Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.232
Filtrar
1.
Fisioterapia (Madr., Ed. impr.) ; 42(4): 185-202, jul.-ago. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-193506

RESUMO

ANTECEDENTES Y OBJETIVO: El seguimiento clínico de la recuperación de lesiones deportivas es fundamental para un retorno deportivo seguro. La identificación de las propiedades psicométricas de los cuestionarios de autoinforme que evalúan funcionalidad, y que han sido validados en deportistas, facilitaría la selección apropiada de cuestionarios para evaluar la recuperación funcional de deportistas. Este estudio tiene como objetivo revisar sistemáticamente la literatura sobre las propiedades psicométricas de los cuestionarios autoinformados que evalúan la funcionalidad en deportistas con afecciones musculoesqueléticas de la extremidad inferior. MATERIALES Y MÉTODOS: Se realizó una búsqueda en las bases de datos MEDLINE/PubMed, SPORTDiscus, Scielo y Google Scholar hasta el 30 de octubre del 2019. Se incluyeron estudios de propiedades psicométricas de cuestionarios autoinformados que evalúan la funcionalidad en deportistas. La calidad metodológica se evaluó utilizando las guías de desarrollo COSMIN. RESULTADOS: Se incluyeron 37 estudios y 13 cuestionarios diferentes. La propiedad psicométrica menos reportada fue la validez transcultural, y la con mayor falta de información fue la validez de contenido. Según los estándares COSMIN, LEFS, CAIT, HAGOS, ACL-RSI, VISA-P y UWRI son válidos y confiables para determinar medidas de resultado durante el proceso de rehabilitación en deportistas. CONCLUSIÓN: La elección del cuestionario más apropiado para evaluar la funcionalidad en deportistas debiese considerar: 1) la enfermedad en la que ha sido validado, 2) el tipo de deporte incluido y 3) la calidad de propiedades psicométricas de los instrumentos disponibles


BACKGROUND AND PURPOSE: Clinical monitoring for the recovery of sports injuries is fundamental for a safe return to the sport. The identification of the psychometric properties of self-report functional questionnaires, which have been validated in the athlete population, may facilitate the appropriate selection of objective methodologies to assess the functional recovery of individuals with sport-related injuries. The aim of this study was to systematically review the literature on the psychometric properties of self-administered questionnaires that measure functionality in athletes with musculoskeletal conditions of the lower limb. MATERIALS AND METHODS: A comprehensive search was carried out in MEDLINE/PubMed, SPORTDiscus, Scielo, and Google Scholar databases up to 30 October 2019. Psychometric properties studies of self-reported questionnaires measuring functionality in sports population were included. The methodological quality was evaluated using the COSMIN methodology. RESULTS: A total of 37 studies and 13 different questionnaires were included. Cross-cultural validity was the least reported psychometric property. Content validity was poorly reported in the majority of questionnaires. According to the COSMIN standards, LEFS, CAIT, HAGOS, ACL-RSI, VISA-P, and UWRI are valid and reliable questionnaires to determine patient-reported outcome measurements during the rehabilitation process of an athlete. CONCLUSION: The selection of the most appropriate questionnaire to assess functionality in athletes should consider: (1) the condition in which it has been validated, (2) the type of sport included, and (3) the quality of the psychometric properties of the available questionnaires


Assuntos
Humanos , Masculino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Psicometria/métodos , Doenças Musculoesqueléticas/reabilitação , Extremidade Inferior/patologia , Traumatismos em Atletas/reabilitação , Inquéritos e Questionários , Comparação Transcultural , Autorrelato
2.
Skeletal Radiol ; 49(11): 1879-1884, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32844243

RESUMO

While initial reports regarding coronavirus disease 2019 (COVID-19) focused on its pulmonary manifestations, more recent literature describes multisystem abnormalities related to its associated microvascular angiopathy. Calciphylaxis is a rare systemic condition characterized by tissue necrosis in the setting of systemic microvascular calcifications. Both COVID-19 and calciphylaxis are procoagulant diagnoses associated with vascular-mediated cutaneous findings. To our knowledge, this is the first report to document the coexistence of COVID-19 associated retiform thrombotic purpura and calciphylaxis in a single patient, to link the pathologic etiologies of the two entities, and to describe the concomitant diagnoses' associated radiologic findings.


Assuntos
Betacoronavirus , Calciofilaxia/complicações , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Púrpura/complicações , Calciofilaxia/diagnóstico por imagem , Calciofilaxia/patologia , Angiografia por Tomografia Computadorizada/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/patologia , Diagnóstico Diferencial , Evolução Fatal , Feminino , Humanos , Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/patologia , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/patologia , Reação em Cadeia da Polimerase , Ultrassonografia/métodos
3.
Dermatol Online J ; 26(6)2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32815693

RESUMO

Superficial granulomatous pyoderma (SGP) is a rare pyoderma gangrenosum (PG) variant that differs from classic PG in that the ulcers tend to be more superficial, lack a rapidly advancing border, and are not typically associated with an underlying systemic disease. The ulcers are most commonly painless and located on the trunk, with a clean granulating base. They generally do not show undermining but may have a vegetative border. Lesions usually respond well to either topical or intralesional corticosteroids with complete healing. The classic histopathologic finding is a "three-layer granuloma" in the superficial dermis consisting of central neutrophilic inflammation and necrosis, a surrounding layer of histiocytes and multinucleated giant cells, and an outer most layer of plasma cells and eosinophils. Herein, we present a unique case of SGP with sporotrichoid-like distribution on the lower extremity.


Assuntos
Granuloma/patologia , Pioderma/patologia , Administração Tópica , Corticosteroides/administração & dosagem , Idoso , Diagnóstico Diferencial , Granuloma/diagnóstico , Granuloma/tratamento farmacológico , Humanos , Extremidade Inferior/patologia , Masculino , Pioderma/diagnóstico , Pioderma/tratamento farmacológico
4.
Jt Dis Relat Surg ; 31(2): 335-340, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584734

RESUMO

OBJECTIVES: This study aims to investigate the effectivity of cement combined demineralized bone matrix (DBM) treatment on new bone formation in the cortical window as well as to evaluate the effect of new bone formation on functional outcomes. PATIENTS AND METHODS: Thirty-two benign bone tumor patients (15 males, 17 females; median age 38 years; range, 12 to 68 years), who were treated with cement combined DBM between February 2010 and December 2014, were evaluated retrospectively. Patient characteristics were recorded as age, gender, tumor localization, histological diagnosis, Enneking stage, tumor size, size of the cortical window, usage of prophylactic fixation, time to return to work, Musculoskeletal Tumor Society (MSTS) functional score, tumor relapse, and new bone formation on the cortical window in the computed tomography scans after one year of surgery. RESULTS: Median tumor volume was 17.2 cm3 (range, 2.8 to 139.6 cm3), median area of the cortical window was 8.3 cm2 (range, 1.6 to 28.4 cm2), and median postoperative one-year MSTS score was 84.5 (range, 66 to 97). MSTS scores were significantly worse with the usage of prophylactic fixation (p<0.001). There was a statistically significant difference between the usage of prophylactic fixation and cortical window size (p=0.013). There was a low-level negative correlation in terms of age and bone formation on the cortical window (p=0.046, r= -0.356) and mid-level negative correlation between cortical window size and functional scores (p=0.001, r= -0.577). CONCLUSION: Application of cement combined with DBM procedure is an effective, alternative, and biological treatment in bone tumors that provides immediate stability and stimulates new bone formation on the cortical window.


Assuntos
Cimentos para Ossos/uso terapêutico , Desmineralização Patológica Óssea/terapia , Neoplasias Ósseas , Transplante Ósseo/métodos , Extremidade Inferior , Neoplasias , Extremidade Superior , Adulto , Neoplasias Ósseas/patologia , Neoplasias Ósseas/cirurgia , Regeneração Óssea , Feminino , Humanos , Extremidade Inferior/patologia , Extremidade Inferior/cirurgia , Masculino , Neoplasias/patologia , Neoplasias/cirurgia , Avaliação de Resultados em Cuidados de Saúde , Estudos Retrospectivos , Resultado do Tratamento , Extremidade Superior/patologia , Extremidade Superior/cirurgia
5.
Plast Reconstr Surg ; 145(6): 1528-1537, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32459781

RESUMO

BACKGROUND: The subfascial compartment (deep to the deep fascia) in extremity lymphedema has not been evaluated. This study investigated the volumetric differences between the suprafascial and subfascial compartments of patients with unilateral lower extremity lymphedema. METHODS: Thirty-two female patients with unilateral lower extremity lymphedema were enrolled, with eight patients in each of Cheng lymphedema grades I to IV. The volumes of the suprafascial and subfascial compartments were calculated after manually drawing the region of interest on computed tomographic images. The volumetric differences and their ratios in the suprafascial and subfascial compartments between each patient's bilateral limbs were compared. RESULTS: The volume of the lymphedematous limbs (9647 ml) was significantly greater than the volume of unaffected limbs (6906 ml), with a median volumetric difference of 2097 ml (30.6 percent) (p < 0.01). The median suprafascial compartment volumetric difference was 1887 ml (56.6 percent) and the subfascial compartment volumetric difference was 208 ml (4.7 percent) (p < 0.01). The median volumetric difference ratio of the thigh and lower leg was 24.6 percent and 40.6 percent, respectively. The median volumetric differences in Cheng lymphedema grades I to IV were 1012, 1787, 2434, and 4107 ml, respectively, which were statistically significant among the four Cheng lymphedema grades using the Kruskal-Wallis test (p < 0.01). CONCLUSIONS: The volumetric differences in the lymphedematous limb were statistically significantly greater than in the unaffected limb, including both suprafascial and subfascial compartments. The volumetric differences are consistent with the Cheng lymphedema grading system as a reliable indicator of unilateral extremity lymphedema. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, IV.


Assuntos
Fáscia/diagnóstico por imagem , Extremidade Inferior/diagnóstico por imagem , Linfedema/diagnóstico , Idoso , Tomografia Computadorizada de Feixe Cônico , Fáscia/patologia , Feminino , Neoplasias dos Genitais Femininos/patologia , Neoplasias dos Genitais Femininos/cirurgia , Humanos , Processamento de Imagem Assistida por Computador , Extremidade Inferior/patologia , Excisão de Linfonodo/efeitos adversos , Linfedema/epidemiologia , Linfedema/etiologia , Linfedema/patologia , Pessoa de Meia-Idade , Prevalência , Procedimentos Cirúrgicos Reconstrutivos , Índice de Gravidade de Doença
6.
Obesity (Silver Spring) ; 28(5): 907-915, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32270924

RESUMO

OBJECTIVE: The aim of this study is to compare tissue sodium and fat content in the upper and lower extremities of participants with lipedema versus controls using magnetic resonance imaging (MRI). METHODS: MRI was performed at 3.0 T in females with lipedema (n = 15, age = 43.2 ± 10.0 years, BMI = 30.3 ± 4.4 kg/m2 ) and controls without lipedema (n = 14, age = 42.8 ± 13.2 years, BMI = 28.8 ± 4.4 kg/m2 ). Participants were assessed for pain and disease stage. Sodium MRI was performed in the forearm and calf to quantify regional tissue sodium content (TSC, mmol/L). Chemical-shift-encoded water-fat MRI was performed in identical regions for measurement of fat/water (ratio). RESULTS: In the calf, skin TSC (16.3 ± 2.6 vs. 14.4 ± 2.2 mmol/L, P = 0.04), muscle TSC (20.3 ± 3.0 vs. 18.3 ± 1.7 mmol/L, P = 0.03), and fat/water (1.03 ± 0.37 vs. 0.56 ± 0.21 ratio, P < 0.001) were significantly higher in participants with lipedema versus control participants. In the forearm, skin TSC (13.4 ± 3.3 vs. 12.0 ± 2.3 mmol/L, P = 0.2, Cohen's d = 0.50) and fat/water (0.65 ± 0.24 vs. 0.48 ± 0.24 ratio, P = 0.07, Cohen's d = 0.68) demonstrated moderate effect sizes in participants with lipedema versus control participants. Calf skin TSC was significantly correlated with pain (Spearman's rho = 0.55, P = 0.03) and disease stage (Spearman's rho = 0.82, P < 0.001) among participants with lipedema. CONCLUSIONS: MRI-measured tissue sodium and fat content are significantly higher in the lower extremities, but not upper extremities, of patients with lipedema compared with BMI-matched controls.


Assuntos
Lipedema/diagnóstico , Extremidade Inferior/patologia , Imagem por Ressonância Magnética/métodos , Sódio/metabolismo , Extremidade Superior/patologia , Adulto , Feminino , Humanos , Masculino
7.
Gerokomos (Madr., Ed. impr.) ; 31(1): 32-35, mar. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-192210

RESUMO

Paciente de 79 años, remitida a consulta de enfermería para valoración de lesión postraumática en miembro inferior derecho de una semana de evolución, tratada con vendaje elástico y heparina de bajo peso molecular. OBJETIVO: Conocer el rol de la enfermería en la prevención y tratamiento de la dermatoporosis, a propósito de un caso clínico. METODOLOGÍA: Caso clínico con planteamiento metodológico, con consentimiento informado de la paciente y fotografías del caso. RESULTADO: La cicatrización se consiguió en un periodo de 65 días, con una correcta preparación del lecho de la herida para el posterior éxito del injerto cutáneo, controlando el edema, exudado y dolor durante las curas, realizadas cada 2-3 días de acuerdo con la efectividad del tratamiento. DISCUSIÓN: La dermatoporosis exige un mayor esfuerzo en prevención primaria y secundaria desde Atención Primaria, sobre todo a partir de la detección de las manifestaciones clínicas y complicaciones iniciales derivadas de la misma


A 79-year-old patient referred to a nursing consultation to evaluate a traumatic lesion in the right lower limb for one week, treated with elastic bandage and low molecular weight heparin. OBJECTIVE: Knowing the role of nursing in the prevention and treatment of dermatoporosis, in relation to a clinical case. METHODOLOGY: Clinical case with methodological approach, with informed consent of the patient and photographs. RESULT:The healing was achieved in a period of 65 days, with a correct preparation of the wound bed for the subsequent success of the skin graft, treating the edema, exudate and pain during the cures, made every 2-3 days in accordance with the effectiveness of the treatment. DISCUSSION: Dermatoporosis requires a greater effort in primary and secondary prevention from primary care, especially from the detection of clinical manifestations and initial complications derived from it


Assuntos
Humanos , Feminino , Idoso , Envelhecimento da Pele/patologia , Diagnóstico de Enfermagem/métodos , Transplante de Pele/métodos , Desbridamento/métodos , Extremidade Inferior/patologia , Cicatrização , Transplante de Pele/enfermagem , Transplante de Pele/reabilitação
9.
Clin Orthop Relat Res ; 478(3): 550-559, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32168066

RESUMO

BACKGROUND: Postoperative wound complications are challenging in patients with localized extremity soft-tissue sarcomas. Various factors have been associated with wound complications, but there is no individualized predictive model to allow providers to counsel their patients and thus offer methods to mitigate the risk of complications and implement appropriate measures. QUESTIONS/PURPOSES: We used data from multiple centers to ask: (1) What risk factors are associated with postoperative wound complications in patients with localized soft-tissue sarcomas of the extremity? (2) Can we create a predictive nomogram that will assess the risk of wound complications in individual patients after resection for soft-tissue sarcoma? METHODS: From 2000 to 2016, 1669 patients undergoing limb-salvage resection for a localized primary or recurrent extremity soft-tissue sarcoma with at least 120 days of follow-up at eight participating United States Sarcoma Collaborative institutions were identified. Wound complications included superficial wounds with or without drainage, deep wounds with drainage because of dehiscence, and intentional opening of the wound within 120 days postoperatively. Sixteen variables were selected a priori by clinicians and statisticians as potential risk factors for wound complications. A univariate analysis was performed using Fisher's exact tests for categorical predictors, and Wilcoxon's rank-sum tests were used for continuous predictors. A multiple logistic regression analysis was used to train the prediction model that was used to create the nomogram. The prediction performance of the datasets was evaluated using a receiver operating curve, area under the curve, and calibration plot. RESULTS: After controlling for potential confounding factors such as comorbidities, functional status, albumin level, and chemotherapy use, we found that increasing age (odds ratio 1.02; 95% confidence interval, 1.00-1.03; p = 0.008), BMI (OR 1.05; 95% CI, 1.02-1.09; p = 0.004), lower-extremity location (OR 6; 95% CI, 2.87-12.69; p < 0.001), and neoadjuvant radiation (OR 2; 95% CI, 1.47-3.16; p < 0.001) were associated with postoperative wound complications (area under the curve 69.2% [range 62.8%-75.6%]). CONCLUSIONS: We found that age, BMI, tumor location, and timing of radiation are associated with the risk of wound complications. Based on these factors, a validated nomogram has been established that can provide an individualized prediction of wound complications in patients with a resected soft-tissue sarcoma of the extremity. This may allow for proactive management with nutrition and surgical techniques, and help determine the delivery of radiation in patients with a high risk of having these complications. LEVEL OF EVIDENCE: Level III, therapeutic study.


Assuntos
Salvamento de Membro/efeitos adversos , Nomogramas , Complicações Pós-Operatórias/etiologia , Sarcoma/terapia , Neoplasias de Tecidos Moles/terapia , Fatores Etários , Índice de Massa Corporal , Feminino , Humanos , Extremidade Inferior/patologia , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/efeitos adversos , Razão de Chances , Valor Preditivo dos Testes , Radioterapia Adjuvante/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Sarcoma/patologia , Neoplasias de Tecidos Moles/patologia , Cicatrização
10.
Curr Cardiol Rev ; 16(3): 164-172, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32164514

RESUMO

Lower extremity venous diseases or insufficiency include clinically deteriorating conditions with morphological and functional alterations of the venous system, including venous hypertension, vascular wall structural abnormality, and venous valvar incompetency in association with an inflammatory process. In fact, the same pathophysiological processes are the main underlying mechanisms of other venous insufficiencies in different vascular territories such as Peripheral Varicose Vein (PVV), varicocele, Pelvic Varicosities or Congestion Syndrome (PCS) and Hemorrhoidal Disease (HD). Regarding the anatomical continuity of lower extremity venous system, urogenital system (pampiniform plexus in male and broad ligament and ovarian veins in female) and anorectal venous system, it is reasonable to expect common symptoms such as pain, burning sensation, pruritis, swelling, which arise directly from the involved tissue itself. High coexistence rate of PVV, varicocele/PCS and HD between each other underlines not only the same vascular wall abnormality as an underlying etiology but also the existence of common symptoms originating from the involved tissue in dilating venous disease. Accordingly, it might be reasonable to query the common symptoms of venous dilating disease in other venous vascular regions in patients with complaints of any particular venous territory.


Assuntos
Dilatação Patológica/fisiopatologia , Extremidade Inferior/patologia , Varizes/fisiopatologia , Veias/fisiopatologia , Feminino , Humanos , Masculino
11.
BMJ Case Rep ; 13(2)2020 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-32047079

RESUMO

Here, we present an unusual case of 26-month male toddler who presented with swelling of right lower limb with painless hyperpigmented patch over right groin of 18 months duration associated with recent onset respiratory distress. Evaluation revealed right chylothorax and MRI revealed altered signal intensity in bones and muscles of right lower limb. Lymphoscintigraphy revealed absence of lymphatic channels in right lower limb. Skin biopsy from hyperpigmented patch was suggestive of vasoformative lesion favouring lymphangiomatosis. A diagnosis of Gorham's syndrome was made, and our patient was managed with drainage of chylothorax followed by pleurodesis, parenteral nutrition and radiotherapy.


Assuntos
Quilotórax/etiologia , Quilotórax/terapia , Edema/etiologia , Extremidade Inferior/patologia , Linfangioma/complicações , Osteólise Essencial/complicações , Pré-Escolar , Diagnóstico Diferencial , Humanos , Masculino , Nutrição Parenteral Total , Pleurodese , Toracentese
12.
Sci Rep ; 10(1): 3182, 2020 02 21.
Artigo em Inglês | MEDLINE | ID: mdl-32081869

RESUMO

This study aimed to analyze the clinical characteristics of lower extremity atherosclerotic disease (LEAD) in Chinese adult type 2 diabetes (T2D) patients, and also explored the risk factors for LEAD and developed simple-to-use nomograms for LEAD and lesion degree in these patients. We retrospectively studied 4422 patients (male = 2084; female = 2338) with T2D who were ≥50. Based on lower extremity arterial ultrasound findings, we divided the patients into three groups: normal, mild, and moderate-to-severe group. The factors related to LEAD in patients with T2D were analyzed by logistic regression analysis. The risk factors for moderate-to-severe LEAD included: high HbA1c (OR = 1.07 95% CI 1.02-1.13), diabetic peripheral neuropathy (OR = 1.93 95% CI 1.57-2.37), and diabetic retinopathy (OR = 1.26 95%CI 1.01-1.57). The overall areas under the receiver operating characteristic curves for the nomograms for predicting the risks of LEAD and moderate-to-severe LEAD in adult T2D patients were 0.793 (95%CI 0.720, 0.824) and 0.736 (95%CI 0.678, 0.795), respectively. The developed nomograms are simple to use and enable preliminary visual prediction of the risk and degree of LEAD in Chinese T2D patients over 50 years. The nomograms are accurate to a certain degree and provide a clinical basis for predicting the occurrence and progression of LEAD.


Assuntos
Grupo com Ancestrais do Continente Asiático , Aterosclerose/complicações , Aterosclerose/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Extremidade Inferior/patologia , Nomogramas , Adulto , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Curva ROC , Fatores de Risco
15.
J Forensic Leg Med ; 69: 101890, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32056808

RESUMO

This retrospective study sought to identify a regular pattern of limb bruising which occurs in association with suicidal or accidental hanging. Following exclusion of cases suspicious for homicide, 82 consecutive cases of hanging from a 10-year period were retrospectively reviewed to identify the pattern of traumatic limb injury in each case. Relevant information such as location, toxicology, and type of suspension was also noted. 72% of the reviewed cases had traumatic limb lesions, the majority of which occurred on the posterior upper limb and the anterior lower limb. Although the distribution of limb injury in our study mirrored that found in the literature, the incidence is much higher than in previous studies (7.4-20%). This could either be due to differences in confounding factors such as intoxication and location of hanging or differences in the practice of recording of limb trauma in hanging between centres. Neither type of suspension nor location of hanging were significantly associated with an increased incidence of traumatic limb injury. Positive toxicology was found to increase the likelihood of sustaining limb injury (p = .044084). In conclusion, the presence of this well documented pattern of traumatic limb lesions in cases of hanging should not always raise suspicion of foul play.


Assuntos
Asfixia/patologia , Extremidade Inferior/lesões , Lesões do Pescoço/patologia , Extremidade Superior/lesões , Adulto , Distribuição por Idade , Asfixia/mortalidade , Depressores do Sistema Nervoso Central/sangue , Depressores do Sistema Nervoso Central/urina , Etanol/sangue , Etanol/urina , Feminino , Ciências Forenses , Humanos , Extremidade Inferior/patologia , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/mortalidade , Preparações Farmacêuticas/sangue , Estudos Retrospectivos , Distribuição por Sexo , Detecção do Abuso de Substâncias , Suicídio Consumado , Extremidade Superior/patologia , Adulto Jovem
16.
Adv Ther ; 37(3): 1013-1033, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31989486

RESUMO

INTRODUCTION: Chronic venous disease (CVD) is a common condition associated with valvular dysfunction, venous hypertension and endothelial inflammation. Sulodexide facilitates the healing of venous ulcers and is frequently used in patients with CVD without ulcer. This review assessed the efficacy and safety of sulodexide for treatment of signs and symptoms of lower extremity CVD. METHODS: We searched MEDLINE, EMBASE, CINAHL and AMED as well as the Cochrane Central Register of Controlled Trials and the World Health Organisation (WHO) International Clinical Trials Registry Platform Search Portal. We also manually searched potentially relevant journals, conference proceedings and journal supplements. Any study monitoring any effect of sulodexide in patients with CVD at any stage of the disease, classified or non-classified, was considered. Treatment effects were estimated using standardised mean differences (SMDs), mean differences (MDs) and risk ratios (RRs), as appropriate. We calculated 95% confidence intervals (CIs) and heterogeneity (Q, tau and I2). RESULTS: The search found 64 studies, but only 23 provided data on 7153 participants (mean age 55 years; 68% female). The 13 studies providing extractable quantitative information included 1901 participants (mean age 55.2 years; 65% female). Sulodexide decreased the intensity of pain, cramps, heaviness, oedema and total symptom score and reduced inflammatory mediators in patients with CVD. The risk of adverse events (AEs) was not different between sulodexide and placebo or heparan sulphate (RR 1.31, 95% CI 0.74-2.32; I2 = 0%; 270 participants). The overall risk of AEs with sulodexide was low: 3% (95% CI 1-4%) estimated from 3656 participants. CONCLUSION: Sulodexide was found to have a beneficial venoactive effect on the major signs and symptoms of CVD such as pain, cramps, heaviness and oedema without increasing the risk of AEs. It is also likely to exert a systemic effect on the course of CVD by interfering with inflammatory chemokines.


Assuntos
Glicosaminoglicanos/uso terapêutico , Extremidade Inferior/patologia , Insuficiência Venosa/tratamento farmacológico , Adulto , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Doença Crônica , Feminino , Glicosaminoglicanos/administração & dosagem , Glicosaminoglicanos/efeitos adversos , Humanos , Mediadores da Inflamação/metabolismo , Masculino , Pessoa de Meia-Idade , Medição da Dor
17.
Ann Vasc Surg ; 66: 609-613, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31978484

RESUMO

BACKGROUND: Soft tissue malignancy of lower limb can involve femoral triangle by direct tumoral invasion or secondary to ganglionic metastasis. Secondary arterial complications can appear during follow-up after initial tumoral resection and local radiation therapy. The aim of this study is to report our experience of secondary extra-anatomical lower limb revascularization following lower limb oncological resection with femoral bifurcation involvement. METHODS: This is a retrospective monocentric study including patients who underwent extra-anatomical iliopopliteal bypass, with a previous treated neoplasia involving homolateral femoral bifurcation. Proximal anastomosis was performed on the iliac artery, tunnelization was made through iliac wing, and distal anastomosis was done on distal superficial femoral or popliteal artery. RESULTS: Five patients underwent extra-anatomic iliopopliteal bypass for oncological purpose from 2008 to 2018 at our institution. Mean age at surgery time was 52 years (standard deviation = 19.3). Prosthetic graft was used in all cases. Primitive tumor involved Scarpa triangle in 3 cases (soft tissue sarcomas) and ganglionic metastasis involved Scarpa triangle in 2 cases (epidermoid carcinoma). Clinical presentation was ischemic in 4 cases and hemorrhagic in 1 case. One patient died during hospitalization. Of the 4 survivors, 3 patients had a patent bypass at the end of follow-up (2 had bypass thrombectomy, 1 patient had major amputation). CONCLUSIONS: Secondary iliopopliteal bypasses through the iliac wing following lower limb tumoral resection have acceptable results. It is a valid option for limb salvage especially after local radiation therapy and tumoral resection. Multidisciplinary management is necessary to obtain acceptable results and follow-up is mandatory.


Assuntos
Implante de Prótese Vascular , Artéria Femoral/cirurgia , Artéria Ilíaca/cirurgia , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/cirurgia , Neoplasias de Tecido Conjuntivo e de Tecidos Moles/cirurgia , Artéria Poplítea/cirurgia , Neoplasias de Tecidos Moles/cirurgia , Adulto , Idoso , Amputação , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Feminino , Artéria Femoral/fisiopatologia , França , Humanos , Artéria Ilíaca/fisiopatologia , Salvamento de Membro , Extremidade Inferior/patologia , Masculino , Pessoa de Meia-Idade , Neoplasias de Tecido Conjuntivo e de Tecidos Moles/secundário , Artéria Poplítea/fisiopatologia , Radioterapia Adjuvante , Estudos Retrospectivos , Neoplasias de Tecidos Moles/patologia , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular
18.
BMC Infect Dis ; 20(1): 60, 2020 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-31959118

RESUMO

BACKGROUND: Necrotizing fasciitis (NF) is a rare and life-threatening necrotizing skin and soft-tissue infection. Infectious pathogens of NF must be detected early and treated rapidly to prevent loss of limb or a fatal outcome. This study aimed to detect more reliable predictors between gram-negative and gram-positive monomicrobial NF of limbs. METHODS: A total of 100 patients with limb monomicrobial NF were diagnosed prospectively from April 2015 to July 2018. These monomicrobial NF pathogens can be divided into gram-negative and gram-positive groups according to the result of Gram staining and final bacterial reports. Data such as demographics, seawater or seafood contact history, infectious location, comorbidities, presenting signs and symptoms, and laboratory findings were recorded and compared. RESULTS: A total of 55 patients were infected with gram-negative organisms and 45 patients with gram-positive organisms. Among the 55 cases of monomicrobial gram-negative NF, 48 (87.3%) were caused mainly by Vibrio spp. (38, 69.1%) and Aeromonas spp. (10, 18.2%). A higher incidence of chronic kidney disease, cerebrovascular accident, tachypnea, and septic shock; a higher rate of band forms of leukocytes of more than 3%, serum lactate of more than 20 mg/dL, and C-reactive protein level of less than 150 mg/dL; prolonged prothrombin time; and a lower fibrinogen level were observed in patients with gram-negative infection. In a multivariate analysis, a higher incidence of seawater or seafood contact history (odds ratio [OR]: 66.301; 95% confidence interval [CI]: 7.467-588.702), a higher rate of hyperlactatemia (OR: 7.904; 95% CI: 1.231-50.744), and a low fibrinogen level (OR: 1.013; 95% CI: 1.004-1.023) indicated gram-negative infection. CONCLUSIONS: In southern Taiwan, NF of limbs mainly affected the lower limbs, exhibited monomicrobial infection, and was predominated by gram-negative bacteria. Gram-negative monomicrobial NF of limbs often occurred in individuals with the more seawater or seafood contact history, hyperlactatemia, and low fibrinogen levels.


Assuntos
Aeromonas/isolamento & purificação , Fasciite Necrosante/epidemiologia , Fasciite Necrosante/microbiologia , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções dos Tecidos Moles/epidemiologia , Infecções dos Tecidos Moles/microbiologia , Vibrio/isolamento & purificação , Idoso , Idoso de 80 Anos ou mais , Fasciite Necrosante/diagnóstico , Feminino , Infecções por Bactérias Gram-Negativas/diagnóstico , Humanos , Incidência , Extremidade Inferior/microbiologia , Extremidade Inferior/patologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Infecções dos Tecidos Moles/diagnóstico , Taiwan/epidemiologia
19.
Aging Clin Exp Res ; 32(1): 67-76, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30840205

RESUMO

BACKGROUND: Knee osteoarthritis is one of the most common orthopedic diseases. However, few studies have reported the morphometric characteristics of the lower leg related to the progression of knee osteoarthritis in regional populations. This study aimed to determine the radiographic morphometries of the lower leg in subjects who showed progression of osteoarthritis of the knee in the TOEI cohort. METHODS: Data were collected from the TOEI study cohort, during the period from 2014 to 2016, to assess osteoarthritis of the knee and radiographic morphometries of the lower leg. The joints were divided into three groups according to osteoarthritis progression over 2 years. There were 323 legs of females and 163 legs of males. Knees which did not exhibit osteoarthritis were in group 1; knees with osteoarthritis that remained stable for 2 years were in group 2; knees that worsened osteoarthritis over 2 years were in group 3. Morphometric parameters in the lower leg were measured by radiographs taken in 2014. RESULTS: In female subjects, group 2 had higher age, lower lever arm ratio and lower hip-knee-ankle angle, and higher height of the hip center compared with group (1). Group 3 had higher age compared with group 1 and lower height of the hip center compared with group (2). In male subjects, group 2 had lower height of the hip center and lower hip-knee-ankle angle compared with group 1. Group 3 had higher patellar shift index compared with group 1, higher height of the hip center and higher femoral neck length compared with group 2. CONCLUSIONS: Higher age was the risk of osteoarthritis progression of the knee in female subjects but not significant risk in male subjects. Hip morphometries such as height of the hip center and femoral neck length in which showed a sex difference might be associated with the progression of knee osteoarthritis.


Assuntos
Progressão da Doença , Extremidade Inferior/patologia , Osteoartrite do Joelho/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Articulação do Joelho/patologia , Extremidade Inferior/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Radiografia , Estudos Retrospectivos , Fatores Sexuais
20.
In Vivo ; 34(1): 291-298, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31882491

RESUMO

BACKGROUND: Management of post-traumatic open fractures resulting from severe injuries of the lower extremity continues to challenge orthopedic and reconstructive surgeons. Moreover, post-traumatic osteoarticular infections due to Clostridium species are rare, with few reports in the literature. We describe possible pathomechanisms and propose treatment options for cases of delayed diagnosis of osteoarticular infections with Clostridium spp. CASE REPORTS: Two patients sustained severe osteoarticular infection due to Clostridium spp. after open epi- and metaphyseal fractures of the lower extremity. In combination with radical debridement, ankle arthrodesis and long-term antibiotic treatment, satisfactory results were achieved after a follow-up of 18 months and 24 years. CONCLUSION: Clostridium species are difficult to identify, treatment is usually delayed and most patients have unfavourable outcomes.


Assuntos
Infecções por Clostridium/patologia , Clostridium/isolamento & purificação , Fixação Interna de Fraturas/efeitos adversos , Fraturas Expostas/cirurgia , Extremidade Inferior/cirurgia , Adulto , Antibacterianos/uso terapêutico , Infecções por Clostridium/tratamento farmacológico , Infecções por Clostridium/microbiologia , Feminino , Fraturas Expostas/patologia , Humanos , Extremidade Inferior/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA