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1.
Medicine (Baltimore) ; 98(41): e17547, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593135

RESUMO

RATIONALE: Leakage of bone cement from femoral medullary cavity is a rare complication after hip arthroplasty, and there is no report on the leaked bone cement entering into iliac vessels. PATIENT CONCERNS: An 89-year-old woman presented with a fracture in the right femoral neck. She had well-fixed right femoral head replacement after careful preoperative examinations, and no adverse reactions appeared. She was able to get off bed to walk at the 2nd day after surgery. DIAGNOSES: Postoperative radiograph showed leakage of bone cement into the joint through femoral medullary cavity entering into iliac vessels, but the patient complained no discomforts. She received a treatment with low-molecular weight heparin and rivaroxaban. OUTCOMES: The patient was able to walk with normal gait, without swelling in both lower extremities and discomfort in the hip. There was no other complication concerning intravascular foreign bodies. LESSONS: This case calls into the phenomenon of leakage of injected bone cement in femoral head replacement regardless of complete and nonfractured femur, which may be into the lower limb and pelvic veins, given that, dangerous consequences will not occur.


Assuntos
Artroplastia de Quadril/efeitos adversos , Cimentos para Ossos/efeitos adversos , Cabeça do Fêmur/cirurgia , Veia Ilíaca/patologia , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Inibidores do Fator Xa/uso terapêutico , Feminino , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Veia Ilíaca/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Radiografia/métodos , Rivaroxabana/uso terapêutico , Resultado do Tratamento
2.
BMC Musculoskelet Disord ; 20(1): 372, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412841

RESUMO

BACKGROUND: This study aimed to investigate the risk factors for mechanical failure of cement spacers and the impact on hip function after two-stage exchange arthroplasty for periprosthetic joint infection (PJI). METHODS: Thirty-one patients (19 males and 12 females) with hip PJIs underwent resection arthroplasty and implantation of cement spacers from January 2014 to December 2015. Patients who encountered spacer-associated mechanical complications in the interim period (14 of 31) were compared with those without complications (17 of 31). Complications were defined as spacer dislocation, spacer fracture, spacer fracture with dislocation, and femoral fracture during or following spacer implantation. Hip functional outcome was assessed using the Harris hip score (HHS). Treatment success was defined according to the following criteria: (1) no symptoms or signs indicative of infection; (2) no PJI-related mortality; and (3) no subsequent surgical intervention for infection after reimplantation surgery. Multivariate logistic regression and Kaplan-Meier survival curves were used for analysis. RESULTS: Fourteen patients (14/31 = 45%) suffered at least one spacer-related complication within the interim period. The development of spacer complications was associated with a younger age (odds ratio [OR] 0.91, 95% confidence interval [CI] 0.83-1.00, p = 0.045) and chronic PJI (OR 14.7, 95% CI 1.19-182, p = 0.036). Patients with spacer complications also had a lower median HHS (37 vs. 60, p < 0.001) before reimplantation in comparison to those without spacer complications. After reimplantation, the two groups had a similar median HHS (90 vs. 89, p = 0.945). Two patients did not undergo reimplantation due to extensive comorbidities, and subsequently retained the antibiotic spacer for definitive treatment. The 2-year treatment success rate was 84.6% in the spacer-complication group and 87.5% in the non-spacer-complication group (p = 0.81). CONCLUSION: There was a high complication rate for articulating PMMA spacers during the interim period of two-stage revision total hip arthroplasty. A young age and chronic infection were the primary risk factors associated with mechanical complications. Patients at high risk of spacer-related mechanical complications should be advised accordingly by surgeons. Knowing the possible risk factors, surgeons should educate patients thoroughly to avoid spacer complications, thereby increasing patient satisfaction in the interim stage. LEVEL OF EVIDENCE: Prognostic Level III.


Assuntos
Artroplastia de Quadril/efeitos adversos , Cimentos para Ossos/efeitos adversos , Prótese de Quadril/efeitos adversos , Falha de Prótese , Infecções Relacionadas à Prótese/cirurgia , Fatores Etários , Idoso , Artroplastia de Quadril/instrumentação , Artroplastia de Quadril/métodos , Doença Crônica , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Polimetil Metacrilato/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/mortalidade , Reoperação/efeitos adversos , Reoperação/instrumentação , Reoperação/métodos , Fatores de Risco , Resultado do Tratamento
3.
World Neurosurg ; 132: e739-e745, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31415893

RESUMO

OBJECTIVE: To evaluate and compare clinical outcomes and cement leakage of high-viscosity bone cement versus low-viscosity bone cement vertebroplasty in treating osteoporotic vertebral compression fractures with intravertebral cleft. METHODS: The study included 72 patients with osteoporotic vertebral compression fractures with intravertebral cleft, who were divided into high-viscosity cement (HVC) (38 cases) and low-viscosity cement (LVC) (34 cases) groups according to the viscosity of bone cement used. Cement leakage, visual analog scale score, Oswestry Disability Index, and kyphotic angle (KA) were evaluated. RESULTS: All patients were followed for at least 12 months. Overall cement leakage rate was 18.4% in the HVC group, lower than the rate of 61.8% obtained in the LVC group. A statistically significant difference was found in the overall cement leakage rate between the groups (P < 0.05). Visual analog scale and Oswestry Disability Index scores were significantly improved after percutaneous vertebroplasty without significant differences between the HVC and LVC groups (P > 0.05). The KA of patients from both groups was also significantly corrected immediately after surgery. Although the KA gradually increased in both groups during the follow-up period, there was no statistically significant difference between the HVC and LVC groups in KA during follow-up (P > 0.05). CONCLUSIONS: Percutaneous vertebroplasty using HVC to treat osteoporotic vertebral compression fractures with intravertebral cleft significantly reduces cement leakage and improves the safety of the operation. In terms of clinical efficacy and prevention of augmented vertebral recollapse, HVC may not have obvious advantages.


Assuntos
Cimentos para Ossos/uso terapêutico , Fraturas por Compressão/cirurgia , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Coluna Vertebral/cirurgia , Vertebroplastia/métodos , Idoso , Idoso de 80 Anos ou mais , Cimentos para Ossos/efeitos adversos , Avaliação da Deficiência , Feminino , Fraturas por Compressão/diagnóstico por imagem , Humanos , Masculino , Fraturas por Osteoporose/diagnóstico por imagem , Medição da Dor , Dor Pós-Operatória/epidemiologia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fraturas da Coluna Vertebral/diagnóstico por imagem , Resultado do Tratamento , Vertebroplastia/efeitos adversos , Viscosidade
4.
J Orthop Surg Res ; 14(1): 228, 2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31324196

RESUMO

OBJECTIVE: Vertebroplasty is the most widely used method for treating osteoporotic vertebral compression fractures (OVCF). During this procedure, bone cement is injected into the vertebral body. Fracture and additional fractures can occur adjacent to the treatment site. Thus, we studied factors causing such vertebral fractures after vertebroplasty and calculated the appropriate amount of bone cement to inject. METHODS: From September 2012 to March 2016, 187 patients with OVCF undergoing vertebroplasty were selected, and 112 patients with complete follow-up information were selected. Of these, 28 had adjacent vertebral fractures (refracture group) during the follow-up period, and 84 patients had no adjacent vertebral fractures (control group). Then, sex, age, body weight, bone mineral density (BMD), and bone cement injection (bone cement injection volume and bone fracture vertebral volume percent) were compared. RESULTS: All patients had significant pain relief within 24 h (preoperative and postoperative [24 h later] VAS scores were 7.4 ± 0.8 and 2.3 ± 0.5, respectively). The age and weight were not statistically significantly different (P > 0.05). BMD values were statistically significantly different between groups as was sex (P < 0.05). CONCLUSIONS: Bone cement injection volume, BMD values, and sex were statistically significantly related to adjacent vertebral fractures after vertebroplasty, and cement injection volumes exceeding 40.5% caused adjacent vertebral fractures.


Assuntos
Cimentos para Ossos/efeitos adversos , Fraturas por Osteoporose/cirurgia , Complicações Pós-Operatórias/etiologia , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/cirurgia , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/lesões , Vértebras Lombares/cirurgia , Masculino , Fraturas por Osteoporose/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Fatores de Risco , Fatores Sexuais , Fraturas da Coluna Vertebral/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/lesões , Vértebras Torácicas/cirurgia , Resultado do Tratamento , Vertebroplastia/tendências
6.
Dtsch Med Wochenschr ; 144(15): 1069-1073, 2019 08.
Artigo em Alemão | MEDLINE | ID: mdl-31350751

RESUMO

HISTORY AND CLINICAL FINDINGS: Emergency admission of a 66-years-old man with right-sided and partly breath-dependent chest pain in the interdisciplinary emergency room. The complaints existed for several days and had a progressive character. Purulent expectoration and fever were negated. There was a history of COPD with occasional pulmonary exacerbations. Several weeks before the current event, community-acquired pneumonia had been treated with antibiotics. Moreover, the patient reported on multiple spine surgery procedures performed in recent months. INVESTIGATIONS AND DIAGNOSIS: In transthoracic echocardiography (TTE), detection of a foreign body (Palacos) in the right ventricle, which was confirmed to be a toothpick-like structure in the supplementary CT scan of the thorax and the transoesophageal echocardiography (TOE). TREATMENT AND COURSE: Foreign body extraction using right anterior mini thoracotomy. Subsequently, iatrogenic pneumothorax with bilateral nosocomial pneumonia and drainage. After short-term convalescence, renewed admission with bilateral pulmonary infiltrates. Under invasive ventilation, new left-sided pneumothorax was diagnosed, which was supplied with a Bülau drainage. Due to the detection of positive blood cultures, re-conducting of a TOE examination. Now first diagnosis of tricuspid valve endocarditis. Despite successful surgical biologic tricuspid valve replacement with an epicardial pacemaker electrode placement, the patient died approximately three quarters of a year after he became an emergency patient due to dyspnoea. DISCUSSION: The present case shows that a typical clinical symptom, associated with a previously known chronic illness, has to be reminded again and again of other and less common diseases. Even everyday diagnostic and therapeutic procedures are associated with a residual risk of possible complications.


Assuntos
Dispneia , Corpos Estranhos , Ventrículos do Coração , Complicações Pós-Operatórias , Vertebroplastia/efeitos adversos , Idoso , Cimentos para Ossos/efeitos adversos , Dispneia/diagnóstico , Dispneia/etiologia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Humanos , Masculino , Polimetil Metacrilato/efeitos adversos , Toracotomia , Tomografia Computadorizada por Raios X
7.
World Neurosurg ; 130: e307-e315, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31226459

RESUMO

INTRODUCTION: Percutaneous kyphoplasty can offer pain relief and restoration of vertebral height immediately after the procedure; however, little is known about how many vertebrae recollapse during follow-up or why recollapse occurs. In the present study, we define recollapse of a treated vertebra, assess how common it is following percutaneous kyphoplasty, and investigate risk factors for the condition. METHODS: In total, 203 consecutive patients who underwent percutaneous kyphoplasty were reviewed after an average 12.7 months to assess what proportion of cement-augmented vertebrae had recollapsed. Potential risk factors for recollapse included age, gender, body weight, body height, body mass index, treated level, duration of symptoms, follow-up duration, preoperative T-scores, surgical approach, the intravertebral cleft, contact of polymethyl methacrylate (PMMA) with endplates, cement volume, cement leakage, and midline vertebral body height. Stepwise multivariate linear regression was conducted to predict recollapse as quantified by midline vertebral height loss. RESULTS: Overall, 38.9% of the augmented vertebrae recollapsed. In the recollapse group, the average midline vertebral height ratio and kyphotic angles statistically significantly changed during follow-up (P < 0.05). Pain scores decreased immediately after percutaneous kyphoplasty and generally remained low at follow-up. Significant predictors of midline vertebral height loss at follow-up included presence of an intravertebral cleft, postoperative vertebral height, and non-PMMA-endplate-contact. Together, these factors accounted for 28% of the variability in midline height loss. CONCLUSIONS: Benefits of percutaneous kyphoplasty are partly offset by subsequent recollapse. Recollapse is greater if there is an intravertebral cleft, non-PMMA-endplate-contact and an increase in the post vertebral height.


Assuntos
Cimentos para Ossos/efeitos adversos , Cifoplastia/efeitos adversos , Cifoplastia/tendências , Vértebras Lombares/cirurgia , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vértebras Torácicas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/etiologia , Estudos Retrospectivos , Fatores de Risco , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologia , Vértebras Torácicas/diagnóstico por imagem , Vertebroplastia/efeitos adversos , Vertebroplastia/tendências
8.
World Neurosurg ; 128: e841-e850, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31082551

RESUMO

OBJECTIVE: Cranioplasty is a technically simple procedure intended to repair defects of the skull to provide protection after craniectomy, improve functional outcomes, and restore cosmesis. Several materials have been used for the restoration of skull defects, including autologous bone grafts (AGs), polymethyl methacrylate (PMMA) flaps, and titanium mesh (T-mesh). However, the long-term results of cranioplasty after use of these materials are controversial. METHODS: Medical records of 596 patients who underwent cranioplasty at our medical center between 2009 and 2015 with at least 2.5 years of follow-up were retrospectively reviewed. Patients were classified into 3 groups according to the materials used: AG, three-dimensional PMMA, and T-mesh. Demographic and clinical characteristics and postoperative complications were analyzed. RESULTS: Cranioplasty with AG had the highest bone flap depression rate (4.9%; P = 0.02) and was associated with a 26% long-term bone flap resorption. Younger age was a risk factor for bone flap resorption. T-mesh had a higher risk of postoperative skin erosion and bone exposure (17%; P = 0.004). Patients with diabetes, previous craniotomy, or hydrocephalus showed a higher risk of postoperative skin erosion. PMMA was associated with the highest rate of postoperative infection (14.4% <3 months, 28.1% >3 months; P < 0.05), and previous craniotomy may increase the infection risk after cranioplasty with PMMA. CONCLUSIONS: Complications after cranioplasty are high, and the various types of cranioplasty materials used are associated with different complications. Surgeons need to be aware of these potential complications and should choose the appropriate material for each individual patient.


Assuntos
Cimentos para Ossos/efeitos adversos , Transplante Ósseo/efeitos adversos , Craniotomia/efeitos adversos , Craniectomia Descompressiva/métodos , Polimetil Metacrilato/efeitos adversos , Telas Cirúrgicas/efeitos adversos , Titânio/efeitos adversos , Adulto , Fatores Etários , Idoso , Craniectomia Descompressiva/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Fatores de Risco , Crânio/cirurgia , Retalhos Cirúrgicos , Adulto Jovem
9.
World Neurosurg ; 128: e975-e981, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31100522

RESUMO

OBJECTIVE: To assess early complications, mortality rate, and cement leakage in elderly patients who had undergone navigation-based pedicle screw placement of the thoracic and lumbar spine. METHODS: Eighty-six patients older than 65 years of age who had received cement-augmented pedicle screws for various conditions were retrospectively included between May 2008 and December 2016. Complications, mortality, and cement leakage were determined. All patients had a radiograph as a control. In patients with cement leakage seen on radiographs, a computed tomography scan of the surgical area was also obtained. RESULTS: Average age was 73.4 years (range 65-86 years). A total of 319 vertebral bodies with 637 screws were inserted, of which 458 screws were cement-augmented; 348 (76%) of the augmented screws were placed in the lumbar spine and 110 (24%) in the thoracic spine. Cement leakage occurred in 55 of 86 patients, of whom 52 (60%) were asymptomatic. In all cases with cement leakage (asymptomatic or symptomatic), cement could be found in the perivertebral veins: in the inferior vena cava in 25%, in the epidural space in 7%, in the azygos vein in 5%, and in pulmonary arteries in 7%. CONCLUSIONS: Our study confirms that the use of cement correlates with a high risk of cement leakage in elderly patients. Using computed tomography navigation for screw placement did not reduce the risk of venous cement leakage, but leakage into the epidural space or through a cortical defect seems to be low.


Assuntos
Cimentos para Ossos , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/métodos , Parafusos Pediculares , Coluna Vertebral/cirurgia , Cirurgia Assistida por Computador/efeitos adversos , Cirurgia Assistida por Computador/métodos , Idoso , Idoso de 80 Anos ou mais , Cimentos para Ossos/efeitos adversos , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Coluna Vertebral/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
10.
J Orthop Surg Res ; 14(1): 138, 2019 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-31096992

RESUMO

BACKGROUND: The vertebral endplate route was demonstrated to be the main pathway for nutrition to the intervertebral disc. However, it is still a controversial issue on whether the blocking of the endplate nutritional pathway could result in intervertebral disc degeneration (IDD) in animal models. The aim was therefore to investigate the effect of the inhibition of both endplate nutritional pathways by bone cement injection on the IDD in a goat model. METHODS: Two lumbar intervertebral discs (L2-3 and L3-4) in eight 24-month-old goats were blocked in both endplate nutritional pathways by cement injection, and the other two lumbar intervertebral discs (L1-2 and L4-5) remained intact as normal controls. Effective blocking area percentage in nucleus pulposus (NP) was calculated, and X-rays, magnetic resonance imaging (MRI), and histology studies were performed at 4, 12, 24, and 48 weeks after operation. RESULTS: The mean effective blocking area percentage was 60.7 ± 5.3%. Imaging examinations at the time of 48 weeks after blocking the endplate nutritional pathways showed obvious IDD, with larger disc height reduction and higher degrees of disc degeneration grading compared with the normal controls. Histological examinations including HE, Masson's trichrome, Sirius Red, and proteoglycan stainings also confirmed the degenerative changes of the blocked discs. CONCLUSIONS: The endplate nutritional route could be inhibited by blocking both endplate pathways with cement injection in a goat model. The severe inhibition in the endplate nutritional pathways may result in IDD.


Assuntos
Cimentos para Ossos/efeitos adversos , Modelos Animais de Doenças , Degeneração do Disco Intervertebral/patologia , Vértebras Lombares/patologia , Animais , Feminino , Cabras , Degeneração do Disco Intervertebral/induzido quimicamente , Vértebras Lombares/efeitos dos fármacos , Vértebras Lombares/fisiologia
11.
J Vasc Interv Radiol ; 30(6): 894-899, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30952522

RESUMO

PURPOSE: To determine the safety and efficacy of percutaneous lumbar discectomy (PLD) and percutaneous disc cementoplasty (PDCP) for painful lumbar disc herniation (LDH) in patients >60 years of age. MATERIALS AND METHODS: Sixteen older patients (mean age, 71.00 ± 6.24 years) with painful LDH were treated with PLD and PDCP. The outcome data (the Macnab criteria, visual analog scale score, and Oswestry disability index) were collected preoperatively; at 1 week postoperatively; at posttreatment months 1, 3, and 6; and every 6 months thereafter. In addition, treatment duration, injection volume of bone cement, length of hospital stay, and complications were assessed. RESULTS: Treatment was successful in all patients. The pain relief rate at the last follow-up was 87.5%. Six, 8, and 2 patients showed excellent, good, and fair results, respectively; no patient showed a poor result. The average visual analog scale for back and leg pain decreased from 6.75 ± 1.06 and 7.00 ± 0.89 before the procedure to 2.81 ± 1.60 and 2.87 ± 1.75 at 1 month, 2.79 ± 1.58 and 2.71 ± 1.64 at 6 months, and 2.90 ± 1.73 and 3.00 ± 1.76 at 1 year, respectively. The scores were 2.44 ± 1.63 and 2.44 ± 1.71, respectively, at the last follow-up. The Oswestry disability index also changed after the procedure, with significant differences between baseline scores and those at each follow-up (P < .001). The mean procedure duration, injection volume of bone cement, and length of hospital stay were 55.69 ± 5.86 minutes, 2.50 ± 0.63 mL, and 7.06 ± 2.41 days, respectively. There were no complications. CONCLUSIONS: The combination of PLD and PDCP is feasible, safe, and effective for older patients with painful LDH.


Assuntos
Dor nas Costas/cirurgia , Cimentos para Ossos/uso terapêutico , Cementoplastia , Discotomia Percutânea , Deslocamento do Disco Intervertebral/cirurgia , Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Idoso , Dor nas Costas/diagnóstico por imagem , Dor nas Costas/fisiopatologia , Cimentos para Ossos/efeitos adversos , Cementoplastia/efeitos adversos , Discotomia Percutânea/efeitos adversos , Feminino , Humanos , Disco Intervertebral/diagnóstico por imagem , Disco Intervertebral/fisiopatologia , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/fisiopatologia , Tempo de Internação , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
12.
Turk J Med Sci ; 49(2): 514-518, 2019 04 18.
Artigo em Inglês | MEDLINE | ID: mdl-30893980

RESUMO

Background/aim: The aim of this study was to investigate postoperative audiometric threshold shifts in patients who underwent primary total knee arthroplasty (TKA) using gentamicin-loaded bone cement (GLBC) in comparison with the ones who underwent TKA without GLBC. Materials and methods: Forty patients (gentamicin group) who underwent primary TKA using GLBC and 29 patients (control group) who underwent primary TKA using standard bone cement were included in this prospective case-control study. Baseline pure-tone audiometric evaluation was performed preoperatively and repeated at the postoperative third day for all patients. Control audiometric evaluation was performed weekly for patients who were diagnosed with ototoxicity according to audiometric threshold shifts. Results: Ototoxicity was diagnosed in 8 of 40 patients (20%) in the gentamicin group according to postoperative audiometric threshold shifts, whereas no ototoxicity was observed in the control group. Patients who were diagnosed with ototoxicity had no permanent audiometric threshold shifts in follow-up audiometric evaluation and these patients had no clinical complaints of difference in hearing. Conclusion: According to our results, audiometric threshold shifts can be detected in patients who undergo primary TKA using gentamicin loaded bone cement. However, no permanent shifts were observed during close follow-up.


Assuntos
Antibacterianos/administração & dosagem , Artroplastia do Joelho/efeitos adversos , Audiometria de Tons Puros , Cimentos para Ossos/farmacologia , Gentamicinas/administração & dosagem , Audição/efeitos dos fármacos , Infecções Relacionadas à Prótese/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Cimentos para Ossos/efeitos adversos , Estudos de Casos e Controles , Feminino , Audição/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecções Relacionadas à Prótese/prevenção & controle , Resultado do Tratamento
13.
J Craniofac Surg ; 30(3): 936-939, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30845082

RESUMO

INTRODUCTION: Glass ionomer bone cement is frequently applied with cartilage grafts in otology, even as a single unit. OBJECTIVE: This experimental study was performed to investigate the histopathological effects of bone cement on cartilage tissue. METHODS: The study was conducted between January 2018 and April 2018 and used 12 New Zealand White rabbits. The right ears of the rabbits constituted the study group, while the left ears were the controls. Ketac Cem Radiopaque (3 M Germany) was used as glass ionomer cement. Tissue samples from the rabbits were subjected to histopathological analysis to compare acute and chronic inflammation, foreign body reaction, angiogenesis, collagenesis, fibrosis, necrosis, cartilage fracture, osseous metaplasia, and loss of chondrocyte nuclei between the groups. RESULTS: The rates of cartilage fracture (P = 0.044), foreign body reaction (P < 0.001), acute inflammation (P = 0.009), chronic inflammation (P = 0.002), and angiogenesis (P = 0.003) were significantly higher in the study group compared with the controls. The study group showed some degree of necrosis; no necrosis was observed in the control group, but the difference was not statistically significant (P = 0.101). There were no significant differences in fibrosis, collagenesis, osseous metaplasia, or loss of chondrocyte nuclei between the groups. CONCLUSIONS: This study showed that application of bone cement can cause acute and chronic inflammation, foreign body reactions, angiogenesis, and cartilage fractures. Further studies are needed to determine the long-term effects of bone cement on cartilage.


Assuntos
Cimentos para Ossos/efeitos adversos , Cartilagem da Orelha/patologia , Reação a Corpo Estranho/etiologia , Cimentos de Ionômeros de Vidro/efeitos adversos , Doença Aguda , Animais , Condrócitos/patologia , Doença Crônica , Cartilagem da Orelha/transplante , Fibrose , Fraturas de Cartilagem/etiologia , Óxido de Magnésio/efeitos adversos , Metaplasia/etiologia , Necrose/etiologia , Neovascularização Patológica/etiologia , Cimento de Policarboxilato/efeitos adversos , Coelhos , Óxido de Zinco/efeitos adversos
15.
J Forensic Leg Med ; 63: 48-51, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30861473

RESUMO

Percutaneous vertebroplasty consists of percutaneous injection of polymethylmethacrylate (PMMA) via a transpedicular approach for the treatment of collapsed osteoporotic or metastatic vertebrae. Even if percutaneous vertebroplasty is considered to be minimally invasive, threatening complications can occur. Cement leakage is the most common complication of percutaneous vertebroplasty. Rigorous patient selection and individual therapeutic strategy may reduce the occurrence of leakage, in particular the risk of cement entry into the venous system and the spinal canal is the potent major hazard of this technique. Cement pulmonary and cardiac embolism are reported in literature as a cause of unexpected death after percutaneous vertebroplasty. Authors report a fatal case of pulmonary cement embolization occurred after vertebroplasty with haemopericardium, due to the perforation of the right atrium wall from a cement solidified fragment. A complete post mortem examination documented the presence of multiple cement fragments in the pulmonary arteries and transmural perforation of the wall of the right atrium by a whitish needle-like foreign body. Pulmonary microembolization was observed under polarized light.


Assuntos
Cimentos para Ossos/efeitos adversos , Morte Súbita/etiologia , Extravasamento de Materiais Terapêuticos e Diagnósticos/complicações , Átrios do Coração/lesões , Embolia Pulmonar/patologia , Vertebroplastia/efeitos adversos , Idoso , Feminino , Corpos Estranhos/patologia , Patologia Legal , Fraturas por Compressão/cirurgia , Átrios do Coração/patologia , Humanos , Fraturas por Osteoporose/cirurgia , Polimetil Metacrilato/efeitos adversos , Fraturas da Coluna Vertebral/cirurgia
16.
Curr Probl Diagn Radiol ; 48(4): 387-392, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30232041

RESUMO

Nonthrombotic pulmonary embolism (NTPE) is less well understood and is encountered less frequently than pulmonary embolism from venous thrombosis. NTPE results from embolization of nonthrombotic material to the pulmonary vasculature originating from many different cell types as well as nonbiologic or foreign materials. For many radiologists NTPE is a challenging diagnosis, presenting nonspecific or unusual imaging findings in the setting of few or unusual clinical signs. The aim of this paper is to review the pathophysiology of diverse causes of NTPE, which should aid radiologists to better understand and, more importantly, diagnose these infrequent events.


Assuntos
Cimentos para Ossos/efeitos adversos , Embolia Amniótica/diagnóstico por imagem , Embolia Gordurosa/diagnóstico por imagem , Corpos Estranhos/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Diagnóstico Diferencial , Embolia Amniótica/diagnóstico , Embolia Gordurosa/complicações , Embolia Gordurosa/diagnóstico , Feminino , Corpos Estranhos/complicações , Corpos Estranhos/diagnóstico , Humanos , Pulmão , Imagem por Ressonância Magnética/métodos , Masculino , Gravidez , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/etiologia , Medição de Risco , Tomografia Computadorizada por Raios X/métodos
17.
World Neurosurg ; 122: 342-348, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30391616

RESUMO

BACKGROUND: A meta-analysis of randomized controlled trials (RCTs) was performed to compare the incidence of cement leakage between unilateral and bilateral percutaneous vertebral augmentation (PVA) in treating osteoporotic vertebral compression fractures (OVCFs). METHODS: PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched to retrieve the reported data from the establishment of the databases until August 1, 2018. The RCTs on unilateral and bilateral PVA for OVCFs were included. RevMan software, version 5.3, was used for the meta-analysis. RESULTS: Six RCTs were selected from the reported data. The studies included a total of 676 vertebras, 339 of which had received unilateral PVA and the rest, bilateral PVA. The incidence of cement leakage in the unilateral PVA group was less than that in the bilateral PVA group, and the difference between the 2 groups was statistically significant (risk ratio, 0.50; 95% confidence interval, 0.35-0.72; P = 0.0002). The cement dosage in the unilateral PVA group was less than that in the bilateral PVA group, and the difference between the 2 groups was statistically significant (weighted mean difference, -1.98; 95% confidence interval, -2.24 to -1.72; P < 0.00001). The cement dosage and the incidence of cement leakage in the unilateral PVA group were lower than those in the bilateral PVA group. CONCLUSIONS: The results of our meta-analysis have provided sufficient evidence to show that the unilateral approach can decrease the incidence of cement leakage in PVA. We believe the unilateral approach could reduce the risk of cement leakage owing to the lower cement dosage in the treated vertebra.


Assuntos
Cimentos para Ossos/efeitos adversos , Extravasamento de Materiais Terapêuticos e Diagnósticos/etiologia , Fraturas por Compressão/cirurgia , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Humanos , Cifoplastia/efeitos adversos , Cifoplastia/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Vertebroplastia/efeitos adversos , Vertebroplastia/métodos
18.
Br J Neurosurg ; 33(2): 215-216, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28421835

RESUMO

Tension pneumocephalus is an exceedingly rare complication of cerebrospinal fluid diversion occurring after surgery, trauma or spontaneous fistula formation. We report a case in a patient with a ventriculoperitoneal shunt who developed symptomatic tension pneumocephalus via a skin defect within 24 hours of undergoing bone cement cranioplasty.


Assuntos
Procedimentos Neurocirúrgicos/efeitos adversos , Pneumocefalia/etiologia , Crânio/cirurgia , Derivação Ventriculoperitoneal/efeitos adversos , Adulto , Cimentos para Ossos/efeitos adversos , Fístula Cutânea/etiologia , Dura-Máter , Fístula/etiologia , Humanos , Masculino , Complicações Pós-Operatórias/etiologia
19.
Eur Radiol ; 29(2): 663-673, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30054794

RESUMO

OBJECTIVE: To evaluate the incidence and risk factors for ICE during a PV. MATERIALS AND METHODS: Single-center retrospective analysis of 1512 consecutive patients who underwent 1854 PV procedures for osteoporotic (34 %), malignant (39.9 %) or other cause (26.1 %) of vertebral compression fractures (VCFs)/spine tumor lesions. Only thoracic or lumbar PVs were included. PVs were performed with polymethylmethacrylate (PMMA) low-viscosity bone cement under fluoroscopic guidance. Chest imaging (X-ray or CT) was performed the same day after PV in patients with high clinical suspicion of ICE. All post-procedural chest-imaging examinations were reviewed, and all ICEs were agreed upon in consensus by two radiologists. RESULTS: ICEs were detected in 72 patients (92 cement embolisms). In 86.1 % of the cases, concomitant pulmonary artery cement leakage was detected. Symptomatic ICEs were observed in six cases (8.3% of all ICEs; 0.32% of all PV procedures). No ICE led to death or permanent sequelae. Multiple levels treated during the same PV session were associated with a higher ICE rate [OR: 3.59, 95% CI: (1.98-6.51); p < 0.001]; the use of flat panel technology with a lower ICE occurrence [OR: 0.51, 95% CI: (0.32-0.83); p = 0.007]. CONCLUSION: Intracardiac cement embolism after PV has a low incidence (3.9 % in our study). Symptomatic complications related to ICE are rare (0.3%); none was responsible for clinical sequelae in our series. KEY POINTS: • The incidence of intracardiac cement embolism (ICE) during PVP is low (3.9%). • Having a high number of treated vertebrae during the same session is a significant risk factor for ICE. • Symptomatic intracardiac cement embolisms have a low incidence (8.3% of patients with ICE).


Assuntos
Cimentos para Ossos/efeitos adversos , Embolia/etiologia , Fraturas por Compressão/cirurgia , Cardiopatias/etiologia , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Embolia/diagnóstico por imagem , Extravasamento de Materiais Terapêuticos e Diagnósticos/diagnóstico por imagem , Feminino , Fluoroscopia , Cardiopatias/diagnóstico por imagem , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Polimetil Metacrilato/efeitos adversos , Complicações Pós-Operatórias/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/etiologia , Radiografia , Radiografia Intervencionista , Estudos Retrospectivos , Fatores de Risco , Fraturas da Coluna Vertebral/diagnóstico por imagem , Vertebroplastia/métodos , Adulto Jovem
20.
Eur J Cardiothorac Surg ; 55(2): 366-368, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-29955843

RESUMO

Bone cement leakage is a common complication after percutaneous kyphoplasty. In rare cases, leakage into the venous system occurs, which can be life-threatening, especially when it embolizes the heart. Here, we present a case of cement embolization of the right ventricle with tricuspid valve involvement. A 69-year-old woman with an asymptomatic severe tricuspid valve regurgitation was referred to our department. She had a history of balloon kyphoplasty because of osteoporotic collapsed vertebrae in 2010. Echocardiography showed a foreign body attached to the right ventricle, prolapsing into the right atrium and causing a severe tricuspid valve regurgitation. The foreign body was surgically removed, and the tricuspid valve was replaced with a biological valve. The foreign body was analysed by scanning electron microscopy and element analysis. Zirconium was identified within the foreign body, which is an additive in bone cement used in orthopaedic surgery. Intracardiac cement embolism following percutaneous kyphoplasty is a rare but life-threatening complication. Here, we present a case of tricuspid valve destruction caused by the long-term presence of an intracardiac foreign body, specifically a cement embolus.


Assuntos
Cimentos para Ossos/efeitos adversos , Corpos Estranhos , Cifoplastia/efeitos adversos , Insuficiência da Valva Tricúspide , Idoso , Feminino , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/etiologia , Corpos Estranhos/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Polimetil Metacrilato , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/etiologia , Insuficiência da Valva Tricúspide/cirurgia
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