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1.
Bone Joint J ; 102-B(1): 64-71, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31888359

RESUMO

AIMS: The purpose of this study was to report the long-term results of extendable endoprostheses of the humerus in children after the resection of a bone sarcoma. METHODS: A total of 35 consecutive patients treated with extendable endoprosthetic replacement of the humerus in children were included. There were 17 boys and 18 girls in the series with a median age at the time of initial surgery of nine years (interquartile range (IQR) 7 to 11). RESULTS: The median follow-up time was 10.6 years (IQR 3.9 to 20.4). The overall implant survival at ten years was 75%. Complications occurred in 13 patients (37%). Subluxation at the proximal humerus occurred in 19 patients (54%) but only six (17%) were symptomatic. Subluxation was seen more commonly in children under the age of nine years (86%) than in those aged nine years or more (33%) (p = 0.002). Implant failure occurred in nine patients (26%): the most common cause was aseptic loosening (four patients, 11%). Lengthening of the implant was carried out in 23 patients (66%). At final follow up, three patients had a limb that was shortened by 5 cm or more. The mean Musculoskeletal Tumor Society (MSTS) functional score was 79% (73% to 90%). CONCLUSION: Extendable endoprosthetic replacement is a reliable method of reconstructing humerus after excision of a bone sarcoma. Children who are less than nine years old have a high risk of subluxation. Cite this article: Bone Joint J 2020;102-B(1):64-71.


Assuntos
Neoplasias Ósseas/cirurgia , Úmero/cirurgia , Osteossarcoma/cirurgia , Membros Artificiais , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/mortalidade , Criança , Condrossarcoma/diagnóstico por imagem , Condrossarcoma/mortalidade , Condrossarcoma/cirurgia , Feminino , Humanos , Úmero/diagnóstico por imagem , Masculino , Margens de Excisão , Metástase Neoplásica , Osteossarcoma/diagnóstico por imagem , Osteossarcoma/mortalidade , Estudos Prospectivos , Próteses e Implantes , Desenho de Prótese , Falha de Prótese , Implantação de Prótese/métodos , Implantação de Prótese/mortalidade , Amplitude de Movimento Articular/fisiologia , Sarcoma de Ewing/diagnóstico por imagem , Sarcoma de Ewing/mortalidade , Sarcoma de Ewing/cirurgia , Resultado do Tratamento
2.
Bone Joint J ; 102-B(1): 117-124, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31888372

RESUMO

AIMS: It is unknown whether kinematic alignment (KA) objectively improves knee balance in total knee arthroplasty (TKA), despite this being the biomechanical rationale for its use. This study aimed to determine whether restoring the constitutional alignment using a restrictive KA protocol resulted in better quantitative knee balance than mechanical alignment (MA). METHODS: We conducted a randomized superiority trial comparing patients undergoing TKA assigned to KA within a restrictive safe zone or MA. Optimal knee balance was defined as an intercompartmental pressure difference (ICPD) of 15 psi or less using a pressure sensor. The primary endpoint was the mean intraoperative ICPD at 10° of flexion prior to knee balancing. Secondary outcomes included balance at 45° and 90°, requirements for balancing procedures, and presence of tibiofemoral lift-off. RESULTS: A total of 63 patients (70 knees) were randomized to KA and 62 patients (68 knees) to MA. Mean ICPD at 10° flexion in the KA group was 11.7 psi (SD 13.1) compared with 32.0 psi in the MA group (SD 28.9), with a mean difference in ICPD between KA and MA of 20.3 psi (p < 0.001). Mean ICPD in the KA group was significantly lower than in the MA group at 45° and 90°, respectively (25.2 psi MA vs 14.8 psi KA, p = 0.004; 19.1 psi MA vs 11.7 psi KA, p < 0.002, respectively). Overall, participants in the KA group were more likely to achieve optimal knee balance (80% vs 35%; p < 0.001). Bone recuts to achieve knee balance were more likely to be required in the MA group (49% vs 9%; p < 0.001). More participants in the MA group had tibiofemoral lift-off (43% vs 13%; p < 0.001). CONCLUSION: This study provides persuasive evidence that restoring the constitutional alignment with KA in TKA results in a statistically significant improvement in quantitative knee balance, and further supports this technique as a viable alternative to MA. Cite this article: Bone Joint J. 2020;102-B(1):117-124.


Assuntos
Artroplastia do Joelho/métodos , Prótese do Joelho , Osteoartrite do Joelho/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Feminino , Humanos , Curva de Aprendizado , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Osteoartrite do Joelho/fisiopatologia , Planejamento de Assistência ao Paciente , Cuidados Pré-Operatórios , Implantação de Prótese/métodos , Amplitude de Movimento Articular/fisiologia , Resultado do Tratamento
3.
Medicine (Baltimore) ; 98(52): e18406, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876713

RESUMO

As an anesthetic reversal agent, there are concerns with cholinesterase inhibitors regarding worsening of Parkinson's disease (PD)-related symptoms. Sugammadex, a relatively new reversal agent, does not inhibit acetylcholinesterase and does not require co-administration of an antimuscarinic agent. The present study compared the recovery profiles of 2 agents initially administered for reversal of neuromuscular blockade in patients with advanced PD who underwent deep brain stimulator implantation.A total of 121 patients with PD who underwent deep brain stimulator implantation were retrospectively analyzed. Patients were divided into 1 of 2 groups according to the type of neuromuscular blockade reversal agent (pyridostigmine vs sugammadex) initially administered. Recovery profiles reflecting time to extubation, reversal failure at first attempt, and hemodynamic stability, including incidence of hypertension or tachycardia during the emergence period, were compared.Time to extubation in the sugammadex group was significantly shorter (P < .001). In the sugammadex group, reversal failure at first attempt did not occur in any patient, while it occurred in seven (9.7%) patients in the pyridostigmine group (P = .064), necessitating an additional dose of pyridostigmine (n = 3) or sugammadex (n = 4). The incidence of hemodynamic instability during anesthetic emergence was significantly lower in the sugammadex group than in the pyridostigmine group (P = .019).Sugammadex yielded a recovery profile superior to that of pyridostigmine during the anesthesia emergence period in advanced PD patients. Sugammadex is also likely to be associated with fewer adverse effects than traditional reversal agents, which in turn would also improve overall postoperative management in this patient population.


Assuntos
Inibidores da Colinesterase/uso terapêutico , Estimulação Encefálica Profunda , Eletrodos Implantados , Bloqueio Neuromuscular/métodos , Doença de Parkinson/terapia , Implantação de Prótese , Brometo de Piridostigmina/uso terapêutico , Sugammadex/uso terapêutico , Período de Recuperação da Anestesia , Estimulação Encefálica Profunda/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Bloqueio Neuromuscular/efeitos adversos , Implantação de Prótese/métodos , Estudos Retrospectivos
4.
Undersea Hyperb Med ; 46(5): 625-632, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31683360

RESUMO

Objective: To evaluate the efficiency of percutaneous patent foramen ovale (PFO) closure on the recurrence of decompression illness (DCI). Design: Retrospective, observational study with interview and questionnaire. Setting: Tertiary referral center. Population: 59 scuba divers with a history of DCI who received a percutaneous PFO closure. Main outcome measurements: Questionnaire about health status, dive habits and recurrence of DCI after PFO closure. Results: A total of 59 divers with DCI were included. The most common manifestations of DCI were cutaneous or vestibular DCI. Procedural complications occurred in four patients but none with long-term consequences. Four patients had recurrence of DCI after closure during a 10-year follow-up. In three of these cases there was residual shunting, all of which were initially considered closed. The fourth patient had aggravating factors for his recurrent DCI. A quarter of the patients stated to have changed their diving habits. Four patients quit diving. Conclusion: Percutaneous PFO closure for secondary prevention of DCI is associated with few, but not negligible, complications. As a large portion of our cohort changed their diving habit after closure it is difficult to ascertain the efficiency of PFO closure for secondary prevention of DCI. However, the study shows that PFO closure does not fully protect against DCI, emphasizing that the relationship between PFO and DCI is but an association. As such it is imperative that divers be counseled to ensure they understand the risks as well as the benefits of percutaneous PFO closure in their specific case.


Assuntos
Doença da Descompressão/prevenção & controle , Mergulho/efeitos adversos , Forame Oval Patente/terapia , Prevenção Secundária/métodos , Dispositivo para Oclusão Septal , Adolescente , Adulto , Idoso , Doença da Descompressão/etiologia , Feminino , Forame Oval Patente/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/etiologia , Doenças Profissionais/prevenção & controle , Implantação de Prótese/efeitos adversos , Implantação de Prótese/métodos , Recreação , Recidiva , Estudos Retrospectivos , Volta ao Esporte/estatística & dados numéricos , Prevenção Secundária/instrumentação , Dispositivo para Oclusão Septal/efeitos adversos , Inquéritos e Questionários , Falha de Tratamento , Adulto Jovem
5.
Plast Reconstr Surg ; 144(2): 218e-229e, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31348345

RESUMO

BACKGROUND: Traditional approaches to amputation are not capable of reproducing the dynamic muscle relationships that are essential for proprioceptive sensation and joint control. In this study, the authors present two caprine models of the agonist-antagonist myoneural interface (AMI), a surgical approach designed to improve bidirectional neural control of a bionic limb. The key advancement of the AMI is the surgical coaptation of natively innervated agonist-antagonist muscle pairs within the residual limb. METHODS: One AMI was surgically created in the hindlimb of each of two African Pygmy goats at the time of primary transtibial amputation. Each animal was also implanted with muscle electrodes and sonomicrometer crystals to enable measurement of muscle activation and muscle state, respectively. Coupled agonist-antagonist excursion in the agonist-antagonist myoneural interface muscles was measured longitudinally for each animal. Fibrosis in the residual limb was evaluated grossly in each animal as part of a planned terminal procedure. RESULTS: Electromyographic and muscle state measurements showed coupled agonist-antagonist motion within the AMI in the presence of both neural activation and artificial muscle stimulation. Gross observation of the residual limb during a planned terminal procedure revealed a thin fibrotic encapsulation of the AMI constructs, which was not sufficient to preclude coupled muscle excursion. CONCLUSIONS: These findings highlight the AMI's potential to provide coupled motion of distal agonist-antagonist muscle pairs preserved during below- or above-knee amputation at nearly human scale. Guided by these findings, it is the authors' expectation that further development of the AMI architecture will improve neural control of advanced limb prostheses through incorporation of physiologically relevant muscle-tendon proprioception.


Assuntos
Amputação/métodos , Eletromiografia/métodos , Propriocepção , Desenho de Prótese , Implantação de Prótese/métodos , Animais , Membros Artificiais , Modelos Animais de Doenças , Eletrodos Implantados , Feminino , Fêmur/cirurgia , Cabras , Masculino , Músculo Esquelético/inervação , Tíbia/cirurgia
6.
Orthopade ; 48(10): 831-836, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31297556

RESUMO

INTRODUCTION: In the treatment of lumbar spinal stenosis, interspinous spacers can be used in a tissue and time sparing technique. Relief of low back pain might be achieved by stress reduction of facet joints and limitation of segmental mobility. AIM: Presentation of dynamic stabilization by means of an interspinous spacer with and without decompression and to compare it with the outcome of decompression and fusion. MATERIAL AND METHODS: As part of a PubMed search, randomized controlled trials (RCTs) and non-RCTs from high-quality controlled clinical trials were selected and contrasted with our own experience. RESULTS: The current literature was evaluated, which assesses interspinous spacers with and without decompression in comparison with the "gold standard", the microsurgical interlaminar decompression. CONCLUSION: Published data indicate that the use of interspinous spacers with or without decompression for the treatment of lumbar spinal stenosis is not less effective than stand-alone decompression. The reoperation rate can only be proven for implants without decompression on the basis of Level I studies. However, as a link between decompression alone and fusion, it cannot yet provide a scientifically clear solution.


Assuntos
Descompressão Cirúrgica/métodos , Fixadores Internos , Vértebras Lombares/cirurgia , Implantação de Prótese/métodos , Fusão Vertebral/métodos , Estenose Espinal/cirurgia , Descompressão Cirúrgica/instrumentação , Humanos , Fixadores Internos/efeitos adversos , Próteses e Implantes , Reoperação , Estenose Espinal/fisiopatologia , Resultado do Tratamento
7.
Indian J Ophthalmol ; 67(7): 1143-1147, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31238430

RESUMO

Purpose: External dacryocystorhinostomy (DCR) surgeries are cost-effective with excellent success rates. The present study was designed to compare the safety and efficacy of conventional external DCR versus external DCR using Pawar silicone implant in chronic dacryocystitis. Methods: This is a prospective, comparative, interventional case series over a period of 18 months with patients managed by external DCR surgery with and without Pawar implant. Institutional review board approval was obtained before the study. The success of the surgery was objectively measured by sac patency on syringing at the last follow up. Results: A total of 65 patients with chronic dacryocystitis were included in the study. The mean age of patients in the series was 41.43 years (median, 41 years; range, 12 years-60 years). All patients presented with epiphora (100%) and underwent external DCR and were chosen for conventional surgery (n = 33, 51%, group 1) or Pawar silicone implant surgery (n = 32, 49%, group 2) on a random basis. The mean duration of the surgery from the time of skin incision to skin closure for group 1 was 27.7 minutes (median, 26 minutes; range, 21-30 minutes) while in group 2, it was 75.5 minutes (median, 75 minutes; range, 60-88 minutes), which was statistically significant (P < 0.01). The success rate of the procedure done in group 1 was 90% which increased to 97% after the management of failed cases as compared to the success rate in group 2 of 91% and 94%, before and after the management of failed cases, respectively. Conclusion: External DCR using Pawar implant is a safe surgery which is faster than conventional external DCR with almost equal success rates between both the procedures.


Assuntos
Dacriocistite/cirurgia , Dacriocistorinostomia/métodos , Ducto Nasolacrimal/cirurgia , Implantação de Prótese/métodos , Elastômeros de Silicone , Adolescente , Adulto , Criança , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Desenho de Prótese , Adulto Jovem
8.
Korean J Ophthalmol ; 33(3): 214-221, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31179652

RESUMO

PURPOSE: To investigate the clinical features and surgical outcomes of encapsulated bleb excision with collagen matrix implantation performed in patients with failed Ahmed glaucoma valve (AGV) implantation. METHODS: Eighteen eyes of 18 patients underwent encapsulated bleb excision and collagen matrix implantation. Patients were divided into two groups by reference to intraocular pressure (IOP) after preoperative ocular massage: group 1, patients who exhibited substantial IOP reductions; and group 2, patients who did not show substantial changes in IOP. Needling was conducted in group 2. The clinical features of the two groups were compared, including IOP changes after ocular massage and needling, AGV status, and surgical outcomes 6 months after surgery. RESULTS: The mean preoperative IOP among the 18 patients was 30.6 ± 5.7 mmHg. After ocular massage, the IOPs decreased by 22 and 26 mmHg in the two patients in group 1 and the 16 patients in group 2 showed a mean IOP reduction of 1.6 ± 2.2 mmHg (p = 0.013). IOPs decreased after needling in group 2 (range, 6 to 30 mmHg; p < 0.001). Fibrovascular tissue ingrowth into the AGV was observed in the two patients in group 1 and the same ingrowth was observed in 10 of the 16 patients in group 2. Six months after surgery the mean IOP among the 18 patients decreased significantly (19.1 ± 3.2 mmHg, p < 0.001). There was no significant difference in the mean postoperative IOP at 6 months between group 1 (14.0 ± 2.8 mmHg) and group 2 (19.8 ± 2.6 mmHg, p = 0.052). CONCLUSIONS: Encapsulated bleb excision with collagen matrix implantation resulted in a significant IOP-lowering effect 6 months after surgery. Fibrovascular ingrowth into the AGV was common but did not seem to be a major cause of AGV implantation failure.


Assuntos
Colágeno/administração & dosagem , Implantes para Drenagem de Glaucoma/efeitos adversos , Glaucoma/cirurgia , Pressão Intraocular/fisiologia , Implantação de Prótese/métodos , Acuidade Visual , Adulto , Idoso , Feminino , Seguimentos , Glaucoma/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodos , Adulto Jovem
9.
Curr Opin Ophthalmol ; 30(4): 220-228, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31170100

RESUMO

PURPOSE OF REVIEW: To review the efficacy of intrastromal corneal ring segments (ICRS) for keratoconus and with other interventions such as contacts lens, keratoplasty, and corneal collagen cross-linking. RECENT FINDINGS: Changes in ICRS thickness and size, combination of procedures, and the adaptation of a more sophisticated classification system have broadened our application of ICRS. Recent studies have shown the long-term efficacy of ICRS in visual acuity, keratometry, and astigmatism. SUMMARY: Studies have demonstrated the short-term and long-term efficacy of ICRS implantation in patients with keratoconus.


Assuntos
Substância Própria/cirurgia , Ceratocone/cirurgia , Próteses e Implantes , Implantação de Prótese/métodos , Colágeno/metabolismo , Lentes de Contato , Substância Própria/metabolismo , Reagentes para Ligações Cruzadas/uso terapêutico , Humanos , Ceratocone/metabolismo , Fotoquimioterapia/métodos , Resultado do Tratamento , Acuidade Visual/fisiologia
10.
J Craniofac Surg ; 30(7): e590-e593, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31157636

RESUMO

PURPOSE: To compare the results of 3 evisceration techniques involving placement of an acrylic implant within the scleral shell without posterior sclerotomy (Group 1), posterior sclerotomy with placement of a porous implant within the intraconal space (Group 2) and posterior sclerotomy with placement of a acrylic implant within the intraconal space (Group 3) with respect to ocular mobility, implant complications and patient satisfaction. METHODS: Single-center, retrospective, interventional case series. A chart review of 72 patients undergoing evisceration between February 2013 and January 2018 was carried out. Thirty-five patients met the inclusion criteria having a normal or near normal size eye and at least 6 months follow-up. The horizontal movements of the implant and the artificial eye was measured by using a ruler. Data analyses were conducted using the Mann-Whitney U test for 2 independent samples. RESULTS: Neither infection nor prolapse of the implant had occurred in any of the patients. The mean implant sizes were 18 mm in Group 1, 20 mm in Group 2 and 20 mm in Group 3. Statistically, a significant difference was assessed between Group 1 and Group 2 in both nasal and temporal movement of the socket; nasal and temporal movement of the prosthesis. Statistically, a significant difference was assessed between Group 1 and Group 3 in both nasal and temporal movement of the socket; nasal and temporal movement of the prosthesis. However, there was no statistically significant difference between Group 2 and Group 3 in neither nasal and temporal movement of the socket nor nasal and temporal movement of the artificial eye. CONCLUSION: Group 1 showed the significantly better movement of both prosthesis and socket in adduction and abduction than Group 2 and 3. The likely explanation for this may be that preserving the scleral shell integrity allows more efficient transmission of muscle contraction to the socket and prosthesis.


Assuntos
Movimentos Oculares , Adolescente , Adulto , Idoso , Criança , Evisceração do Olho , Olho Artificial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nariz , Implantes Orbitários , Satisfação do Paciente , Porosidade , Complicações Pós-Operatórias , Implantação de Prótese/métodos , Estudos Retrospectivos , Esclera/cirurgia , Adulto Jovem
11.
BMC Musculoskelet Disord ; 20(1): 213, 2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-31092237

RESUMO

BACKGROUND: An interspinous process device, the Device for Intervertebral Assisted Motion (DIAM™) designed to treat lumbar neurogenic disease secondary to the lumbar spinal stenosis, it provides dynamic stabilization after minimally invasive (MI) lumbar decompression. The current study was conducted using an experimentally validated L1-L5 spinal finite element model (FEM) to evaluate the limited decompression on range of motion (ROM) and stress distribution on a neural arch implanted with the DIAM. METHODS: The study simulated bilateral laminotomies with partial discectomy at L3-L4, as well as unilateral and bilateral laminotomies with partial discectomy combined with implementation of the DIAM at L3-L4. The ROM and maximum von Mises stresses in flexion, extension, lateral bending, and axial torsion were analyzed in response to the hybrid protocol in comparison with the intact model. RESULTS: The investigation revealed that decreased ROM, intradiscal stress, and facet joint force at the implant level, but considerably increased stress at the pars interarticularis were found during flexion and torsion at the L4, as well as during extension, lateral bending, and torsion at the L3, when the DIAM was implanted compared with the defect model. CONCLUSION: The results demonstrate that the DIAM may be beneficial in reducing the symptoms of stress-induced low back pain. Nevertheless, the results also suggest that a surgeon should be cognizant of the stress redistribution at the pars interarticularis results from MI decompression plus the application of the interspinous process device.


Assuntos
Vértebras Lombares/cirurgia , Modelos Biológicos , Próteses e Implantes , Implantação de Prótese/métodos , Estenose Espinal/cirurgia , Discotomia/instrumentação , Discotomia/métodos , Estudos de Viabilidade , Análise de Elementos Finitos , Humanos , Disco Intervertebral/fisiologia , Disco Intervertebral/cirurgia , Laminectomia/instrumentação , Laminectomia/métodos , Vértebras Lombares/fisiologia , Implantação de Prótese/instrumentação , Amplitude de Movimento Articular/fisiologia , Estresse Mecânico
12.
Graefes Arch Clin Exp Ophthalmol ; 257(8): 1741-1750, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31093766

RESUMO

PURPOSE: To compare the efficacy and safety of the XEN45 implant with that of trabeculectomy (TRAB), either alone or in combination with phacoemulsification (PHACO), in patients with open-angle glaucoma (OAG). METHODS: Retrospective, single-center and comparative study conducted on OAG patients. Patients were divided into four groups: group 1 (XEN alone); group 2 (XEN+PHACO); group 3 (TRAB alone); group 4 (TRAB+PHACO). For statistical purposes, groups 1 and 2 were combined (XEN implant), while groups 3 and 4 were also combined (TRAB surgery). The main outcome measure was intraocular pressure (IOP). RESULTS: Ninety-one patients (121 eyes; 65 XEN and 56 TRAB) were included. IOP reduction was - 6.7 (- 10.4 to - 3.0) mmHg, p = 0.0013; - 3.5 (- 5.0 to - 2.0) mmHg, p < 0.0001; - 8.1 (- 10.4 to - 5.9) mmHg, p < 0.0001l; and - 7.3 (- 9.3 to - 5.3) mmHg, p < 0.0001 in the XEN alone, XEN+PHACO, TRAB alone, and TRAB+PHACO, respectively. At month 12, an IOP ≥ 6 and ≤ 16 mm without treatment was achieved by 44 (67.7%) and 43 (76.8%), p = 0.2687 in the XEN implant and the TRAB surgery groups, respectively. The mean number of antiglaucoma medications was significantly reduced in all the study groups (p < 0.0001 each). Needling occurred in 20.0% (13/65) of eyes in the XEN implant group, while hyphema occurred in 30.4% (17/56) of eyes in the TRAB group. CONCLUSIONS: XEN implant, either alone or in combination with phacoemulsification, significantly reduces both IOP and the number of antiglaucoma medications to a similar rate than trabeculectomy, but with a better safety profile.


Assuntos
Catarata/complicações , Glaucoma de Ângulo Aberto/cirurgia , Pressão Intraocular/fisiologia , Facoemulsificação/métodos , Implantação de Prótese/métodos , Esclera/cirurgia , Trabeculectomia/métodos , Idoso , Feminino , Seguimentos , Glaucoma de Ângulo Aberto/complicações , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Masculino , Desenho de Prótese , Estudos Retrospectivos , Acuidade Visual
13.
Khirurgiia (Mosk) ; (4): 72-76, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31120451

RESUMO

It is presented diagnosis and treatment of 53-year-old man with multiple echinococcosis of the lungs and mediastinum. The diagnosis was confirmed by chest CT. Patient previously underwent surgery for liver echinococcosis. Excision of echinococcosis lesions in the lungs and mediastinum was performed. Chest wall repair was made by using of pedicled flap from the right lateral surface of the thorax followed by donor site plasty by polypropylene mesh. There were no intraoperative complications. In the postoperative period, intermediate bronchus occlusion mas made by occluder due to persistent air output through the pleural drains. The device was removed after 4 days. The patient was discharged. Multidisciplinary approach is useful to achieve good results in these patients.


Assuntos
Equinococose/cirurgia , Doenças do Mediastino/cirurgia , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Parede Torácica/cirurgia , Fístula Anastomótica/terapia , Brônquios/cirurgia , Equinococose/diagnóstico , Equinococose Pulmonar/diagnóstico , Equinococose Pulmonar/cirurgia , Humanos , Masculino , Doenças do Mediastino/diagnóstico , Pessoa de Meia-Idade , Implantação de Prótese/métodos , Recidiva , Retalhos Cirúrgicos , Procedimentos Cirúrgicos Torácicos/métodos , Tomografia Computadorizada por Raios X
14.
Eur Arch Otorhinolaryngol ; 276(8): 2165-2170, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31053966

RESUMO

PURPOSE: We compared our historical medium-term data obtained with an active semi-implanted bone conduction device and the hearing results of a new passive bone conduction hearing device to determine its predictive value for the hearing results with the semi-implanted device. METHODS: The study sample was 15 patients with an active bone conduction implant (mean follow-up 26 months). Pure tone audiometry was performed with headphones, sound field speech audiometry was conducted unaided, and free-field speech audiometry was carried out with both the active bone conduction system and the passive device switched off. RESULTS: As compared with the unaided condition, speech reception was significantly improved with both devices. Comparison of speech reception threshold at 100% of word recognition showed no difference between the active and the passive device. At lower intensity the difference in speech perception was significant in the patients with monaural fitting (group A) and was non-statistically significant in those with binaural fitting (group B); the speech reception threshold at 50% of word recognition was 26.00 dB (± 10.22) with the active implant and 30.50 dB (± 7.98) with the passive device in group A (p = 0.047) and 24.00 dB (± 5.48) and 29.00 dB (± 2.24) in group B (p = 0.052), respectively. CONCLUSIONS: The hearing outcome after active bone conduction implant was comparable to published data. Compared with the unaided condition, speech recognition was significantly improved with the passive device. The device may also provide value to predict the hearing outcome with the implanted device, especially at higher intensities. LEVEL OF EVIDENCE: IV.


Assuntos
Condução Óssea , Auxiliares de Audição , Perda Auditiva Condutiva , Implantação de Prótese/métodos , Qualidade de Vida , Adulto , Audiometria da Fala/métodos , Feminino , Auxiliares de Audição/classificação , Auxiliares de Audição/tendências , Perda Auditiva Condutiva/diagnóstico , Perda Auditiva Condutiva/psicologia , Perda Auditiva Condutiva/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Percepção da Fala
15.
J Surg Oncol ; 120(1): 57-64, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31055849

RESUMO

Advanced pancreaticobiliary malignancy tends to be uncurable at presentation and causes significant morbidity for patients. Palliation for malignant biliary obstruction should be minimally invasive, cost-effective, and aim to improve quality of life of patients. Strategies of endoscopic palliation of malignant biliary obstruction can differ based on sites and degree of biliary obstruction with complex decisions of optimal stent type and placement that involve conscientious planning by a multidisciplinary team.


Assuntos
Neoplasias dos Ductos Biliares/complicações , Colestase/cirurgia , Endoscopia do Sistema Digestório/métodos , Cuidados Paliativos , Neoplasias dos Ductos Biliares/diagnóstico por imagem , Colestase/diagnóstico por imagem , Colestase/etiologia , Constrição Patológica , Drenagem/métodos , Humanos , Neoplasias Pancreáticas/complicações , Implantação de Prótese/métodos , Stents
16.
Medicine (Baltimore) ; 98(21): e15777, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31124968

RESUMO

The present study sought to assess the feasibility and effectiveness of double stent insertion as a means of managing combined malignant airway and superior vena cava (SVC) obstruction (CMASO).From July 2010 to January 2018, twelve consecutive patients with CMASO were treated by double stent insertion (airway and SVC stents) in our centers. We assessed data pertaining to both technical and clinical success rates, as well as to long-term patient outcomes.The use of double stents (12 airway stents and 19 SVC stents) was technically successful in all study subjects, with a 0 to 92 days period between the 2 stent insertions (mean 27.8 days). Patients did not show evidence of any procedure-related complications. Mean patient Hugh-Jones grades improved from 4.4 ±â€Š0.5 before inserting the airway stent down to 1.2 ±â€Š0.4 following this insertion (P < .001). Mean SVC pressure was reduced from 17.5 ±â€Š2.8 mm Hg before the stent insertion down to 6.7 ±â€Š1.4 mm Hg following this insertion (P < .001). Fifty-six days after insertion, a single patient experienced re-obstruction of their SVC stent. All patients died within the follow-up period, with a median survival time of 113 days for these 12 patients.This double stent insertion protocol is both effective and safe as a means of offering palliative care to those with CMASO.


Assuntos
Obstrução das Vias Respiratórias/cirurgia , Neoplasias Pulmonares/cirurgia , Implantação de Prótese/instrumentação , Stents , Síndrome da Veia Cava Superior/cirurgia , Idoso , Obstrução das Vias Respiratórias/etiologia , Estudos de Viabilidade , Feminino , Humanos , Neoplasias Pulmonares/complicações , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/métodos , Implantação de Prótese/métodos , Estudos Retrospectivos , Síndrome da Veia Cava Superior/complicações , Resultado do Tratamento
17.
Cochrane Database Syst Rev ; 5: CD011150, 2019 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-31087649

RESUMO

BACKGROUND: Keratoconus is a degenerative condition of the cornea that profoundly affects vision and vision-specific quality of life. The axial cornea thins and protrudes, resulting in irregularity and, eventually, scarring of the cornea. There are multiple options available for treating keratoconus. Intrastromal corneal ring segments are small, crescent-shaped plastic rings that are placed in the deep, peripheral corneal stroma in order to flatten the cornea. They are made of polymethylmethacrylate (PMMA). The procedure does not involve corneal tissue nor does it invade the central optical zone. Intrastromal corneal ring segments are approved for use when contact lenses or spectacles are no longer adequate. OBJECTIVES: To evaluate the effectiveness and safety of intrastromal corneal ring segments as a treatment for keratoconus. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2018, Issue 1); Ovid MEDLINE; Embase.com; PubMed; Latin American and Caribbean Health Sciences Literature Database (LILACS); ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We did not implement any date or language restrictions in the electronic search for trials. We last searched the electronic databases on 25 January 2018. SELECTION CRITERIA: Two review authors independently assessed records from the electronic searches to identify randomized controlled trials (RCTs). Disagreements were resolved by discussion. DATA COLLECTION AND ANALYSIS: We planned for two authors to independently review full-text reports, using standard methodological procedures expected by Cochrane. MAIN RESULTS: We found no RCTs comparing intrastromal corneal ring segments with spectacles or contact lenses. AUTHORS' CONCLUSIONS: In the absence of eligible RCTs to review, no conclusions can be drawn.


Assuntos
Substância Própria/cirurgia , Ceratocone/cirurgia , Implantação de Prótese/métodos , Transplante de Córnea/métodos , Humanos , Próteses e Implantes
18.
Gac Med Mex ; 155(2): 196-198, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31056601

RESUMO

The treatment of refractory terminal heart failure has been heart transplantation. However, there are limitations with regard to clinical conditions of the recipient and availability of donors, and ventricular support has therefore been alternatively used as destination therapy. We describe the case is of a female patient with ischemic cardiomyopathy-associated heart failure who had a left ventricular assist device successfully implanted and at eight months of the procedure was at functional class I, with no complications.


Assuntos
Insuficiência Cardíaca/cirurgia , Coração Auxiliar , Isquemia Miocárdica/cirurgia , Idoso , Feminino , Seguimentos , Humanos , Isquemia Miocárdica/complicações , Implantação de Prótese/métodos
19.
J Card Surg ; 34(6): 424-427, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31017328

RESUMO

BACKGROUND AND AIM OF THE STUDY: Cardiac implantable electronic device (CIED) implantation is associated with an increase in CIED infection. For pacemaker-dependent patients, temporary pacemaker leads are implanted until infection remission, which allows new CIED implantation. We compared the outcome of pacemaker-dependent patients with infected CIED based on whether a combined single procedure of epicardial pacemaker implantation with system extraction or a temporary transjugular pacemaker implantation with interval system implantation was performed. METHODS: This retrospective study included pacemaker-dependent patients with CIED infection who were divided into two groups: the Tempo and Epi groups. The Tempo group received temporary transvenous pacemaker connected to an external pulse generator. After infection remission, a new permanent pacemaker was implanted, and the temporary pacemaker leads were removed. The Epi group received implantable epicardial right-ventricular pacemaker through infrasternal inferior pericardiotomy, and a permanent pulse generator was implanted through the same incision between the subcutaneous tissue and abdominal fascia. RESULTS: Sixty-six patients were included. Forty-two patients with epicardial pacemakers were discharged after 9.5 ± 8.8 days without infection of the newly implanted epicardial pacemaker. Patients with temporary transjugular pacemaker lead were discharged 23 ± 15 days after receiving permanent pacemakers. No serious complications were recorded in the Epi group. CONCLUSIONS: CIED infections in pacemaker-dependent patients can be treated through epicardial pacemaker implantation that allows early patient mobility and reduces hospital stay with no risk of epicardial pacemaker infection. Epicardial pacemakers can be used as a bridge until permanent intravenous CIED is implanted or as a replacement for permeant intravenous CIED.


Assuntos
Desfibriladores Implantáveis , Remoção de Dispositivo/métodos , Marca-Passo Artificial , Implantação de Prótese/métodos , Infecções Relacionadas à Prótese/cirurgia , Idoso , Desfibriladores Implantáveis/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial/efeitos adversos , Pericardiectomia/métodos , Estudos Retrospectivos , Resultado do Tratamento
20.
Br J Radiol ; 92(1098): 20180957, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31017467

RESUMO

OBJECTIVE: To evaluate the efficacy and safety of fluoroscopic self-expandable metallic stent (SEMS) placement for treating postoperative nonanastomotic strictures in the proximal small bowel. METHODS: Data from 8 consecutive patients (mean age, 63.8 ± 6.9 years; 7 males and 1 female) who underwent 17 fluoroscopic SEMS placement procedures in total for treating postoperative nonanastomotic strictures in the proximal jejunum were retrospectively reviewed. The most recent surgery for all the patients was total gastrectomy with esophagojejunostomy. Strictures were located in the proximal jejunum in all patients. The mean length of the strictures was 5.8 ± 2.0 cm. Five patients with comorbidities were poor surgical candidates. Four patients underwent fluoroscopic balloon dilation, three of whom showed no resolution of obstructive symptoms and one demonstrated recurrence of symptoms. RESULTS: Technical and clinical success was achieved in 100% (17/17) SEMS procedures. Complete resolution of obstructive symptoms and improvement in oral intake status occurred within 3 days after all procedures, rendering a clinical success rate of 100% (17/17). No complication occurred during or after the procedures. The median follow-up duration was 167 [interquartile range (IQR), 48-576] days. Stent malfunction occurred after 58.8% (10/17) of the procedures, including six occurrences of stent migration and four of benign tissue hyperplasia. Surgical removal of the migrated stents was performed in two patients. Recurrence of symptoms occurred after 64.7% (11/17) of the procedures. The median stent dwell and recurrence-free times were 32 (IQR, 20-193) and 68 (IQR, 38-513) days, respectively. CONCLUSION: Fluoroscopic SEMS placement may be effective and safe for treating postoperative nonanastomotic strictures, but stent malfunction and recurrence are major drawbacks. ADVANCES IN KNOWLEDGE: SEMS placement is effective and relatively safe in patients with postoperative nonanastomotic strictures in the proximal small bowel. Patients section and counseling is highly encouraged.


Assuntos
Obstrução Intestinal/cirurgia , Doenças do Jejuno/cirurgia , Complicações Pós-Operatórias/cirurgia , Stents Metálicos Autoexpansíveis , Remoção de Dispositivo/métodos , Feminino , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Falha de Prótese/etiologia , Implantação de Prótese/métodos , Recidiva
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