Two-stage hybrid open-endovascular repair of a Crawford type IV aortic aneurysm: therapeutic challenge / Tratamento híbrido (debranching) de aneurisma tóraco-abdominal tipo IV de Crawford: desafio terapêutico

We present a case of a patient with Crawford type IV aortic thoracoabdominal aneurysm. The patient underwent hybrid repair in two stages. Initially a Dacron(r) graft was implanted surgically with revascularization of all visceral branches from the left external iliac artery (debranching). On a later date, the second stage of treatment was with an endovascular technique with bi aorto-iliac endoprosthesis. After 2 years the patient remains asymptomatic and in full working activity...

Apresentamos o caso de um paciente com aneurisma aórtico tóraco-abdominal tipo IV de Crawford submetido à correção híbrida em dois estágios. Inicialmente submetido a implante cirúrgico de prótese de Dacron® com revascularização de todos os ramos viscerais a partir da ilíaca externa esquerda (debranching) e, posteriormente, tratado pela técnica endovascular com endoprótese aorto bi-ilíaca. Após dois anos, o paciente permanece assintomático e em plena atividade laborativa...

Endovascular treatment of iatrogenic penetrating trauma of the carotid artery: case report / Tratamento endovascular de trauma penetrante iatrogênico de artéria carótida: relato de caso

Carotid trauma demands early diagnosis and treatment. Open repair may be technically challenging if the trauma is at the base of the neck. We present a case of iatrogenic penetrating carotid trauma caused by insertion of a hemodialysis catheter. Treatment was accomplished by placement of a covered stent-graft in the common carotid artery, covering the puncture site. This case suggests that placement of a covered stent-graft is a good option for treatment of iatrogenic injury to the carotid artery...

O trauma da carótida exige diagnóstico e tratamento precoces. O tratamento convencional pode ser tecnicamente desafiador se o trauma penetrante for na base do pescoço. Apresentamos um caso de trauma penetrante da carótida associado ao implante iatrogênico de um cateter para hemodiálise. O tratamento foi realizado através da colocação de uma endoprótese na artéria carótida comum, cobrindo o local da punção. Este caso sugere que a colocação de uma endoprótese é uma boa opção para o tratamento de lesão iatrogênica da artéria carótida...

Avaliação funcional dos pacientes portadores de sarcomas ósseos submetidos à tratamento cirúrgico utilizando a endoprótese total ou parcial, na substituição da extremidade distal do fêmur / Functional assessment of patients with bone sarcomas submitted to surgical treatment using total or partial prosthesis in replacement of the distal femoral end

OBJETIVO: O Osteosarcoma e o Sarcoma de Ewing são as principais neoplasias malignas primárias ósseas, que acometem indivíduos menores de 15 anos. O objetivo deste estudo é comparar, retrospectivamente, os resultados funcionais dos pacientes submetidos à ressecção da extremidade distal do fêmur e à reconstrução com endoprótese não convencional, total ou parcial, do joelho. MÉTODOS: Foram analisados 26 pacientes portadores de sarcomas ósseos da extremidade distal do fêmur, acompanhados no Centro Infantil Boldrini, no período de 1990 a 2003. Vinte e quatro eram portadores de Osteossarcoma e 2 de Sarcoma de Ewing. O sistema de avaliação foi o proposto por Enneking (1987), preconizado pela Musculoskeletal Tumor Society. Para a comparação das médias entre cada critério e também entre os escores finais, utilizou-se o teste de Wilcoxon, com erro alfa de 5 por cento. RESULTADOS: A idade variou de 5 a 17 anos, média=11,9 anos. A predominância foi no sexo feminino (61,5 por cento). Na avaliação funcional, a comparação entre as médias de cada critério, foi encontrada diferença estatisticamente significativa somente relacionada ao item estabilidade (p=0,0037). Nos demais critérios, não foi observado diferença estatisticamente significativa: movimento (p=0,7546), dor (p=0,4848), deformidade (p=0,8695), força (p=1,0000), atividade funcional (p=0,9127) e resultado funcional (p=0,5866). CONCLUSÕES: O escore final global da avaliação funcional não apresentou diferença estatisticamente significativa (p=0,6027). O tipo de endoprótese utilizado para reconstrução do fêmur não interferiu nos resultados funcionais dos pacientes.

OBJECTIVES: Osteosarcoma and Ewing's sarcoma are the most common malignant primary bone tumors in individuals under the age of 15 years. The purpose of the study is to retrospectively compare functional outcomes of patients submitted to resection of the distal femoral end and to reconstruction with total or partial non-conventional prosthesis of the knee. METHODS: We assessed 26 patients with bone sarcomas in the distal femoral end treated at the Boldrini's Children Center between 1990 and 2003. Twenty-four presented with Osteosarcoma and two had Ewing's sarcoma. The assessment system employed was the one proposed by Enneking (1987) as recognized by the Musculoskeletal Tumor Society. For the statistical analysis between the criteria and final scores, we have used the Wilcoxon test, with an alpha error of 5 percent. RESULTS: Ages ranged from 5 to 17 years, (mean: 11 years and 9 months); with prevalence being higher in females (61.5 percent). The only statistically significant difference found in this study was concerned to stability (p=0.0037). No statistical significance was found on any other criteria such as movement (p=0.7546), pain (p=0.4848), deformity (p=0.8695), strength (p=1.0000), functional activities (p=0.9127) and final functional outcome (p=0.5866). CONCLUSIONS: The overall functional end score did not show statistically significant differences (p=0.6027). The type of prosthesis for femoral reconstruction did not affect patients' functional outcomes.

Efecto del ejercicio físico sobre las prótesis articulares / Effect of physical exercise on articular prostheses

El individuo adulto que tiene una artrosis grave de rodilla o cadera presenta dolor e incapacidad para la actividad física, lo que puede interferir con las actividades de la vida diaria. En ocasiones el tratamiento conservador no es suficiente para mejorar esta patología, por lo que la cirugía puede proporcionar mejoras sustanciales en estos pacientes. La sustitución protésica de rodilla y cadera son los procedimientos quirúrgicos que se practican de forma más habitual en los hospitales de Cirugía Ortopédica y Traumatología en España. Representan una clara mejoría en la sintomatología y calidad de vida de estos pacientes. En general el éxito del resultado depende de la selección del paciente y de sus expectativas, de la técnica, del diseño de los componentes, de la rehabilitación y de la prevención de las complicaciones. Los resultados de las artroplastias de sustitución se han estudiado utilizando parámetros o escalas que analizan el dolor, la función, los hallazgos radiológicos, la calidad de vida e incluso su coste-efectividad. Muy poco se ha analizado sobre el ejercicio y la actividad física tras una artroplastia de sustitución. El objetivo de este trabajo es realizar una revisión de las recomendaciones de ejercicio físico tras una prótesis total de cadera o rodilla y cuáles son esos conocimientos científicos y biomecánicos que justifican dichas recomendaciones (AU)

Rodillas protésicas. Clasificación e indicaciones clínicas / Prosthitic knees. Clasification and clinical prescription

La rodilla protésica es uno de los elementos claves en el diseño de las prótesis modulares y la aparición de nuevos mecanismos junto con la proliferación de rodillas ha complicado su clasificación y prescripción. En este trabajo revisamos los distintos mecanismos de rodillas, los agrupamos según su mecanismo de acción y proponemos al lector una guía orientativa para su prescripción. Para ello hemos realizado una revisión bibliográfica en la base de datos médica Medline y hemos recabado información de la industria ortoprotésica. Para aquellos puntos en que no existen criterios firmes exponemos el criterio que seguimos según nuestra experiencia (AU)

Estudo biomecânico em flexão da coluna cervical de cadáveres humanos submetida à corpectomia e estabilização com enxerto de fíbula / Cervical spine flexion biomechanical study in cadaver submitted to resection of vertebral body and stabilization with fibular graft

Este estudo apresenta e discute os resultados da análise biomecânica, radiográfica e anatômica de 20 peças de coluna cervical de cadáveres humanos, submetidas à corpectomia de C5, discectomia adjacente e estabilização com enxerto de fíbula. Os ensaios em flexão foram realizados em Máquina Universal de Testes. Nenhuma fratura ou extrusão do enxerto foi observada. A falha mecânica ocorreu na interface corpo vertebral-enxerto fibular, caracterizada por fratura dos corpos vertebrais adjacentes em 11 experimentos e afundamento da esponjosa em nove. O ligamento longitudinal posterior e o complexo ligamentar posterior não foram lesados em nenhuma das peças. Concluem que, em estudo experimental, o enxerto de fíbula é resistente e proporciona estabilidade imediata à coluna cervical quando submetido a carga em flexão.

Colocación de prótesis metálica recubierta autoexpandible Wallstent en la paliación de estenosis maligna de esofagoyeyunoanastomosis secundaria a recidiva de cáncer de la unión esofagogástrica / Malignant stenosis of the proximal digestive tract colocation of self-expanding metallic Wallstent protesis

Desde 1992 se ha intentado el tratamiento paliativo de las estenosis malignas del tubo digestivo proximal en el cáncer esofágico gástrico, duodenal inoperable en la recidiva post-quirúrgica o por invasión adyacente con signo de obstrucción del tubo digestivo proximal con colocación de prótesis metálica autoexpandible con buenos resultados y bajos índices de morbilidad, por lo cual nosotros presentamos un caso de cáncer de la unión esofagogástrica tratado con colocación de prótesis metálica Wallstent

Reabilitação óculo-palpebral sobre implantes osseointegrados / Oculo-palpebral rehabilitation upper osseointegrated implants

O uso de implantes osseointegrados nas reconstruções faciais tem encontrado bastante aceptividade, visto que as próteses faciais retidas por implantes oferecem muitas vantagens em relação às próteses retidas com adesivos convencionais: O implante oferece retenção e estabilidade à prótese, eliminando a necessidade de adesivos e removedores, consequentemente, aumentando o tempo de vida útil da peça protética. Somando-se à estas vantagens, temos o fácil posicionamento da prótese que é mais leve do que as convencionais. Neste caso clínico, os autores descrevem a confecção de uma prótese orbital retida por implantes num paciente de 68 anos que sofreu a exenteração da órbita direita em decorrência de um carcinoma escamo-celular

The effect of prosthetic rehabilitation in lower limb amputees.

The objectives of this project were to ascertain whether, to date, the views concerning the determination of prosthetic candidacy have been optimal and whether the training methods applied have been effective and have resulted in constant use of the prosthesis after conclusion of the training programme. Secondly it was intended to set up guidelines for future budgeting as well as providing a reference framework for the process of rehabilitation. An inquiry based on questionnaires was the first phase in a quality assurance project carried out among 29 amputees trained in 1990 and 1991. The result of the inquiry was that rehabilitation using PTB prostheses for 19 trans-tibial amputations in 18 cases (one patient was a bilateral trans-tibial amputee) led to constant use of the prosthesis and that advanced age was no hindrance to constant use in this group. For 10 trans-femoral amputees the inquiry revealed that advanced age combined with problems of donning the prosthesis was a hindrance to constant use in two cases. It is concluded that there is a need for testing/developing new types of femoral prostheses. The patients' evaluation of the rehabilitation process and their prostheses stresses the need for communication between the team of professionals and the patients in the decision process concerning the provision of a prosthesis as well as the provision of complete information on the patients' future functional possibilities. Qualitative measurements must include the kind and number of medical complications and the social conditions of the amputee as well as tests of physical and mental resources.

A device for long-term ambulatory monitoring in trans-tibial amputees.

Long-term monitoring of walking in trans-tibial amputees (TTA) is considered important for prosthetic prescription and therapy evaluation. The purpose of this study was to develop a device with the following design criteria: lightweight, easy attachment to the prosthesis, energy and memory capacity for five days and practical in clinical use. The prototype (CAMP: Continuous Ambulatory Monitoring of Prosthetic walking) consists of a cylindrical unit containing an accelerometer, a miniature computer and six batteries. Specifications, data acquisition and processing, instructions for users and first results are presented and discussed. The CAMP prototype proved to be a useful device for measuring relevant aspects of prosthetic use for up to five days.

Face: possibilidade de reconstruçäo protética: relato de um caso / Face: possibility of prosthetics reconstruction: report of one case

Os autores relatam um caso de deformidade facial decorrente de cirurgia oncológica com reconstruçäo protética. Para essa reconstruçäo foi realizada uma prótese óculo-palpebro-maxilo-nasal e uma prótese total obturadora palatina. As próteses foram fixadas através de retençäo magnética

Acute prosthetic replacement for severe fractures of the proximal humerus.

Nineteen patients with 20 severe proximal humeral fractures were treated early with a Neer humeral prosthesis from 1979 to 1986. There were 18 four-part and two three-part fractures. The average age of the patients at the time of injury was 64 years. Follow-up evaluation was performed at an average of 40 months. Pain relief was satisfactory in 18 of 20 fractures. Patients were satisfied with the result in 16 of the 20 shoulders. Functional evaluation was good or fair in 15 of 20 patients. Active forward elevation averaged 72 degrees and active external rotation 16 degrees. Complications consisted of one axillary nerve palsy, one postoperative posterior dislocation, loosening of one uncemented humeral prosthesis, and one breakage of fixation wire requiring subsequent removal. Patients who could not comply with the postoperative rehabilitation program had poor results. Poor function appeared to be directly related to lack of rotator cuff integrity. Surgical techniques designed to securing tuberosity union are essential.

O idoso submetido à amputaçäo de membros inferiores e as alteraçöes nas atividades da vida diária / Aged patient submited to amputation of their lower limbs

O presente estudo é parte da monografia de Diogo12 e tem por objetivo verificar as alteraçöes identificadas nos idosos submetidos à amputaçäo de membros inferiores em relaçäo as atividades da vida diária. Os dados foram coletados junto a 25 pacientes internados e de ambulatório, de um hospital universitário governamental. A análise dos resultados nos sugere que as alteraçöes referidas pelos pacientes submetidos à amputaçäo há menos de 10 dias coincidem com as referidas pelos idosos que tiveram membros amputados há um mês ou mais nos itens relacionados à higiene corporal e locomoçäo.

Protesis testicular de acrílico / Acrilic testicular prosthesis

Se presenta la experiencia del Servicio de Cirugía Pediátrica del Hospital Gustavo Fricke en el uso de Prótesis Testiculares de Acrílico (PTA), en los últimos 15 años. Se revisaron las historias clínicas de 45 pacientes a los que se les instaló un total de 55 prótesis. Se comparan los resultados obtenidos con los entregados por la literatura. Recomdamos el uso de las PTA durante la edad pediátrica, mientras el paciente tiene la edad suficiente para recibir una prótesis de adulto. Además, la aconsejamos por su fácil fabricación, buena tolerancia y bajísimo costo, lo que la hace accequible a los pacientes hospitalarios

Plastica de las piernas / Plastic of the legs

El autor relata su experiencia en la cirugia estetica de las piernas para el contorno inestetico de las llamadas "piernas delgadas" debido a las hipotrofias de los musculos gastrocnemios y musculos de la fase interna de los muslos. Protesis de silicona-gelatinosa son implantadas debajo del aponeurosis o sobre el musculo. La tecnica es simple y presentada en sus detalles. El autor utiliza un instrumental especial que facilita y ayuda en la diseccion y colocacion de las protesis realizada por medio de una pequena incision de 2,5 cm. en la region politea o en la linea subglutea. se logra asi un aspecto mas armonioso del contorno de las piernas.

The Jaipur foot: the best option for the West Indian amputee - abstract

The amputation rate at the Port-of-Spain General Hospital has doubled over the last 10 years from 114 and 102 in 1979 and 1980 to 274 and 225 in 1988 and 1989. The majority of the amputees are not able to work again because of the unavailability of a suitable prosthesis and physical and psychological rehabilitation are severely compromised. In order to overcome this, we decided to carry out a programme of fitting of prostheses. Of 200 amputees who were assessed 92 were fitted with prostheses, 60 (65 percent) above and 32 (35 percent) below the knee. Most were diabetics ranging in age from 18 to 62 years with a M:F ratio of 1.2:1. The Jaipur foot prosthesis was chosen for its light weight (about 2 kg), low cost (US$8 - $18), and good features (waterproof, well ventilated, good grip, shock absorbent, flexible and cosmetic appearance). Four patients returned for minor adjustments to the stump/socket interface and 90 percent expressed extreme satisfaction with their prosthesis. The Jaipur foot prosthesis seems ideal for West Indian amputees and there is a strong case for an on-going well co-ordinated programme involving trained technicians, physiotheraptists and surgeons to address the needs of the large amputee population in Trinidad and Tobago (AU)_

Acquired limb loss in patients with traumatic brain injury.

The outcome associated with long-term prosthetic use was evaluated in 12 patients who had a dual disability of severe traumatic brain injury and an extremity amputation. The incidence and nature of complications after limb loss was also reviewed. The 12 patients sustained 15 extremity amputations. Lower extremity amputations were the most common disability. Fifty percent of the patients had at least one postoperative complication after amputation. All patients (100%) had at least one complication documented on rehabilitation admission. No patient was using a prosthesis at the time of rehabilitation admission. At discharge six patients were able to use a prosthesis. Only one patient was considered independent. Patient follow-up averaged 28.6 months. At long-term follow-up six patients were using a prosthesis. Four were considered independent. One-third of the total group was considered able to use the prosthesis independently in the community. Of the lower extremity amputated population, only 40% became ambulatory. This is considerably less than can be expected to become ambulatory if there was no amputation. All three upper extremity amputees did not use a prosthesis. All efforts should be directed at salvaging a limb threatened by amputation after survival of traumatic brain injury. Early transfer to a facility specializing in traumatic brain injury rehabilitation may decrease complications, reduce total hospitalization and improve overall functional ability.