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2.
Res Vet Sci ; 136: 616-621, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33905955

RESUMO

Surgical site infection (SSI) is associated with increased morbidity, cost and mortality in human medicine and with increased morbidity and cost in veterinary medicine. The aim of this study was to evaluate risk factors for SSI development after clean surgical procedures in dogs, treated at both first opinion clinics as well as referral hospitals. 1550 dogs scored 1 or 2 according to the American Society of Anesthesiologists (ASA), that underwent clean surgical procedures at 103 clinics located in Northern and Central Europe were included in the study. Data regarding the surgical procedure, surgery time use of perioperative antimicrobial prophylaxis (AMP), surgery type, intraoperative hypothermia, and the use of surgical implants were recorded according to predefined protocols. Active 30-day SSI surveillance was performed. A random effects logistic regression model was used to evaluate the association between the perioperative variables and SSI development. SSI was detected in 85/1550 dogs (5.5%); 25 occurred in the 500 orthopedic/neurosurgery procedures (5.0%), and 60 in the 1050 soft tissue procedures (5.7%). A total of 1524 dogs were included in the final multivariable model. Increased surgery time was the only variable associated with an increased risk of SSI. No association between the other risk factors evaluated in the study and SSI occurrence was detected. Efforts must therefore be made to keep the surgery time as short as possible. Orthopedic and neurosurgical procedures including those where an implant is placed should not automatically be regarded as high-risk procedures benefiting from perioperative AMP.


Assuntos
Doenças do Cão/etiologia , Cães/cirurgia , Procedimentos Ortopédicos/veterinária , Infecção da Ferida Cirúrgica/veterinária , Animais , Anti-Infecciosos/administração & dosagem , Modelos Logísticos , Procedimentos Ortopédicos/efeitos adversos , Próteses e Implantes/efeitos adversos , Próteses e Implantes/veterinária , Fatores de Risco , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle
4.
J Laryngol Otol ; 135(2): 130-133, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33531092

RESUMO

OBJECTIVE: The audiological benefits of a bone conducting hearing implant are well documented; however, there is a paucity of literature comparing pre- and post-operative quality of life benefits. This study assessed the quality of life status before and after the device is implanted. METHODS: A prospective study was conducted of all adult bone conducting hearing implants inserted in a teaching hospital between 2012 and 2017. All patients completed the Glasgow Health Status Inventory, a validated quality of life questionnaire, before and three to six months after implantation. RESULTS: Sixty-two patients received a unilateral bone conducting hearing implant. All scores except the social score improved post-operatively. The paired t-test showed that the differences in the means for the Glasgow Health Status Inventory total, general and physical scores were statistically significant at the 5 per cent level (p < 0.0001). CONCLUSION: This study, one of the few to assess quality of life pre- and post-implantation, showed a vast improvement in patients' perceived quality of life from the pre- to the post-operative phase.


Assuntos
Condução Óssea/fisiologia , Implante Coclear/psicologia , Perda Auditiva/cirurgia , Próteses e Implantes/efeitos adversos , Qualidade de Vida/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Implante Coclear/métodos , Feminino , Auxiliares de Audição/efeitos adversos , Auxiliares de Audição/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Percepção/fisiologia , Período Pós-Operatório , Período Pré-Operatório , Estudos Prospectivos , Inquéritos e Questionários
5.
Bone Joint J ; 103-B(2): 234-244, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517726

RESUMO

Antibiotic resistance represents a threat to human health. It has been suggested that by 2050, antibiotic-resistant infections could cause ten million deaths each year. In orthopaedics, many patients undergoing surgery suffer from complications resulting from implant-associated infection. In these circumstances secondary surgery is usually required and chronic and/or relapsing disease may ensue. The development of effective treatments for antibiotic-resistant infections is needed. Recent evidence shows that bacteriophage (phages; viruses that infect bacteria) therapy may represent a viable and successful solution. In this review, a brief description of bone and joint infection and the nature of bacteriophages is presented, as well as a summary of our current knowledge on the use of bacteriophages in the treatment of bacterial infections. We present contemporary published in vitro and in vivo data as well as data from clinical trials, as they relate to bone and joint infections. We discuss the potential use of bacteriophage therapy in orthopaedic infections. This area of research is beginning to reveal successful results, but mostly in nonorthopaedic fields. We believe that bacteriophage therapy has potential therapeutic value for implant-associated infections in orthopaedics. Cite this article: Bone Joint J 2021;103-B(2):234-244.


Assuntos
Artrite Infecciosa/terapia , Infecções Bacterianas/terapia , Doenças Ósseas Infecciosas/terapia , Dispositivos de Fixação Ortopédica/efeitos adversos , Terapia por Fagos/métodos , Próteses e Implantes/efeitos adversos , Infecções Relacionadas à Prótese/terapia , Humanos , Resultado do Tratamento
6.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33541940

RESUMO

A 25-year-old man presented with decreased vision in both eyes, approximately 4 years following bilateral bright ocular cosmetic iris implantation. On examination, he was found to have bilateral elevated intraocular pressures, anterior chamber cells and flare, chronic peripheral anterior synechiae and significantly reduced endothelial cell counts. Ultrasound biomicroscopy demonstrated compression of the peripheral iris, resulting in synechial angle closure in both eyes. Surgical removal of the implants was performed without additional complication. On removal, bilateral iris atrophy was evident with non-reacting pupils and permanent mydriasis. Optical coherence tomography angiography showed a reduction in iris vasculature density that is more pronounced in the area of the iris atrophic defects. This case suggests that cosmetic iris implants may compress iris vasculature, resulting in decreased iris perfusion resulting in atrophic mydriasis and iris defects. This is a potential novel mechanism for complications in eyes with cosmetic iris implants.


Assuntos
Pressão Intraocular , Doenças da Íris/complicações , Iris/cirurgia , Midríase/diagnóstico , Próteses e Implantes/efeitos adversos , Acetaminofen/uso terapêutico , Acetazolamida/uso terapêutico , Administração Intravenosa , Adulto , Analgésicos não Narcóticos/uso terapêutico , Inibidores da Anidrase Carbônica/uso terapêutico , Humanos , Latanoprosta/uso terapêutico , Masculino , Soluções Oftálmicas/uso terapêutico , Tomografia de Coerência Óptica
7.
J Clin Neurosci ; 84: 66-74, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33485602

RESUMO

Decompressive craniectomy is widely used to treat medically refractory intracranial hypertension. There were still few studies focusing on the complications between titanium cranioplasty with non-titanium materials cranioplasty. Our systematic review and meta-analysis aimed to assess the complications following titanium cranioplasty and to make a comparison with nontitanium materials. A systematic review was used to review titanium cranioplasty characters in recent articles. A systematic literature review and meta-analysis were performed by using PubMed/MEDLINE, Scopus, the Cochrane databases and Embase for studies reporting on cranioplasty procedures that compared complication outcomes between titanium with non-titanium materials. The final 15 studies met inclusion criteria and represented 2258 cranioplasty procedures (896 titanium, 1362 nontitanium materials). Overall complications included surgical site infection, hematoma, implant exposure, seizure, cerebrospinal fluid leak, imprecise fitting. Titanium cranioplasty was associated with a significant decrease in overall complications rate (OR, 0.72; P = 0.007), hematoma rate (OR, 0.31; P = 0.0003) and imprecise fitting rate (OR, 0.35; P = 0.04). However, it also suggested that titanium cranioplasty can be greatly increased implant exposure rate (OR, 4.11; P < 0.00001). Our results confirmed the advantages of titanium cranioplasty in reducing complications including hematoma, imprecise fitting, and also suggested that clinicians should pay more attention to postoperative implant exposure. With new synthetic materials emerging, it would also be interesting to study the cost-effect and functional outcomes associated with cranioplasty materials.


Assuntos
Craniotomia/efeitos adversos , Craniotomia/instrumentação , Próteses e Implantes/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Titânio , Adulto , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Crânio/cirurgia
8.
ASAIO J ; 67(2): 214-219, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33512917

RESUMO

Device-related thrombosis and thromboembolic complications remain a major clinical concern and often impact patient morbidity and mortality. Thus, improved preclinical thrombogenicity assessment methods that better predict clinical outcomes and enhance patient safety are needed. However, there are several challenges and limitations associated with developing and performing preclinical thrombogenicity assessments on the bench and in animals (e.g., the clinical relevance of most in vitro tests has not been established, animal studies may not accurately predict clinical thrombotic events). To facilitate a discussion on how to overcome some of these challenges and to promote collaboration between the Food and Drug Administration (FDA), industry, and academia for the development of more reliable test methods, a scientific forum was organized by FDA and held in Washington, DC, on June 15, 2018 at the ASAIO 64th Annual Conference. Three subject matter experts from the medical device industry and FDA presented their perspectives at this forum, and several audience experts provided input during the open dialogue session. This article summarizes the key messages from the forum regarding the current status and challenges of preclinical thrombogenicity testing, important areas of needed research, and mechanisms for working with FDA to further improve thrombogenicity evaluations of medical devices.


Assuntos
Testes de Coagulação Sanguínea/métodos , Próteses e Implantes/efeitos adversos , Tromboembolia/diagnóstico , Tromboembolia/etiologia , Animais , Modelos Animais de Doenças , Humanos , Técnicas In Vitro
9.
J Pediatr Orthop ; 41(3): e204-e210, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33370003

RESUMO

BACKGROUND: There are few reports on the surgical management of early-onset scoliosis (EOS) associated with Marfan syndrome (MFS). Affected patients tend to have more rapid curve progression than those with idiopathic EOS, and their course is further complicated by medical comorbidities. As surgical techniques and implants for growing spines become more widely applied, this study seeks to better delineate the safety and efficacy of growth-friendly spinal instrumentation in treating this population. METHODS: A prospective registry of children treated for EOS was queried for MFS patients treated between 1996 and 2016. Forty-two patients underwent rib-based or spine-based growing instrumentation and were assessed on preoperative, surgical, and postoperative clinical and radiographic parameters including complications and reoperations. Subgroup analysis was performed based on spine-based versus rib-based fixation. RESULTS: Patients underwent their index surgery at a mean age of 5.5 years, when the major coronal curve and kyphosis measured 77 and 50 degrees, respectively. Over half were treated with traditional growing rods. Patients underwent 7.2 total surgical procedures-4.7 lengthening and 1.9 revision surgeries not including conversion to fusion-over a follow-up of 6.5 (±4.1) years. Radiographic correction was greatest at index surgery but maintained over time, with a final thoracic height measuring 23.8 cm. Patients experienced a mean of 2.6 complications over the course of the study period; however, a small group of 6 patients experienced ≥6 complications while over half of patients experienced 0 or 1. Implant failures represented 42% of all complications with infection and pulmonary complications following. CONCLUSIONS: This is the largest report on patients with EOS and MFS. All subtypes of growth-friendly constructs reduced curve progression in this cohort, but complications and reoperations were nearly universal; patients were particularly plagued by implant failure and migration. Further collaborations are needed to enhance understanding of optimal timing and fixation constructs for those with MFS and other connective tissue diseases.


Assuntos
Síndrome de Marfan/cirurgia , Procedimentos Ortopédicos/instrumentação , Próteses e Implantes/estatística & dados numéricos , Escoliose/cirurgia , Vértebras Torácicas/cirurgia , Adolescente , Criança , Pré-Escolar , Progressão da Doença , Feminino , Humanos , Lactente , Cifose/etiologia , Cifose/cirurgia , Masculino , Síndrome de Marfan/complicações , Procedimentos Ortopédicos/estatística & dados numéricos , Próteses e Implantes/efeitos adversos , Reoperação , Estudos Retrospectivos , Escoliose/etiologia , Fusão Vertebral , Resultado do Tratamento
10.
Am J Otolaryngol ; 42(1): 102781, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33166859

RESUMO

BACKGROUND: Syndrome of the trephined (ST) refers to the rare, reversible event of neurological deterioration following craniectomy. ST is also known as "sinking skin flap syndrome" and typically occurs in the weeks to months following operation. The mechanism underlying syndromic onset is poorly understood. Changes to cerebrospinal fluid flow, alteration of temperature-related perfusion, and scarring at the intracranial surgical site have all been proposed. Patients present with a variety of symptoms related to paradoxical increased intracranial pressure. Sometimes falsely attributed as a consequence of the initial cranial insult, ST is more specifically a symptomatic process resulting as direct consequence of the craniectomy procedure. With timely identification and subsequent cranioplasty, the associated neurological dysfunction can be corrected - this rectification being the primary confirmatory feature of the syndrome. CASE: A 59-year-old female was seen with regards to a wound of the temporoparietal scalp, with exposed cranial implant. She had suffered a traumatic brain injury and underwent craniectomy after a motor vehicle accident 10 years prior. Her injury was complicated by necrosis of her cranial bone flap after reimplantation and at least 10 subsequent attempts to reconstruct her wound. When delayed cranial reconstruction was attempted on two separate occasions, the patient suffered severe syndrome of the trephined and required hospitalization for symptoms of impending herniation. Ultimately, she required revision and replacement of titanium mesh and latissimus dorsi free flap for soft tissue coverage of the titanium mesh. CONCLUSION: This case presents a unique surgical challenge in that chronic infection was perpetuated by the replacement of implant material in the wound. Soft tissue reconstruction alone was not possible given the patient's severe ST. Free tissue transfer was required in order to bring vascularized myofascial tissue to prevent recolonization of the newly implanted mesh and allow the cranial wound to heal.


Assuntos
Lesões Encefálicas Traumáticas/cirurgia , Craniotomia/efeitos adversos , Doenças do Sistema Nervoso/etiologia , Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias/etiologia , Próteses e Implantes/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Crânio/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Reoperação , Couro Cabeludo/cirurgia , Retalhos Cirúrgicos , Telas Cirúrgicas , Síndrome , Titânio
11.
Facial Plast Surg ; 36(5): 517-527, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33368076

RESUMO

In Asian countries, augmentation rhinoplasty is especially common, where alloplastic implants are used much more commonly than autologous tissues. In rhinoplasty, such artificial materials include silicone, expanded polytetrafluoroethylene (ePTFE), porous high-density polyethylene (pHDPE), and acellular human dermis. As the use of implants has become increasingly common in rhinoplasty, more adverse effects such as infection, extrusion, movement, irregularities, absorption, prolonged swelling, seroma, and contracture have been recognized and reported in the literature. Surgeons should be able to recognize these probable complications and manage them successfully. Early detection and prompt management of the complication are essential for minimizing the severity of the deformity. Proper management of complications is key for the success of dorsal augmentation using alloplastic implants.


Assuntos
Implantes Dentários , Rinoplastia , Materiais Biocompatíveis/efeitos adversos , Humanos , Politetrafluoretileno/efeitos adversos , Próteses e Implantes/efeitos adversos , Rinoplastia/efeitos adversos , Silicones/efeitos adversos
12.
Medicine (Baltimore) ; 99(45): e23073, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157970

RESUMO

INTRODUCTION: Contracture of dacryocyst by an implanted lacrimal silicone tube is rare. This report describes a unique case of secondary dacryocystitis and the contracture of dacryocyst caused by a lacrimal silicone tube that was placed in the lacrimal system for 10 years. PATIENT CONCERNS: A 63-year-old female was diagnosed with chronic dacryocystitis at a local hospital and underwent surgical treatment 10 years ago. In the past month, the patient complained of persistent tearing and purulent secretion from the eyes. DIAGNOSIS: The patient was diagnosed with secondary dacryocystitis, based on clinical features and the presence of the silicone stent, granulation tissue formation, and dacryocyst contracture in the lacrimal duct, as observed by nasal endoscopy. INTERVENTIONS: For treatment, the implanted silicone tube in the patient was removed, the lacrimal duct and nasal mucosa was anastomosed, and a new lacrimal silicone tube was placed again. OUTCOMES: Following the surgery, the patient recounted that there were no symptoms, and follow-up examinations performed over a 1-month period posttreatment revealed no recurrence of obstruction or dacryocystitis. Therefore, the surgeon removed the lacrimal drainage tube and asked the patient to return to the outpatient department regularly for examination. CONCLUSION: The findings, in this case, suggest that silicone tubes are safe and effective, and can be placed in the lacrimal drainage system. However, in this patient, prolonged intubation caused chronic inflammation, granulation tissue formation, and dacryocyst contracture. Our findings could inform surgeons to consider the reasonable duration of intubation for treating cases of lacrimal obstruction, in order to avoid unnecessary complications.


Assuntos
Dacriocistite/etiologia , Ducto Nasolacrimal/cirurgia , Complicações Pós-Operatórias/etiologia , Próteses e Implantes/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Desenho de Prótese , Silicones , Fatores de Tempo
14.
J Med Life ; 13(3): 336-341, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33072205

RESUMO

Implant-prosthetic rehabilitation registers multiple variants, but their short- and long-term evolution has been a frequent concern. This study aimed to evaluate the peri-implant bone resorption at the level of the tilted implants in the SKY fast & fixed restorations, with reference to clinical and treatment parameters. An observational study was conducted on a convenience sample of patients with implant-prosthetic rehabilitation in one or both jaws, according to the SKY fast & fixed protocol (Bredent, Germany). Bone resorption was assessed on panoramic radiography. Other data were collected from the patient's medical records. Thirty tilted implants were analyzed, 12 of which were in the maxilla and 18 in the mandible. After the follow-up period, both bone resorption (maximum 7 mm) and bone apposition (maximum 8 mm) were observed. There was a tendency for the resorption to be more pronounced in the mandible, in patients where tooth loss was due to periodontal disease, and when implants with length less than 16 mm were used. Resorption was statistically significantly lower when bone addition materials and membranes were used at the extraction socket, and when SKY fast & fixed rehabilitation was performed in both jaws. SKY fast & fixed implant-prosthetic technique, which involves applying a small number of implants, and a fixed prosthesis corresponding to a shortened dental arch, is a viable method of treatment that outcomes the need for complex and expensive surgical interventions, and proves to be beneficial in maintaining the optimal parameters of bone support.


Assuntos
Reabsorção Óssea/etiologia , Próteses e Implantes/efeitos adversos , Implantação de Prótese , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Mandíbula/cirurgia , Maxila/cirurgia , Pessoa de Meia-Idade
15.
Bone Joint J ; 102-B(10): 1375-1383, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32993330

RESUMO

AIMS: To investigate metallosis in patients with magnetically controlled growing rods (MCGRs) and characterize the metal particle profile of the tissues surrounding the rod. METHODS: This was a prospective observational study of patients with early onset scoliosis (EOS) treated with MCGRs and undergoing rod exchange who were consecutively recruited between February 2019 and January 2020. Ten patients were recruited (mean age 12 years (SD 1.3); 2 M:8 F). The configurations of the MCGR were studied to reveal the distraction mechanisms, with crucial rod parts being the distractable piston rod and the magnetically driven rotor inside the barrel of the MCGR. Metal-on-metal contact in the form of ring-like wear marks on the piston was found on the distracted portion of the piston immediately outside the barrel opening (BO) through which the piston rod distracts. Biopsies of paraspinal muscles and control tissue samples were taken over and away from the wear marks, respectively. Spectral analyses of the rod alloy and biopsies were performed to reveal the metal constituents and concentrations. Histological analyses of the biopsies were performed with haematoxylin and eosin staining. RESULTS: Titanium (Ti), vanadium (V), and neodymium (Nd) concentrations in the biopsies taken near the wear marks were found to be significantly higher than those in the control tissue samples. Significantly increased Nd concentrations were also found in the tissues near the barrel of the MCGR. Chronic inflammation was revealed by the histological studies with fibrosis and macrophage infiltration. Black particles were present within the macrophages in the fibrotic tissues. CONCLUSION: Ti and V were generated mainly at the BO due to metal-on-metal contact, whereas the Nd from the rotor of the MCGR is likely released from the BO during distraction sessions. Phagocytotic immune cells with black particles inside raise concern regarding the long-term implications of metallosis. Cite this article: Bone Joint J 2020;102-B(10):1375-1383.


Assuntos
Reação a Corpo Estranho/etiologia , Próteses e Implantes/efeitos adversos , Escoliose/cirurgia , Biópsia , Criança , Feminino , Reação a Corpo Estranho/diagnóstico por imagem , Humanos , Magnetismo , Masculino , Neodímio/efeitos adversos , Estudos Prospectivos , Escoliose/diagnóstico por imagem , Titânio/efeitos adversos , Vanádio/efeitos adversos
16.
Int J Nanomedicine ; 15: 6705-6720, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32982228

RESUMO

Over the last decades, joint arthroplasty has become a successful treatment for joint disease. Nowadays, with a growing demand and increasingly younger and active patients accepting these approaches, orthopedic surgeons are seeking implants with improved mechanical behavior and longer life span. However, aseptic loosening as a result of wear debris from implants is considered to be the main cause of long-term implant failure. Previous studies have neatly illustrated the role of micrometric wear particles in the pathological mechanisms underlying aseptic loosening. Recent osteoimmunologic insights into aseptic loosening highlight the important and heretofore underrepresented contribution of nanometric orthopedic wear particles. The present review updates the characteristics of metallic and ceramic nanoparticles generated after prosthesis implantation and summarizes the current understanding of their hazardous effects on peri-prosthetic cells.


Assuntos
Artroplastia de Quadril/instrumentação , Nanopartículas/efeitos adversos , Nanopartículas/química , Próteses e Implantes/efeitos adversos , Animais , Artroplastia de Quadril/efeitos adversos , Interface Osso-Implante , Cerâmica/química , Humanos , Nanopartículas Metálicas/efeitos adversos , Nanopartículas Metálicas/química , Osteoblastos/patologia , Osteoclastos/patologia
17.
Rev. esp. cir. oral maxilofac ; 42(3): 139-142, jul.-sept. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-196631

RESUMO

Actualmente las sustancias de relleno son la forma más popular para el rejuvenecimiento facial y el aumento de los tejidos. Existen varios problemas añadidos que han condicionado el aumento de las complicaciones con los materiales de relleno, que son el uso de sustancias adulteradas, la inyección de varios materiales en la misma zona o la administración por personal no entrenado/autorizado. Varias investigaciones sugieren que la ecografía de alta frecuencia (EAF) es una herramienta útil, de bajo coste y no invasiva para demostrar el tipo material de relleno e identificar el lugar de inyección y la cantidad de material inyectado. Presentamos en caso de una mujer de 64 años que presentaba edema hemifacial después de 15 años de haberse inyectado silicona líquida (SIL) en los labios, tratada con minociclina, mostrando mejoría clínica significativa


Currently injectable materials are popular for facial rejuvenation and soft tissue augmentation. There are some added problems, which have been conditioned by the increase in complications with fillers, that are the use of adulterated materials, injections of various types of substances in the same area or because administration by inexperienced/untrained professionals. Several studies suggest that high frequency ultrasound (HUS) is an economical, useful and non-invasive diagnostic tool to determine the nature and type of material and to identify the injection site and quantity of injected filler. We report a case of a 64-year-old woman who presented hemifacial swelling after 15 years of being injected with 1 infiltration of liquid injectable silicone (LIS) in the lips, treated with Minocycline, showing a significant clinical improvement


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Edema/diagnóstico por imagem , Silicones/efeitos adversos , Preenchedores Dérmicos/efeitos adversos , Assimetria Facial/etiologia , Próteses e Implantes/efeitos adversos , Prednisona/uso terapêutico , Minociclina/uso terapêutico
18.
PLoS One ; 15(8): e0237047, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32745086

RESUMO

Deep prosthetic hip infection is a devastating complication of hip replacement surgery, and treatment often involves multiple revision surgeries with antibiotic chemotherapy to control the infection. The aim of this study was to explore patients' experiences of early and longer-term recovery after one-stage or two-stage revision with an excised hip, a temporary cement spacer or a custom-made articulating spacer. We interviewed 32 participants taking part in a surgical trial at two time points (2-4 months and 18 months) following one- or two-stage revision surgery. The analytic approach was inductive using the constant comparative method to generate themes from the data. Participants' early recovery after revision was characterised by a long hospital stay with burdensome antibiotics and limited physiotherapy provision. Participants undergoing two-stage revision with an excised hip or a cement spacer described severe mobility restrictions which affected all aspects of their lives, while those undergoing one-stage revision, or two-stage revision with an articulating spacer were more mobile and independent, with some limitations. Participants with a cement spacer also reported more pain than other treatment groups, while those with an articulating spacer appeared to perceive that their recovery was slow. At 18 months, participants in all groups described both improvements and losses in mobility and functional ability. Participants in all treatment groups expressed considerable emotional resilience during recovery from revision, which may be linked to opportunities to talk with the trial personnel. Participants identified the need for better information and psychological and physical support. Experience of recovery differs after one- and two-stage revision, and further in relation to the use of spacers. Mobility, function, independence and pain are important aspects of recovery which affect all aspects of day-to-day life. Increased information and more opportunities to talk and share experiences may provide psychological support during recovery.


Assuntos
Infecções Relacionadas à Prótese/psicologia , Recuperação de Função Fisiológica/fisiologia , Reoperação/psicologia , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Artroplastia de Quadril/efeitos adversos , Cimentos Ósseos/uso terapêutico , Feminino , Humanos , Articulações/cirurgia , Masculino , Pessoa de Meia-Idade , Próteses e Implantes/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Pesquisa Qualitativa , Reoperação/efeitos adversos
19.
Niger J Clin Pract ; 23(7): 897-899, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32620716

RESUMO

Background: The most important advantages of laparoscopic hernia repair include less postoperative pain, good cosmetic results, and early return to daily activities. Different methods and mesh types are used in inguinal hernia repair. Aims: The objective of this study was to evaluate the complications and recurrence rates in patients who underwent laparoscopic inguinal hernia repair with and without mesh fixation. Subjects and Methods: A total of 183 patients who underwent total extraperitoneal (TEP) inguinal hernia repair in the general surgery clinic between January 2012 and January 2015 patients operated due to inguinoscrotal hernia and those lost to follow-up were excluded from the study. Patients were divided into two groups. Group 1 consisted of patients in whom 3D (Bard 3D Max) mesh was used and fixed with symphysis pubis absorbable tucker, while group 2 included patients without mesh fixation. All statistical analyses were performed using SPSS 22.0 statistical package software. The differences were considered statistically significant if the P value was less than 0.05. Results: In the study, 178 patients were included. The median age was 48 years. Of all patients, 98 had right-sided, 72 left-sided, and eight bilateral hernias. The mean follow-up duration was 45 months. The demographic data between the groups were similar. Operation time was 51.82 ± 18.87 min in group 1 and 52 ± 19.92 in group 2 (P = 0.089). No statistically significant difference was found between both groups in terms of the development of early and late complications. Intraoperative complications, port-site hernia, and mortality were not seen in any patient. Conclusion: TEP seems to be a safe and effective surgical approach in inguinal hernia treatment with acceptable operation times and postoperative results. It was determined that not performing mesh fixation in the TEP application did not cause a statistical increase in morbidity and recurrence rates.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Telas Cirúrgicas/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Dor Pós-Operatória/etiologia , Próteses e Implantes/efeitos adversos , Recidiva , Resultado do Tratamento
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