diet results showed statistically significant improvements in both questionnaires. Conclusion. Lactose intolerance may account for the symptoms presented by a significant number of patients with gas bloat syndrome following antireflux surgery; these patients could benefit from consuming a lactose-free diet, which we expect to alleviate or, in some cases, eliminate the above symptoms.

3.
Genome Res ; 29(12): 2073-2087, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31537640

RESUMO

The most widely appreciated role of DNA is to encode protein, yet the exact portion of the human genome that is translated remains to be ascertained. We previously developed PhyloCSF, a widely used tool to identify evolutionary signatures of protein-coding regions using multispecies genome alignments. Here, we present the first whole-genome PhyloCSF prediction tracks for human, mouse, chicken, fly, worm, and mosquito. We develop a workflow that uses machine learning to predict novel conserved protein-coding regions and efficiently guide their manual curation. We analyze more than 1000 high-scoring human PhyloCSF regions and confidently add 144 conserved protein-coding genes to the GENCODE gene set, as well as additional coding regions within 236 previously annotated protein-coding genes, and 169 pseudogenes, most of them disabled after primates diverged. The majority of these represent new discoveries, including 70 previously undetected protein-coding genes. The novel coding genes are additionally supported by single-nucleotide variant evidence indicative of continued purifying selection in the human lineage, coding-exon splicing evidence from new GENCODE transcripts using next-generation transcriptomic data sets, and mass spectrometry evidence of translation for several new genes. Our discoveries required simultaneous comparative annotation of other vertebrate genomes, which we show is essential to remove spurious ORFs and to distinguish coding from pseudogene regions. Our new coding regions help elucidate disease-associated regions by revealing that 118 GWAS variants previously thought to be noncoding are in fact protein altering. Altogether, our PhyloCSF data sets and algorithms will help researchers seeking to interpret these genomes, while our new annotations present exciting loci for further experimental characterization.

4.
Sci Rep ; 9(1): 11812, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31413291

RESUMO

Many generalist species are composed of individuals varying in the size of their realized niches within a population. To understand the underlying causes and implications of this phenomenon, repeated samplings on the same individuals subjected to different environmental conditions are needed. Here, we studied individual specialization of feeding strategies in breeding and non-breeding grounds of Cory's shearwaters (Calonectris borealis) for 2-8 years, and its relationship with fitness. Individuals were relatively flexible in non-breeding destinations, but specialized in diet, habitat use and daily activity across years. Daily activity was also consistent throughout the year for the same individual, suggesting that it is driven by individual constraints, whereas individual diet and habitat use changed between breeding and non-breeding grounds, indicating that these specializations may be learned at each area. Moreover, individuals that were intermediate specialized in their diet tended to show higher breeding success than those with weakly and highly specialized diets, suggesting stabilizing selection. Overall, this study suggests that the development of individual specialization is more flexible than previously thought, i.e. it emerges under specific environmental conditions and can develop differently when environmental conditions vary. However, once established, individual specialization may compromise the ability of individuals to cope with environmental stochasticity.

5.
Cir Cir ; 86(1): 15-23, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30951034

RESUMO

Introduction: Surgery is performed more frequently now at days, due to the increasing incidence of melanoma and no-melanoma skin cancer. There are different opinions among dermatologic surgeons between to continue or discontinue antithrombotic therapy prior to the procedure, which increases the risk of thromboembolic events. Prophylaxis with oral antibiotics in the postsurgical period is controversial. Objective: To report the safety of surgery without suspending antithrombotic therapy and without oral antibiotic prophylaxis in dermatology surgery of patients with multiple comorbidities and polypharmacy. Method: We designed a retrospective study. We included a total of 655 patients; 96.6% had at least one comorbidity; 27.7% used aspirin and 4.3% some type of antithrombotic therapy. The most common type of skin tumor was basal cell carcinoma with 69.8. Results: The complication rate was 4.2%; the most was wound dehiscence (1.1%), followed by partial necrosis (0.9%), infection (0.9%), reaction to foreign body (0.6%), complete necrosis (0.3%), bleeding (0.2%) and fistulae (0.2%). Conclusions: Based on the literature and our experience, dermatologic surgery is safe without suspending antithrombotic therapy or antibiotic prophylaxis in patients with multiple comorbidity.


Assuntos
Anticoagulantes/uso terapêutico , Melanoma/cirurgia , Inibidores da Agregação de Plaquetas/uso terapêutico , Complicações Pós-Operatórias/epidemiologia , Neoplasias Cutâneas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais , Humanos , Incidência , Masculino , Melanoma/complicações , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias Cutâneas/complicações , Fatores de Tempo , Adulto Jovem
6.
J Gastrointest Surg ; 23(5): 1030-1036, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30187327

RESUMO

INTRODUCTION: In the last 20 years, various procedures have been suggested for the treatment of anal fistula whilst minimising anal sphincter injury and preserving optimal function. Since 2011, patients at our hospital have been treated for anal fistula by means of platelet-rich fibrin plugs. To do so, three different application techniques have been used, the most recent of which is a non-surgical approach. In this paper, we compare and contrast the results obtained by each of these three techniques. MATERIAL AND METHOD: This study compares three procedures in which the anal fistula was sealed using platelet-rich fibrin: for the patients in group A, the plug was surgically inserted, under anaesthesia, and traditional methods were used to curette the fistula tract and close the internal orifice; for those in group B, the plug was surgically inserted, under anaesthesia, after curettage of the fistula tract using a graduated set of cylindrical curettes, and the internal orifice was closed as before; and for those in group C, the plug was inserted during outpatient consultation, without anaesthesia, without curettage and without closure of the internal orifice. RESULTS: The patients in the three groups were homogeneous in terms of sex, age, ASA classification, location of the fistula and previous insertion of the seton. There were no significant differences in morbidity or postoperative continence. However, there was a statistically significant difference in the outcomes achieved, in favour of group B, while groups A and C obtained similar results. CONCLUSIONS: Outpatient treatment of perianal fistula is totally innocuous. It is a very low cost procedure and the results obtained are highly acceptable (similar to those of the surgical insertion of a plug, with traditional curettage). Therefore, we believe this approach should be considered a valid initial treatment for perianal fistula, reserving surgical treatment (curettage and sealing using a cylindrical-curette kit) for cases in which this initial method is unsuccessful. This would avoid many complications and achieve considerable financial savings for the health system.

7.
Nucleic Acids Res ; 47(D1): D766-D773, 2019 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-30357393

RESUMO

The accurate identification and description of the genes in the human and mouse genomes is a fundamental requirement for high quality analysis of data informing both genome biology and clinical genomics. Over the last 15 years, the GENCODE consortium has been producing reference quality gene annotations to provide this foundational resource. The GENCODE consortium includes both experimental and computational biology groups who work together to improve and extend the GENCODE gene annotation. Specifically, we generate primary data, create bioinformatics tools and provide analysis to support the work of expert manual gene annotators and automated gene annotation pipelines. In addition, manual and computational annotation workflows use any and all publicly available data and analysis, along with the research literature to identify and characterise gene loci to the highest standard. GENCODE gene annotations are accessible via the Ensembl and UCSC Genome Browsers, the Ensembl FTP site, Ensembl Biomart, Ensembl Perl and REST APIs as well as https://www.gencodegenes.org.

8.
Cir. Esp. (Ed. impr.) ; 96(10): 627-633, dic. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-176530

RESUMO

Introducción: El hiperparatiroidismo (HPT) asociado al MEN 1 se caracteriza por ser una afectación multiglandular, no afectándose todas las glándulas en el mismo momento. Suele ser asintomático, aunque la afectación ósea es elevada en los pacientes jóvenes. Las tasa de recidiva y persistencias es de 25-35%. Los objetivos fueron: a) estudiar HPT-MEN 1; y b) analizar las variables relacionadas con la presencia o no de clínica y con la persitencia. Método: De 97 sujetos con MEN 1 diagnosticados en el HUVA, Murcia, pertenecientes a 16 familias, se han estudiado restrospectivamente 71 pacientes con afectación paratiroidea. Las variables estudiadas son: mutación, edad de diagnóstico, clínica, los valores de calcio, fóforo y PTHi, MIBI, técnica quirúrgica, valores de la PTHi y tasa de recidiva. Resultados: La edad media fue de 38 años, y 50 estaban asintomáticos en el momento del diagnóstico. La técnica quirúgica realizada fue: paratiroidectomía subtotal (n = 55), paratiroidectomía de 3 glándulas (n = 7) y resección de menos de 3 glándulas (n = 9). Se asoció timectomía transcervical en 53. El seguimiento medio ha sido de 102,9 meses. Se han encontrado 21 recidivas (10 cirugía incompleta). Encontramos una relación estadísticamente significativa entre: la edad de diagnóstico (p < 0,0005) y los valores elevados de calcio (p < 0,008) y la presencia de clínica en el momento del diagnóstico, la técnica quirúrgica incompleta (p < 0,003), no timectomía (p < 0,0001) y seguimiento (p < 0,001) y la recidiva tras la cirugía. Conclusión: La realización de screening genético y clínico nos permite un diagnóstico en fase asintomática y tratamiento precoz, evitando así complicaciones secundarias a la evolución del HPT. La tasa de recidiva del HPT en el MEN 1 es elevada, siendo los factores de recidiva el tiempo de seguimiento y la técnica quirúrgica realizada


Introduction: Primary hyperparathyroidism (pHPT) in MEN 1 is characterized by multiglandular disease and early involvement of parathyroid glands at different times. Persistence and recurrence range from 25%-35%. The purpose was: a) to describe the experience and the treatment of patients with pHPT in MEN 1; b) to analyze the variables related with clinical presentation and recurrence. Method: A total of 97 patients with MEN 1 were diagnosed in a tertiary hospital. A retrospective analysis was made in patients with pHPT (n = 71). Study variables: age at diagnosis, mutation, clinical presentation, laboratory tests, surgical technique, and recurrence of HPT. Results: Mean age was 38 years, and 50 patients were asymptomatic. The surgical technique was: subtotal parathyroidectomy (n = 55), resection of three glands (n = 7), and resection of less glands (n = 9). Transcervical thymectomy was performed in 53 patients. Mean follow-up was 102.9 months. There were 21 recurrences, There were correlations between age at diagnosis and serum calcium levels with the presence of symptoms (P < .0001). There were also correlations between recurrence and surgical technique (P < .03), non-association with thymectomy (P < .0001), and follow-up time (P < .03). Conclusion: Performing genetic and clinical screening allows us to make a diagnosis in the asymptomatic period and to provide early treatment for HPT in MEN 1. The recurrence rate is high, and follow-up time and the surgical technique used are risk factors for recurrence


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/etiologia , Timectomia/métodos , Paratireoidectomia/métodos , Neoplasia Endócrina Múltipla Tipo 1/epidemiologia , Neoplasia Endócrina Múltipla Tipo 1/secundário , Neoplasia Endócrina Múltipla/epidemiologia , Neoplasia Endócrina Múltipla/fisiopatologia , Procedimentos Cirúrgicos Endócrinos , Recidiva Local de Neoplasia/complicações , Neoplasia Endócrina Múltipla Tipo 1/genética
9.
Opt Lett ; 43(19): 4691-4694, 2018 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-30272716

RESUMO

Subwavelength grating (SWG) structures are an essential tool in silicon photonics, enabling the synthesis of metamaterials with a controllable refractive index. Here we propose, for the first time to the best of our knowledge, tilting the grating elements to gain control over the anisotropy of the metamaterial. Rigorous finite difference time domain simulations demonstrate that a 45° tilt results in an effective index variation on the fundamental TE mode of 0.23 refractive index units, whereas the change in the TM mode is 20 times smaller. Our simulation predictions are corroborated by experimental results. We furthermore propose an accurate theoretical model for designing tilted SWG structures based on rotated uniaxial crystals that is functional over a wide wavelength range and for both the fundamental and higher order modes. The proposed control over anisotropy opens promising venues in polarization management devices and transformation optics in silicon photonics.

10.
Cir. Esp. (Ed. impr.) ; 96(8): 466-472, oct. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-176648

RESUMO

La necesidad de cooperación sanitaria en países de bajo desarrollo es conocida y se implementa día a día. Sin embargo, la asistencia sanitaria quirúrgica en estos países, en el siglo XXI, es más discutida, y se encuentra por debajo de niveles deseables y con soluciones más complejas. Por otra parte, el número de cirujanos que buscan implicarse aumenta progresivamente. Se analizan las causas que originan estos bajos niveles de asistencia, como la falta de personal cualificado, fuga de profesionales, coste de la asistencia o la falta de cuantificación de las necesidades. Las oportunidades de mejora, como el hermanamiento institucional, las misiones quirúrgicas de corta duración o la realización de acciones dirigidas a la educación, evaluación, evidencia y formación son algunas de las posibilidades propuestas


The need for healthcare cooperation in low- and middle-income countries is known and is implemented day by day. However, the surgical sanitary assistance in these countries in the 21st century is very controversial, as it is still below desirable levels and entails complex solutions. On the other hand, the number of surgeons seeking to get involved is increasing progressively. We analyze the causes of the low levels of medical assistance, such as the lack of qualified personnel, the brain drain of surgeons, healthcare costs or the lack of quantified needs. Opportunities for improvement, such as institutional twinning, short-term surgical missions or activities aimed at education, evaluation, evidence and training, are some of the possibilities proposed


Assuntos
Humanos , Políticas e Cooperação em Ciência, Tecnologia e Inovação , Cooperação Internacional , Assistência à Saúde/organização & administração , Especialidades Cirúrgicas/tendências , Procedimentos Cirúrgicos Operatórios/tendências , Missões Médicas , Cooperação Técnica , Países Baixos , Voluntários
11.
Cir Esp ; 96(8): 466-472, 2018 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30173919

RESUMO

The need for healthcare cooperation in low- and middle-income countries is known and is implemented day by day. However, the surgical sanitary assistance in these countries in the 21st century is very controversial, as it is still below desirable levels and entails complex solutions. On the other hand, the number of surgeons seeking to get involved is increasing progressively. We analyze the causes of the low levels of medical assistance, such as the lack of qualified personnel, the brain drain of surgeons, healthcare costs or the lack of quantified needs. Opportunities for improvement, such as institutional twinning, short-term surgical missions or activities aimed at education, evaluation, evidence and training, are some of the possibilities proposed.


Assuntos
Cooperação Internacional , Procedimentos Cirúrgicos Operatórios , Países em Desenvolvimento , Humanos , Pobreza
12.
Heliyon ; 4(9): e00775, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30263971

RESUMO

Three-dimensional-porous scaffolds of bone graft substitutes play a critical role in both cell targeting and transplantation strategies. These scaffolds provide surfaces that facilitate the response of stem cells related to attachment, survival, migration, proliferation, and differentiation. Objective: The aim of this study was to evaluate the in vitro behavior of human dental pulp mesenchymal stem cells cultured on scaffolds of polylactic/polyglycolic acid with and without hydroxyapatite. Method: We performed an in vitro experimental study using dental pulp stem cells obtained from samples of premolars, molars. The cells were cultured on scaffolds with osteogenic differentiation medium. Cell proliferation, adhesion and cell differentiation to an osteoblastic linage in the biomaterial were evaluated at three different time points: 7, 15 and 30 days. Each experiment was performed in triplicate. Analysis of the data was performed with the Split Plot block and MANOVA model. Results: The differentiation capability of hDPSCs towards the osteoblast lineage was better in the scaffold of PLGA/HA at 7, 15 and 30 days, as indicated by the high expression of osteogenic markers RUNX2, ALP, OPN and COL-I, compared with differentiation in the PLGA scaffold. No statistically significant differences were found in cell adhesion between the two types of scaffolds. Conclusion: The PLGA/HA scaffold provided better physical and chemical signals, as judged by the ability of dental pulp stem cells to adhere, proliferate and differentiate toward the osteogenic lineage.

13.
Cir Esp ; 96(10): 627-633, 2018 Dec.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30056973

RESUMO

INTRODUCTION: Primary hyperparathyroidism (pHPT) in MEN 1 is characterized by multiglandular disease and early involvement of parathyroid glands at different times. Persistence and recurrence range from 25%-35%. The purpose was: a) to describe the experience and the treatment of patients with pHPT in MEN 1; b) to analyze the variables related with clinical presentation and recurrence. METHOD: A total of 97 patients with MEN 1 were diagnosed in a tertiary hospital. A retrospective analysis was made in patients with pHPT (n=71). STUDY VARIABLES: age at diagnosis, mutation, clinical presentation, laboratory tests, surgical technique, and recurrence of HPT. RESULTS: Mean age was 38 years, and 50 patients were asymptomatic. The surgical technique was: subtotal parathyroidectomy (n=55), resection of three glands (n=7), and resection of less glands (n=9). Transcervical thymectomy was performed in 53 patients. Mean follow-up was 102.9 months. There were 21 recurrences, There were correlations between age at diagnosis and serum calcium levels with the presence of symptoms (P<.0001). There were also correlations between recurrence and surgical technique (P<.03), non-association with thymectomy (P<.0001), and follow-up time (P<.03). CONCLUSION: Performing genetic and clinical screening allows us to make a diagnosis in the asymptomatic period and to provide early treatment for HPT in MEN 1. The recurrence rate is high, and follow-up time and the surgical technique used are risk factors for recurrence.


Assuntos
Hiperparatireoidismo Primário/complicações , Neoplasia Endócrina Múltipla Tipo 1/complicações , Adolescente , Adulto , Idoso , Feminino , Humanos , Hiperparatireoidismo Primário/cirurgia , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Adulto Jovem
14.
J Vis Surg ; 4: 93, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29963382

RESUMO

We present an alternative treatment to resolve lower gastrointestinal bleeding by the application of FloSeal, a haemostatic matrix. Fundamentally, the treatment consists of inserting the tube containing the Sengstaken-Blakemore probe impregnated with FloSeal into the rectum-sigma. This procedure is simple, easy to reproduce and can be very useful to control bleeding in the last section of the gastrointestinal tract.

15.
J Biosci Bioeng ; 126(6): 742-749, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30001876

RESUMO

Sewage sludge can be treated by anaerobic processes that frequently are followed by physical separation processes. In this work, a high-throughput sequencing technology, based on variation in the bacterial 16S rRNA gene, has been used to characterise the bacterial populations present in samples taken from different points of an industrial anaerobic digestion process fed with sewage sludge. Relative abundances of phyla and classes throughout the biological process and the subsequent separation steps were determined. Results revealed that the Bacteroidetes, Firmicutes and Proteobacteria phyla were the most representative. However, significant changes in relative abundance were detected along treatments, showing the influence of operational parameters on the distribution of microorganisms throughout the process. After anaerobic digestion, phylum Firmicutes doubled its relative abundance, which seems to indicate that the anaerobic conditions and the nutrients favoured its growth, in contrast to other phyla that almost disappeared. After centrifugation, Proteobacteria went preferentially to the solid phase, in contrast to Firmicutes which was the dominant phylum in the liquid phase. After decanting the liquid phase during 45 h, an important growth of Proteobacteria, Spirochaetes and Tenericutes was detected. At class level, only significantly changes were observed for Proteobacteria classes being α-proteobacteria dominant in the digestate, while γ-proteobacteria was the majority since this point to the final steps. To know the changes on the kind and abundance of microbial populations throughout the anaerobic and separation processes is very important to understand how the facilities design and operation conditions can influence over the efficiencies of next biological treatments.


Assuntos
Reatores Biológicos/microbiologia , Fermentação , Microbiota/fisiologia , Anaerobiose , Bactérias/citologia , Bactérias/genética , Bactérias/metabolismo , Bacteroidetes/citologia , Bacteroidetes/genética , Bacteroidetes/metabolismo , Centrifugação , Precipitação Fracionada , Hidrólise , Microbiota/genética , Proteobactérias/citologia , Proteobactérias/genética , Proteobactérias/metabolismo , RNA Ribossômico 16S/análise , RNA Ribossômico 16S/genética , Esgotos/microbiologia
17.
Pain Res Manag ; 2018: 7938492, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29849848

RESUMO

Introduction: Factors that contribute to swelling and trismus are complex, and they are originated by surgical trauma. The aim of the present study was to determine whether clinical and radiographic factors could predict the level of swelling and trismus after lower third molar surgery, through longitudinal approach. Methodology: A prospective longitudinal trial was carried out. Forty-five patients of both genders with clinical and radiographic diagnosis of asymptomatic mandibular impacted third molar and with no intake of analgesic or anti-inflammatory drugs 12 h prior to surgery were recruited and evaluated in a 72 h follow-up period. A mixed repeated measures model and backward and restricted maximal likelihood methods were used to analyze the data. Results: Male gender, body mass index (BMI), the relation to the lingual and buccal walls, and age were determinants for predicting postoperative swelling and for exerting a significant influence (P < 0.05). Conclusions: This study suggests the association of male gender, the relation to lingual and buccal walls, BMI, and age with measurement of swelling.


Assuntos
Edema/diagnóstico por imagem , Dente Serotino/cirurgia , Dor Pós-Operatória/diagnóstico por imagem , Radiografia/métodos , Dente Impactado/cirurgia , Trismo/diagnóstico por imagem , Adolescente , Adulto , Edema/etiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Medição da Dor , Dor Pós-Operatória/etiologia , Distribuição Aleatória , Trismo/etiologia , Adulto Jovem
18.
Int J Dermatol ; 57(8): 938-942, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29774953

RESUMO

BACKGROUND: Connective tissue autoimmune diseases (CTADs) constitute a group of conditions, including rheumatoid arthritis; systemic lupus erythematosus; mixed connective tissue disease; calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia (CREST) syndrome; scleroderma; dermatomyositis; and Sjögren syndrome. There are few studies on the alterations in filiform papillae in CTAD. Thus, the objective of this work was to determine whether there are changes in the macroscopic and dermoscopic patterns of filiform papillae. METHODS: This case-control study included patients who were diagnosed with CTAD. The dependent variable was the dermoscopic pattern of filiform papillae of the tongue, and the independent variables were age, gender, time of evolution, and current treatment. A photograph of the back of the tongue was taken, and subsequently, the same site was examined by dermatoscopy. The microscopic and dermoscopic patterns of filiform papillae were classified (Maeda). RESULTS: We included 50 cases and 50 controls, 94% of whom were female. The mean age was 43.96 ± 14.65 years. Of the cases with CTAD, 25% presented with a normal macroscopic pattern, versus 36% (18) with pattern II, 12% (6) with pattern III, and 20% (10) with pattern IV. The dermoscopic pattern was type I in 23 cases (46%), type II in 16 (32%), type III in 10 (20%), and type IV in one patient (2%). CONCLUSIONS: We have noted alterations in filiform papillae in CTADs, which emphasizes the importance of a detailed intraoral exploration and the macroscopic and dermoscopic evaluation of the dorsum of the tongue, specifically the filiform papillae.


Assuntos
Doenças Autoimunes/diagnóstico por imagem , Doenças do Tecido Conjuntivo/diagnóstico por imagem , Dermoscopia , Língua/diagnóstico por imagem , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
19.
Cir Cir ; 86(1): 20-28, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-29681629

RESUMO

Introduction: Surgery is performed more frequently now at days, due to the increasing incidence of melanoma and no-melanoma skin cancer. There are different opinions among dermatologic surgeons between to continue or discontinue antithrombotic therapy prior to the procedure, which increases the risk of thromboembolic events. Prophylaxis with oral antibiotics in the postsurgical period is controversial. Objective: To report the safety of surgery without suspending antithrombotic therapy and without oral antibiotic prophylaxis in dermatology surgery of patients with multiple comorbidities and polypharmacy. Method: We designed a retrospective study. We included a total of 655 patients; 96.6% had at least one comorbidity; 27.7% used aspirin and 4.3% some type of antithrombotic therapy. The most common type of skin tumor was basal cell carcinoma with 69.8% . Results: The complication rate was 4.2%; the most was wound dehiscence (1.1%), followed by partial necrosis (0.9%), infection (0.9%), reaction to foreign body (0.6%), complete necrosis (0.3%), bleeding (0.2%) and fistulae (0.2%). Conclusions: Based on the literature and our experience, dermatologic surgery is safe without suspending antithrombotic therapy or antibiotic prophylaxis in patients with multiple comorbidity.


Assuntos
Anticoagulantes/efeitos adversos , Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/cirurgia , Melanoma/cirurgia , Inibidores da Agregação de Plaquetas/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Neoplasias Cutâneas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibioticoprofilaxia , Anticoagulantes/uso terapêutico , Comorbidade , Feminino , Humanos , Incidência , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/uso terapêutico , Hemorragia Pós-Operatória/induzido quimicamente , Hemorragia Pós-Operatória/epidemiologia , Estudos Retrospectivos , Deiscência da Ferida Operatória/epidemiologia , Tromboembolia/epidemiologia , Tromboembolia/prevenção & controle , Adulto Jovem
20.
Ann Vasc Surg ; 50: 140-147, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29455010

RESUMO

BACKGROUND: The acute aortic arch angle and narrow aortic diameter in young patients may lead to bird-beak configuration and excessive oversizing of the stent graft in thoracic endovascular aortic repair (TEVAR) for blunt traumatic thoracic aortic injury (BTTAI). Little is known about the association of these factors and complications in long-term follow-up. We evaluated the long-term outcomes in terms of complications, reinterventions, and survival, focusing on the effects of bird-beak configuration and oversizing. METHODS: This prospective cohort study included patients who underwent TEVAR for BTTAI in our department between October 1999 and January 2015. The main outcomes were migration, collapse, intragraft mural thrombus, reintervention, and survival and their association with oversizing and bird-beak configuration. RESULTS: Thirty-four patients were included. Median age was 36 years, and 21% were women. Mean graft oversizing was 19% (range: 8-27%) at the proximal end and 27% (range:, -20% to 50%) at the distal end. Mean follow-up was 98 months (12-198 months). Seven patients presented intragraft mural thrombus, one of whom developed an occlusive parietal thrombosis 1 year after the procedure. Four patients (9%) required reintervention: postoperative revascularization of the left subclavian artery in 2 cases and aortic reinterventions in 2 others. No migration or mortality was seen during follow-up. Bird-beak configuration was seen in 65%: the mean protrusion extension was 16 mm (standard deviation [SD]: 7.4 mm) and the mean angle was 51° (SD: 16°). The association between the complications and bird beak was not statistically significant. Patients with complications had significantly higher proximal end oversizing (23%) than the group with no complications (17%) (P = 0.0007). CONCLUSIONS: TEVAR for BTTAI shows good results in the long-term follow-up. Complications in our series seemed related to proximal end oversizing. Thoracic stent grafts with a smaller diameter should be available in all trauma centers to avoid excessive oversizing.


Assuntos
Aorta Torácica/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Desenho de Prótese , Stents , Traumatismos Torácicos/cirurgia , Lesões do Sistema Vascular/cirurgia , Ferimentos não Penetrantes/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/lesões , Aorta Torácica/fisiopatologia , Aortografia/métodos , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Retratamento , Estudos Retrospectivos , Fatores de Risco , Traumatismos Torácicos/diagnóstico por imagem , Traumatismos Torácicos/mortalidade , Traumatismos Torácicos/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/fisiopatologia , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/mortalidade , Ferimentos não Penetrantes/fisiopatologia , Adulto Jovem
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