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1.
J Pediatr Orthop ; 40(2): 71-77, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31923166

RESUMO

BACKGROUND: The majority of research on medial (MCL) and lateral (LCL) collateral ligament injuries has focused on adults and combined collateral/cruciate injuries. The purpose of this study was to determine characteristics associated with isolated collateral ligament injuries in adolescents, and assess timing for return to sports. METHODS: Electronic medical records were queried to identify patients aged below 17 years who sustained a magnetic resonance imaging-confirmed isolated MCL or LCL injury over an 8-year period. Retrospective review then documented patient and injury characteristics and clinical course. General linear modeling was used to analyze risk factors for prolonged return to sports, continued pain or reinjury. RESULTS: Fifty-one knees (33 in males, 65%), mean age 13.8 years (range, 5 to 17), were identified, of which 40 (78%) had MCL injuries. Over half (29, 57%) of knees had an open distal femoral physis including all 5 bony avulsion injuries. Eleven (22%) had LCL injuries of which 3 (6%) had concurrent posterolateral corner injuries. Forty-two (82%) knees had injuries that occurred during sports. Eleven knees (28%) with MCL tears had a simultaneous patellar instability episode. Knee injuries that occurred during sports had 37% shorter recovery time (P=0.02). Eight knees (16%) experienced a reinjury and 12 (24%) were followed over an extended period of time for various knee issues. Football injuries were more likely to be grade 3 (P=0.03), and football and soccer accounted for all grade III injuries. The mean return to sports was 2.2 months, with grade III cases returning at 2.4 months, and 95% of cases within 4 months. CONCLUSIONS: Isolated collateral ligament injuries are rare in adolescent athletes. MCL injuries, one-quarter of which occurred in conjunction with patellar instability events, were 4 times more common than LCL injuries, one quarter of which have other posterolateral corner structures involved. Grade III injuries represent 20% to 25% of collateral ligament injuries and occurred most commonly in football and soccer. LEVEL OF EVIDENCE: Level IV-retrospective case series.


Assuntos
Instabilidade Articular/complicações , Traumatismos do Joelho/complicações , Ligamento Colateral Médio do Joelho/lesões , Articulação Patelofemoral/lesões , Volta ao Esporte , Adolescente , Traumatismos em Atletas/diagnóstico por imagem , Traumatismos em Atletas/terapia , Criança , Feminino , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/terapia , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/terapia , Imagem por Ressonância Magnética , Masculino , Ligamento Colateral Médio do Joelho/diagnóstico por imagem , Recidiva , Estudos Retrospectivos , Lesões dos Tecidos Moles/complicações , Lesões dos Tecidos Moles/diagnóstico por imagem , Lesões dos Tecidos Moles/terapia , Fatores de Tempo
2.
Medicine (Baltimore) ; 98(44): e17728, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689815

RESUMO

The effects of soft tissue damage and ulnar angulation deformity on radial head instability in Monteggia fractures are unclear. We tested the hypothesis that radial head instability correlates with the magnitude of ulnar angular deformity and the degree of proximal forearm soft tissue injury in Bado type I Monteggia fractures.We performed a biomechanical study in 6 fresh-frozen cadaveric upper extremities. Monteggia fractures were simulated by anterior ulnar angulation osteotomy and sequential sectioning of ligamentous structures. We measured radial head displacement during passive mobility testing in pronation, supination, and neutral rotation using an electromagnetic tracking device. Measurements at various ligament sectioning stages and ulnar angulation substages were statistically compared with those in the intact elbow.Radial head displacement increased with sequential ligament sectioning and increased proportionally with the degree of anterior ulnar angulation. Annular ligament sectioning resulted in a significant increase in displacement only in pronation (P < .05). When the anterior ulnar deformity was reproduced, the radial head displaced least in supination. The addition of proximal interosseous membrane sectioning significantly increased the radial head displacement in supination (P < .05), regardless of the degree of anterior ulnar angulation.Our Monteggia fracture model showed that radial head instability is influenced by the degree of soft tissue damage and ulnar angulation. Annular ligament injury combined with a minimal (5°) ulnar deformity may cause elbow instability, especially in pronation. The proximal interosseous membrane contributes to radial head stability in supination, regardless of ulnar angulation, and proximal interosseous membrane injury led to significant radial head instability in supination.


Assuntos
Articulação do Cotovelo/fisiopatologia , Traumatismos do Antebraço/fisiopatologia , Instabilidade Articular/fisiopatologia , Fratura de Monteggia/fisiopatologia , Lesões dos Tecidos Moles/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Cadáver , Articulação do Cotovelo/lesões , Feminino , Traumatismos do Antebraço/complicações , Humanos , Instabilidade Articular/etiologia , Masculino , Pessoa de Meia-Idade , Fratura de Monteggia/complicações , Rádio (Anatomia)/lesões , Amplitude de Movimento Articular , Lesões dos Tecidos Moles/complicações , Ulna/lesões
3.
Pediatr. aten. prim ; 21(83): 271-273, jul.-sept. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-188645

RESUMO

El seroma de Morel-Lavallée consiste en una separación de la piel y el tejido celular subcutáneo con respecto a la fascia muscular, lo que origina un espacio que se rellena por líquido. Se presenta el caso de un niño de ocho años que acudió a nuestra consulta por tumefacción fluctuante tras antecedente traumático


Morel-Lavallée seroma consists of a separation of the skin and the subcutaneous cellular tissue from the muscular fascia, which originates a space that is filled by liquid. We present the case of an eight-year-old boy who went to our medical office for fluctuating swelling after traumatic antecedent


Assuntos
Humanos , Masculino , Criança , Seroma/diagnóstico , Desenluvamentos Cutâneos/diagnóstico , Extremidade Inferior/lesões , Diagnóstico Diferencial , Lesões dos Tecidos Moles/complicações , Edema/etiologia , Hematoma/etiologia
4.
Int Orthop ; 43(11): 2539-2547, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31440891

RESUMO

BACKGROUND: Tibiofibular syndesmosis injury leads to ankle pain and dysfunction when ankle injuries are not treated properly. Despite several studies having been performed, many questions about diagnosis and treatment remain unanswered, especially in ankle syndesmosis injury with interosseous membrane injury. Therefore, the purpose of this study was to help guide best practice recommendations. METHODS: This review explores the mechanism of injury, clinical features, diagnosis methods, and the treatment strategy for ankle syndesmosis injury with interosseous membrane injury to highlight the current evidence in terms of the controversies surrounding the management of these injuries. RESULTS: Radiological and CT examination are an important basis for diagnosing ankle syndesmosis injury. Physical examination combined with MRI to determine the damage to the interosseous membrane is significant in guiding the treatment of ankle syndesmosis injury with interosseous membrane injury. In the past, inserting syndesmosis screws was the gold standard for treating ankle syndesmosis injury. However, there were increasingly more controversies regarding loss of reduction and broken nails, so elastic fixation has become more popular in recent years. CONCLUSIONS: Anatomical reduction and effective fixation are the main aspects to be considered in the treatment of ankle syndesmosis injury with interosseous membrane injury and are the key to reducing postsurgery complications.


Assuntos
Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Membrana Interóssea/lesões , Membrana Interóssea/cirurgia , Adulto , Fraturas do Tornozelo/complicações , Fraturas do Tornozelo/diagnóstico por imagem , Fraturas do Tornozelo/cirurgia , Traumatismos do Tornozelo/complicações , Fíbula/diagnóstico por imagem , Fíbula/lesões , Fíbula/cirurgia , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Masculino , Guias de Prática Clínica como Assunto , Lesões dos Tecidos Moles/complicações , Lesões dos Tecidos Moles/diagnóstico por imagem , Lesões dos Tecidos Moles/cirurgia , Tíbia/diagnóstico por imagem , Tíbia/lesões , Tíbia/cirurgia
5.
Int J Surg Pathol ; 27(7): 722-728, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31208254

RESUMO

Patients often cite a history of trauma prior to the diagnosis of a sarcoma. Sparse literature suggests that there may be a link between sarcoma development and trauma. A 10-year review of academic tertiary-referral sarcoma center database was examined to identify patients who developed a sarcoma after having a history of a significant musculoskeletal trauma. A total of 501 patients were treated for a sarcoma during this time period. Six patients were identified as previously having a significant musculoskeletal trauma at the site of sarcoma development. Half of the sarcomas arose in bone and the other half in soft tissue. Five (83%) patients had multiple operations for the injury with 3 (50%) patients having a postoperative wound infection. The average time from injury to development of the sarcoma was 19.8 years. Survival after diagnosis was poor, and 4 (67%) of the patients died due to their metastatic disease within 3 years of diagnosis. Our findings suggest the possibility of post-traumatic sarcomas.


Assuntos
Neoplasias Ósseas/etiologia , Neoplasias Musculares/etiologia , Procedimentos Ortopédicos/efeitos adversos , Sarcoma/etiologia , Lesões dos Tecidos Moles/complicações , Infecção da Ferida Cirúrgica/complicações , Adulto , Idoso , Neoplasias Ósseas/patologia , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Musculares/patologia , Sistema Musculoesquelético/lesões , Sistema Musculoesquelético/patologia , Sistema Musculoesquelético/cirurgia , Estudos Retrospectivos , Sarcoma/patologia , Lesões dos Tecidos Moles/patologia , Lesões dos Tecidos Moles/cirurgia , Análise de Sobrevida , Centros de Atenção Terciária/estatística & dados numéricos
6.
J Foot Ankle Surg ; 58(4): 702-705, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31079983

RESUMO

Soft tissue injuries associated with malleolar fracture-dislocations may increase postoperative rates of wound complication. Ankle-spanning frame plays a fundamental role in the local damage control orthopedics while gaining time for definitive surgery. The objective of this study was to evaluate the effect of a 2-stage surgery for the unstable malleolar fracture-dislocations with severe soft tissue injuries compared to a 1-stage surgery in terms of the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot-ankle and Olerud-Molander ankle scores (OMAS). We analyzed 45 patients who met our study criteria. The patients were divided into 2 groups according to staged surgeries. Demographic data of patients, comorbidities, alcohol and tobacco use, Tscherne soft tissue injury scores, the AOFAS hindfoot-ankle and OMAS, postoperative complications, total hospitalization times, waiting time between stages, and waiting time from admission to surgery times were investigated. There was a statistically significant difference between the groups in terms of the mean total hospitalization times (p = .007), waiting time from admission to surgery (p < .001), gender (p = .005), and Tscherne soft tissue injury scores (p < .001). The mean AOFAS hindfoot-ankle and OMAS of the groups did not differ statistically at a minimum of 12 months of the follow-up period (p = .094 and p = .126, respectively). A 2-stage surgery can be performed safely in the carefully selected patients with the unstable malleolar fracture-dislocations with Tscherne grades 2 and 3 soft tissue injuries, and this surgery does not affect the postoperative AOFAS hindfoot-ankle and OMAS statistically compared to a 1-stage surgery at a minimum of 12 months of the follow-up period.


Assuntos
Traumatismos do Tornozelo/cirurgia , Fixadores Externos , Fratura-Luxação/cirurgia , Fixação de Fratura/métodos , Lesões dos Tecidos Moles/cirurgia , Adulto , Articulação do Tornozelo/cirurgia , Feminino , Fratura-Luxação/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Lesões dos Tecidos Moles/complicações , Resultado do Tratamento
7.
BMJ Case Rep ; 12(4)2019 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-30948414

RESUMO

We report the case of an initial misdiagnosis of significant scalp soft tissue hidden beneath a semirigid cervical collar. A 16-year-old unrestrained rear seat passenger was involved in an RTA sustaining a subdural haematoma, cervical spine fractures and what was initially diagnosed as a significant degloving scalp injury. The patient was admitted to the intensive care unit intubated sedated, and with a cervical collar. The scalp injury was dressed with a view that potential reconstructive surgery would be needed subsequently.This case demonstrates that while cervical collars remain a fundamental aspect of initial prehospital care in trauma, they have potential drawbacks to their use, which need to be carefully noted. Some of these drawbacks have been reported extensively in the literature. This case outlines the necessity of a thorough secondary survey in the trauma patient as the cervical collar can obscure the assessment of significant head and neck soft tissue injuries.


Assuntos
Vértebras Cervicais/lesões , Imobilização/efeitos adversos , Aparelhos Ortopédicos/efeitos adversos , Lesões dos Tecidos Moles/diagnóstico , Fraturas da Coluna Vertebral/terapia , Contenções/efeitos adversos , Acidentes de Trânsito , Adolescente , Traumatismos Craniocerebrais , Erros de Diagnóstico , Feminino , Humanos , Imobilização/instrumentação , Couro Cabeludo/lesões , Lesões dos Tecidos Moles/complicações , Fraturas da Coluna Vertebral/complicações
8.
Rev Med Inst Mex Seguro Soc ; 56(6): 566-569, 2019 Mar 15.
Artigo em Espanhol | MEDLINE | ID: mdl-30889347

RESUMO

Background: The physiological properties of the interstitial subcutaneous tissue of the limbs could bring the abnormal distribution of air coming from superficial trauma of the skin. We present the case of a young woman who developed subcutaneous emphysema after a superficial trauma and discussed the differential diagnosis and treatment. Clinical case: A teenager woman 13 years old had subcutaneous emphysema in the left arm, following the scratch produced by her cat, of two months of evolution, without signs suggestive of local or systemic infection, it was resolved spontaneously during the period of observation. During this period she also presented subcutaneous emphysema in the right arm as a complication of a peripheral venous access performed for the administration of parenteral solutions, in the same way, it resolved spontaneously within a few days. Conclusion: Benign subcutaneous emphysema is a rare clinical condition which should be considered only after the exclusion of other pathologies that require a more aggressive early medical intervention, such as necrotizing fasciitis, which, if not detected in a timely manner, could endanger life.


Assuntos
Traumatismos do Braço/complicações , Lesões dos Tecidos Moles/complicações , Enfisema Subcutâneo/etiologia , Adolescente , Animais , Gatos , Feminino , Humanos , Recidiva
9.
J Craniofac Surg ; 30(3): e251-e254, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30839456

RESUMO

Nasal fractures are the most common facial bone fractures, and soft tissue injuries are frequently accompanied. This study intends to make a deep analysis on the relationship between the 2.Patients diagnosed with nasal fracture between 2015 and 2017 were included. Patients younger than 17 years and those with previous facial fractures or aesthetic surgeries were excluded. Nasal fractures were classified according to the Stranc-Robertson (S-R) classification, and the severity of soft tissue injury was evaluated by length and depth. The authors compared the frequency of soft tissue injury between frontal and lateral groups. Second, the authors investigated whether the incidence of soft tissue injuries increases as a function of the increase in the S-R classification both in frontal and lateral group (from plane I to III). The authors also analyzed the difference in severity of soft tissue injuries in each group. Pearson chi-square analysis, linear by linear and Jonckheere-Terpstra tests were used for statistical analysis.Of 621 patients, 296 were frontal plane and 325 were lateral plane. The frontal group had a higher incidence of soft tissue injury than the lateral group (P = 0.004). The incidence of soft tissue injury and severity by depth increased as a function of the increase in the S-R classification only in the frontal group (P = 0.046, 0.019).In nasal fractures, frontal impact is more associated with frequency and severity of soft tissue injury than lateral impact. This seems to be related to the anatomical characteristics of nasal area and mechanism of injuries in each group.


Assuntos
Osso Nasal/lesões , Fraturas Cranianas/classificação , Fraturas Cranianas/complicações , Lesões dos Tecidos Moles/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índices de Gravidade do Trauma , Adulto Jovem
10.
J Bone Joint Surg Am ; 101(5): e17, 2019 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-30845041

RESUMO

BACKGROUND: Elbow injuries disrupt the surrounding periarticular soft tissues, which include the muscles, tendons, capsule, ligaments, and cartilage. Damage to these tissues as a result of elbow trauma causes clinically significant contracture in 50% of patients. However, it is unclear which of these tissues is primarily responsible for the decreased range of motion. We hypothesized that all tissues would substantially contribute to elbow contracture after immobilization, but only the capsule, ligaments, and cartilage would contribute after free mobilization, with the capsule as the primary contributor at all time points. METHODS: Utilizing a rat model of posttraumatic elbow contracture, a unilateral soft-tissue injury was surgically induced to replicate the damage that commonly occurs during elbow joint dislocation. After surgery, the injured limb was immobilized for 42 days. Animals were evaluated after either 42 days of immobilization (42 IM) or 42 days of immobilization with an additional 21 or 42 days of free mobilization (42/21 or 42/42 IM-FM). For each group of animals, elbow mechanical testing in flexion-extension was completed post-mortem with (1) all soft tissues intact, (2) muscles/tendons removed, and (3) muscle/tendons and anterior capsule removed. Total extension was assessed to determine the relative contributions of muscles/tendons, capsule, and the remaining intact tissues (i.e., ligaments and cartilage). RESULTS: After immobilization, the muscles/tendons and anterior capsule contributed 10% and 90% to elbow contracture, respectively. After each free mobilization period, the muscles/tendons did not significantly contribute to contracture. The capsule and ligaments/cartilage were responsible for 47% and 52% of the motion lost at 42/21 IM-FM, respectively, and 26% and 74% at 42/42 IM-FM, respectively. CONCLUSIONS: Overall, data demonstrated a time-dependent response of periarticular tissue contribution to elbow contracture, with the capsule, ligaments, and cartilage as the primary long-term contributors. CLINICAL RELEVANCE: The capsule, ligaments, and cartilage were primarily responsible for persistent motion loss and should be considered during development of tissue-targeted treatment strategies to inhibit elbow contracture following injury.


Assuntos
Contratura/fisiopatologia , Membro Anterior/lesões , Articulações/lesões , Transtornos dos Movimentos/fisiopatologia , Lesões dos Tecidos Moles/fisiopatologia , Animais , Fenômenos Biomecânicos/fisiologia , Contratura/etiologia , Modelos Animais de Doenças , Masculino , Distribuição Aleatória , Amplitude de Movimento Articular/fisiologia , Ratos Long-Evans , Lesões dos Tecidos Moles/complicações
11.
Rev. iberoam. micol ; 36(1): 41-43, ene.-mar. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-185493

RESUMO

Antecedentes: La posibilidad de infección fúngica debe tenerse presente en heridas extensas que hayan estado en contacto con el suelo o materia orgánica, aun cuando el paciente sea inmunocompetente. Nuestro objetivo al presentar este caso es contribuir al conocimiento epidemiológico y perfil de sensibilidad de hongos filamentosos que son aislados raramente en muestras clínicas y que pueden ocasionar infecciones potencialmente muy graves. Caso clínico: En las heridas de una paciente inmunocompetente víctima de un atropello se aislaron cuatro hongos filamentosos: Lichtheimia corymbifera, Scedosporium boydii, Fusarium solani y Purpureocillium lilacinum. Algunos de ellos fueron aislados simultáneamente de diversas localizaciones. Se realizó un estudio de sensibilidad a la anfotericina B, posaconazol, voriconazol, itraconazol y anidulafungina mediante Etest a los cuatro hongos. El perfil de sensibilidad obtenido no resultó discordante con los datos aportados en la literatura consultada. Conclusiones: La actuación precoz ante infecciones por hongos filamentosos es primordial, tanto en el tratamiento antifúngico como, muy importante, en la realización de cirugía, limpieza y desbridamientos periódicos de los tejidos afectados. Establecer el perfil de sensibilidad de los hongos implicados contribuye al mejor conocimiento de estos patógenos infrecuentes, cuya incidencia aumenta


Background: Fungal infections should be suspected in severe wounds that have been contaminated with organic material or soil, even when the patient is immunocompetent. The aim of this article is to contribute to a better understanding and knowledge of the antifungal sensitivity and epidemiology of some rare pathogens that may trigger severe infections. Case report: Four different moulds were isolated from the wounds of an immunocompetent woman who was involved in a road accident: Lichtheimia corymbifera, Scedosporium boydii, Fusarium solani and Purpureocillium lilacinum. Some of them were isolated from different sites. A profile of in vitro resistance was performed with an Epsilometer (Etest(TM)) using five antifungal agents: voriconazole, posaconazole, itraconazole, anidulafungin an amphotericin B. The results obtained were consistent with those from other cases reported in the literature. Conclusions: Early aggressive surgery, antifungal therapy and, above all, frequent debridement of necrotic tissue, are the tools against filamentous fungi infections. Antifungal sensitivity of any mould involved in an infection has to be determined, in order to a better understanding of these rare pathogens whose incidence is increasing


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Antifúngicos/uso terapêutico , Micoses/tratamento farmacológico , Micoses/etiologia , Lesões dos Tecidos Moles/complicações , Antifúngicos/farmacologia , Fungos/efeitos dos fármacos , Fungos/isolamento & purificação , Testes de Sensibilidade Microbiana , Micoses/microbiologia
12.
Am J Physiol Regul Integr Comp Physiol ; 316(5): R621-R627, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30811247

RESUMO

Early posttrauma hyperglycemia (EPTH) is correlated with later adverse outcomes, including acute kidney injury (AKI). Controlling EPTH in the prehospital setting is difficult because of the variability in the ideal insulin dosage and the potential risk of hypoglycemia, especially in those with confounding medical comorbidities of obesity and insulin resistance. Glucagon-like peptide-1 (GLP-1) controls glucose levels in a glucose-dependent manner and is a current target in antidiabetic therapy. We have shown that after orthopedic trauma, obese Zucker rats exhibit EPTH and a later development of AKI (within 24 h). We hypothesized that GLP-1 treatment after trauma decreases EPTH and protects renal function in obese Zucker rats. Obese Zucker rats (~12 wk old) were fasted for 4 h before trauma. Soft tissue injury, fibula fracture, and homogenized bone component injection were then performed in both hind limbs to induce severe extremity trauma. Plasma glucose levels were measured before and 15, 30, 60, 120, 180, 240, and 300 min after trauma. GLP-1 (3 µg·kg-1·h-1, 1.5 ml/kg total) or saline was continuously infused from 30 min to 5 h after trauma. Afterwards, rats were placed in metabolic cages overnight for urine collection. The following day, plasma interleukin (IL)-6 levels, renal blood flow (RBF), glomerular filtration rate (GFR), and renal oxygen delivery (Do2) and consumption (V̇o2) were measured. EPTH was evident within 15 min after trauma but was significantly ameliorated during the 5 h of GLP-1 infusion. One day after trauma, plasma IL-6 was markedly increased in the trauma group and decreased in GLP-1-treated animals. RBF, GFR, and Do2 all significantly decreased with trauma, but renal V̇o2 was unchanged. GLP-1 treatment normalized RBF, GFR, and Do2 without affecting V̇o2. These results suggest that GLP-1 decreases EPTH and protects against a later development of AKI. Early treatment with GLP-1 (or its analogs) to rapidly, effectively, and safely control EPTH may be beneficial in the prehospital care of obese patients after trauma.


Assuntos
Lesão Renal Aguda/prevenção & controle , Glicemia/efeitos dos fármacos , Fraturas Ósseas/complicações , Peptídeo 1 Semelhante ao Glucagon/farmacologia , Hiperglicemia/tratamento farmacológico , Hipoglicemiantes/farmacologia , Rim/efeitos dos fármacos , Obesidade/complicações , Lesões dos Tecidos Moles/complicações , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/fisiopatologia , Animais , Biomarcadores/sangue , Glicemia/metabolismo , Modelos Animais de Doenças , Taxa de Filtração Glomerular/efeitos dos fármacos , Hiperglicemia/sangue , Hiperglicemia/etiologia , Resistência à Insulina , Rim/metabolismo , Rim/fisiopatologia , Masculino , Consumo de Oxigênio/efeitos dos fármacos , Ratos Zucker , Fatores de Tempo
13.
Can J Rural Med ; 24(1): 7-12, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30638191

RESUMO

Introduction: The Canadian island of Newfoundland has a long history of fishing; however, no study to date has developed a regional profile of fishhook injuries on its east coast. Methods: To this end, we conducted a retrospective review of fishhook injuries at all Newfoundland East coast emergency departments from 2013 to 2015. Patient presentations were reviewed for the date of arrival, sex of the patient, location of fishhook injury, tetanus immunisation status, anaesthetic utilisation, diagnostic imaging, antibiotic management and technique of removal. Results: Information was retrieved for 165 patients. Most injuries occurred to the hand (80.6%), and out of five documented techniques, "advance and cut" was the most common extraction method (55.5%). There was a high percentage of prophylactic oral antibiotics prescribed (57%) and X-ray imaging (20%) utilised. Consultation was required for 4.2% of the fishhook injuries including consultation to a local fire department service. Conclusions: On the east coast of Newfoundland, fishhook injuries are addressed inconsistently, with potentially suboptimal methods for removal, coupled with unnecessary imaging and antibiotics. We believe that there is a role for education and other initiatives to improve the care delivered.


Assuntos
Corpos Estranhos/terapia , Recreação , Lesões dos Tecidos Moles/terapia , Ferimentos Penetrantes/terapia , Medicina de Família e Comunidade/métodos , Feminino , Corpos Estranhos/complicações , Humanos , Masculino , Terra Nova e Labrador , Estudos Retrospectivos , Lesões dos Tecidos Moles/complicações , Ferimentos Penetrantes/complicações
14.
Rev Iberoam Micol ; 36(1): 41-43, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-30686746

RESUMO

BACKGROUND: Fungal infections should be suspected in severe wounds that have been contaminated with organic material or soil, even when the patient is immunocompetent. The aim of this article is to contribute to a better understanding and knowledge of the antifungal sensitivity and epidemiology of some rare pathogens that may trigger severe infections. CASE REPORT: Four different moulds were isolated from the wounds of an immunocompetent woman who was involved in a road accident: Lichtheimia corymbifera, Scedosporium boydii, Fusarium solani and Purpureocillium lilacinum. Some of them were isolated from different sites. A profile of in vitro resistance was performed with an Epsilometer (Etest™) using five antifungal agents: voriconazole, posaconazole, itraconazole, anidulafungin an amphotericin B. The results obtained were consistent with those from other cases reported in the literature. CONCLUSIONS: Early aggressive surgery, antifungal therapy and, above all, frequent debridement of necrotic tissue, are the tools against filamentous fungi infections. Antifungal sensitivity of any mould involved in an infection has to be determined, in order to a better understanding of these rare pathogens whose incidence is increasing.


Assuntos
Antifúngicos/uso terapêutico , Micoses/tratamento farmacológico , Micoses/etiologia , Lesões dos Tecidos Moles/complicações , Antifúngicos/farmacologia , Feminino , Fungos/efeitos dos fármacos , Fungos/isolamento & purificação , Humanos , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Micoses/microbiologia
15.
Acta Chir Belg ; 119(6): 390-395, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29734868

RESUMO

Introduction: Lipomas are the most common benign mesenchymal tumors which can be found in any part of the body. Nevertheless, their etiology and pathogenesis remain unknown. It is hypothesized that some of these lesions could result from an acute or chronic trauma. Patients and methods: We report a case of a 54-year-old man presenting a perineal lipoma which volume grew rapidly after he fell on his buttock, in the context of inaugural epileptic seizure. Pelvic MRI showed a voluminous fatty mass, measuring 6.6 × 5 × 9 cm without any signs of local invasion. Furthermore, we review the latest research on lipomas originating from traumatic lesion. Results: The mass was completely excised in one block under general anesthaesia, using an elliptical incision and a deep dissection. We did not close the skin incision in view of the cutaneous defect. Post-operative recovery was uneventful and the patient was discharged from hospital two days after the operation. Histopathology indicated a reorganised lipoma with no evidence of malignancy. Conclusion: Perineal lipomas are extremely rare, pathological examination of imaging guided biopsies are needed to exclude malignancy especially a well-differentiated liposarcoma. MRI remains the first option and radical surgical excision is the gold standard treatment.


Assuntos
Neoplasias do Ânus/etiologia , Lipoma/etiologia , Neoplasias Pélvicas/etiologia , Períneo/lesões , Lesões dos Tecidos Moles/complicações , Acidentes por Quedas , Neoplasias do Ânus/cirurgia , Humanos , Lipoma/diagnóstico por imagem , Lipoma/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias Pélvicas/cirurgia , Períneo/diagnóstico por imagem , Períneo/cirurgia , Convulsões/complicações
16.
Front Immunol ; 9: 2851, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30564244

RESUMO

Despite decades of research, the goal of achieving scarless wound healing remains elusive. One of the approaches, treatment with polymeric microcarriers, was shown to promote tissue regeneration in various in vitro models of wound healing. The in vivo effects of such an approach are attributed to transferred cells with polymeric microparticles functioning merely as inert scaffolds. We aimed to establish a bioactive biopolymer carrier that would promote would healing and inhibit scar formation in the murine model of deep skin wounds. Here we characterize two candidate types of microparticles based on fibroin/gelatin or spidroin and show that both types increase re-epithelialization rate and inhibit scar formation during skin wound healing. Interestingly, the effects of these microparticles on inflammatory gene expression and cytokine production by macrophages, fibroblasts, and keratinocytes are distinct. Both types of microparticles, as well as their soluble derivatives, fibroin and spidroin, significantly reduced the expression of profibrotic factors Fgf2 and Ctgf in mouse embryonic fibroblasts. However, only fibroin/gelatin microparticles induced transient inflammatory gene expression and cytokine production leading to an influx of inflammatory Ly6C+ myeloid cells to the injection site. The ability of microparticle carriers of equal proregenerative potential to induce inflammatory response may allow their subsequent adaptation to treatment of wounds with different bioburden and fibrotic content.


Assuntos
Cicatriz/prevenção & controle , Portadores de Fármacos/administração & dosagem , Reepitelização/efeitos dos fármacos , Pele/lesões , Cicatrização/efeitos dos fármacos , Animais , Cicatriz/imunologia , Cicatriz/patologia , Fator de Crescimento do Tecido Conjuntivo/imunologia , Fator de Crescimento do Tecido Conjuntivo/metabolismo , Citocinas/imunologia , Citocinas/metabolismo , Modelos Animais de Doenças , Portadores de Fármacos/química , Fator 2 de Crescimento de Fibroblastos , Fibroblastos/efeitos dos fármacos , Fibroblastos/imunologia , Fibroblastos/metabolismo , Fibroínas/administração & dosagem , Fibroínas/química , Fibrose/imunologia , Fibrose/prevenção & controle , Gelatina/administração & dosagem , Gelatina/química , Humanos , Injeções Subcutâneas , Queratinócitos/efeitos dos fármacos , Queratinócitos/imunologia , Queratinócitos/metabolismo , Macrófagos/efeitos dos fármacos , Macrófagos/imunologia , Macrófagos/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Tamanho da Partícula , Reepitelização/imunologia , Pele/efeitos dos fármacos , Pele/patologia , Lesões dos Tecidos Moles/complicações , Lesões dos Tecidos Moles/tratamento farmacológico , Lesões dos Tecidos Moles/imunologia , Lesões dos Tecidos Moles/patologia , Resultado do Tratamento , Cicatrização/imunologia
17.
Oper Orthop Traumatol ; 30(5): 294-308, 2018 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-30182178

RESUMO

OBJECTIVE: Debridement of soft tissue and bone in an open fracture situation to minimize infection risk and achieve primary skin closure, or to provide conditions for early soft tissue coverage. INDICATIONS: Indications are Gustilo-Anderson grade I-III A-C open fractures. CONTRAINDICATIONS: Contraindications are injuries requiring amputation, burns, and life-threatening injuries which make appropriate treatment temporarily impossible. SURGICAL TECHNIQUE: Removal of gross contamination and macroscopic contaminants; debridement of the wound; complete resection of contaminated and dirty tissue; sparse step-by-step resection of contaminated or non-vital wound and bone margins until vital, bleeding tissue begins; low-pressure irrigation with isotonic irrigation fluid; diagnostic biopsies for microbiological testing; reduction of dead space by interpositioning of muscle or cement spacers loaded with local antibiotics; primary wound closure if tension-free closure possible; otherwise, if resources and knowhow permit and satisfactory clean debridement was achieved, local flap; if flap impossible, debridement not satisfactory, secondary tissue necrosis likely, potential remaining contamination or contamination with fecal matter, then vacuum-assisted closure therapy. POSTOPERATIVE MANAGEMENT: Wound inspection on the second postoperative day, generous indication for second-look surgery after 36-48 h, wound inspection on the second postoperative day, wound inspection every other day, primary antibiotic prophylaxis with a first- or second-generation cephalosporin (e. g., cefuroxime), and adaptation of antibiotic therapy according to susceptibility screening. RESULTS: Infection rates of 2-4.7% are reported for immediate primary wound closure in Gustilo-Anderson grade I, II, and III A open fractures. For Gustilo-Anderson grade III B, good wound healing, bony consolidation, and no need for secondary surgery was reported in 86.7% when primary wound closure was achieved.


Assuntos
Fraturas Expostas/cirurgia , Lesões dos Tecidos Moles/cirurgia , Antibacterianos/administração & dosagem , Antibioticoprofilaxia , Desbridamento , Fraturas Expostas/complicações , Fraturas Expostas/tratamento farmacológico , Humanos , Lesões dos Tecidos Moles/complicações , Lesões dos Tecidos Moles/tratamento farmacológico , Retalhos Cirúrgicos , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Irrigação Terapêutica , Resultado do Tratamento , Cicatrização
18.
Muscle Nerve ; 58(6): 843-851, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30230560

RESUMO

INTRODUCTION: Posttraumatic elbow contracture is clinically challenging because injury often disrupts multiple periarticular soft tissues. Tissue specific contribution to contracture, particularly muscle, remains poorly understood. METHODS: In this study we used a previously developed animal model of elbow contracture. After surgically inducing a unilateral soft tissue injury, injured limbs were immobilized for 3, 7, 21, and 42 days (IM) or for 42 IM with 42 days of free mobilization (42/42 IM-FM). Biceps brachii active/passive mechanics and morphology were evaluated at 42 IM and 42/42 IM-FM, whereas biceps brachii and brachialis gene expression was evaluated at all time points. RESULTS: Injured limb muscle exhibited significantly altered active/passive mechanics and decreased fiber area at 42 IM but returned to control levels by 42/42 IM-FM. Gene expression suggested muscle growth rather than a fibrotic response at 42/42 IM-FM. DISCUSSION: Muscle is a transient contributor to motion loss in our rat model of posttraumatic elbow contracture. Muscle Nerve 58:843-851, 2018.


Assuntos
Neuropatias do Plexo Braquial/complicações , Contratura/fisiopatologia , Regulação da Expressão Gênica/fisiologia , Músculo Esquelético/fisiopatologia , Lesões dos Tecidos Moles/patologia , Animais , Colágeno Tipo I/metabolismo , Fator de Crescimento do Tecido Conjuntivo/genética , Fator de Crescimento do Tecido Conjuntivo/metabolismo , Modelos Animais de Doenças , Matriz Extracelular/metabolismo , Matriz Extracelular/patologia , Lateralidade Funcional , Imobilização , Laminina/metabolismo , Masculino , Metaloproteinase 2 da Matriz/genética , Metaloproteinase 2 da Matriz/metabolismo , Proteínas Musculares/genética , Proteínas Musculares/metabolismo , Amplitude de Movimento Articular/fisiologia , Ratos , Ratos Long-Evans , Lesões dos Tecidos Moles/complicações , Fatores de Tempo , Inibidor Tecidual de Metaloproteinase-2/genética , Inibidor Tecidual de Metaloproteinase-2/metabolismo , Fator de Crescimento Transformador beta3/genética , Fator de Crescimento Transformador beta3/metabolismo
20.
J Wound Care ; 27(Sup6): S14-S19, 2018 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-29883293

RESUMO

Open fractures of the leg with large loss of tissue require extensive reconstructive methods that can injure the donor area. The use of negative pressure wound therapy (NPWT) may minimise the impact of these reconstructive methods because of its capacity to create granulation tissue that will form a wound bed for the skin graft, thus reducing the volume of soft tissue defect and saving the donor region. This case study describes the effectiveness of NPWT in the treatment and reconstruction of an open fracture of the leg, with massive loss of soft tissue, associated with elastic intramedullary nailing in a 10-year-old female patient, who was a victim of a car accident. Clinical examination revealed a Gustilo-Anderson IIIB open fracture of the left leg, with the avulsion of the fifth toe, disarticulation of the fifth metatarsal bone, extensively damaged skin and subcutaneous tissue in the medium and distal third of the left leg and left foot. The bone was exposed in the distal part of the leg, external malleolus and left calcaneus. Profuse lavage, reduction of the tibial fracture and elastic intramedullary nailing, amputation of the fifth left toe, necrectomy and debridement of devitalised tissue were performed. NPWT was started, with the dressing changed every five days. After 55 days of using NPWT, granulation tissue covered the soft tissue defect and created a wound bed for the skin graft. NPWT helped the management of this open wound, achieving a wound bed for the skin graft, avoiding the use of complex reconstructive methods.


Assuntos
Fratura Avulsão/terapia , Fraturas Expostas/terapia , Lesões dos Tecidos Moles/terapia , Fraturas da Tíbia/terapia , Acidentes de Trânsito , Criança , Desbridamento , Feminino , Fratura Avulsão/complicações , Fraturas Expostas/complicações , Humanos , Traumatismos da Perna/complicações , Traumatismos da Perna/terapia , Traumatismo Múltiplo , Tratamento de Ferimentos com Pressão Negativa , Procedimentos Cirúrgicos Reconstrutivos , Transplante de Pele , Lesões dos Tecidos Moles/complicações , Fraturas da Tíbia/complicações , Dedos do Pé/lesões , Cicatrização
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