Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.946
Filtrar
3.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32994176

RESUMO

A healthy Hispanic boy was born via cesarean delivery after an uncomplicated pregnancy. At 4 weeks old , his parents brought him to the emergency department for bruising on both soles of the feet. At 6 weeks old, his parents brought him to primary care for new bruises on his arms and back. After evaluation, primary care referred the patient to the emergency department. The parents denied any recent trauma, fever, cough, decreased urine, or change in appetite. Because of 2 episodes of unexplained bruising, the Department of Children and Families was granted emergency custody of the child. Hematology and ophthalmology did not identify any clear abnormalities. Skeletal surveys were normal. Dermatology was consulted. The examination was normal except for pink blanching patches on the upper back and linearly arranged pink blanching papules on the right lower leg. No crusting, erosions, hyperpigmentation, purpura, petechiae, or ecchymoses were seen. These lesions completely resolved the next day. He tested positive for dermatographism and developed similar lesions on his soles after pushing his feet down onto a soft surface. The intermittent urticarial skin changes were most consistent with physical urticaria. Such lesions could be mistaken for trauma; however, blood vessel damage typically results in progressive coloration changes for >1 day. At the emergency court hearing, given the concurring medical opinions of the dermatologist, pediatrician, and Child Protective Services, the judge returned full custody to the parents. This case reveals the value of dermatologic expertise in assessing skin changes, particularly those associated with physical abuse.


Assuntos
Pressão/efeitos adversos , Urticária/diagnóstico , Serviços de Proteção Infantil , Dermatologia , Diagnóstico Diferencial , Humanos , Lactente , Masculino , Abuso Físico , Encaminhamento e Consulta
4.
J Laryngol Otol ; 134(8): 735-738, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32718361

RESUMO

BACKGROUND: Coronavirus disease 2019 is an international pandemic. One of the cardinal features is acute respiratory distress syndrome, and proning has been identified as beneficial for a subset of patients. However, proning is associated with pressure-related side effects, including injury to the nose and face. METHOD: This paper describes a pressure-relieving technique using surgical scrub sponges. This technique was derived based on previous methods used in patients following rhinectomy. CONCLUSION: The increased use of prone ventilation has resulted in a number of referrals to the ENT team with concerns regarding nasal pressure damage. The described technique, which is straightforward and uses readily available materials, has proven effective in relieving pressure in a small number of patients.


Assuntos
Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pressão/efeitos adversos , Decúbito Ventral/fisiologia , Respiração Artificial/métodos , Tampões de Gaze Cirúrgicos/normas , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Desenho de Equipamento/métodos , Traumatismos Faciais/prevenção & controle , Humanos , Nariz/lesões , Nariz/cirurgia , Posicionamento do Paciente/métodos , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia
6.
J Pharmacol Sci ; 143(3): 199-208, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32414690

RESUMO

The optimum strategy for heart failure (HF) treatment has yet to be elucidated. This study intended to test the benefit of a combination of valsartan (VAL) and perifosine (PER), a specific AKT inhibitor, in protecting against pressure overload induced mouse HF. Mouse were subjected to aortic banding (AB) surgery to establish HF models and then were given vehicle (HF), VAL (50 mg/kg/d), PER (30 mg/kg/d) or combination of VAL and PER for 4 weeks. Mouse with sham surgery treated with VEH were used for control (VEH). VAL or PER treatment could significantly alleviate mouse heart weight, attenuate cardiac fibrosis and improve cardiac function. The combination treatment of VAL and PER presented much better benefit compared with VAL or PER group respectively. PER treatment significantly inhibited AKT/GSK3ß/mTORC1 signaling. Besides the classic AT1 inhibition, VAL treatment significantly inhibited MAPK (ERK1/2) signaling. Furthermore, VAL and PER treatment could markedly prevent neonatal rat cardiomyocyte hypertrophy and the activation of neonatal rat cardiac fibroblast. Combination of VAL and PER also presented superior beneficial effects than single treatment of VAL or PER in vitro experiments respectively. This study presented that the combination of valsartan and PER may be a potential treatment for HF prevention.


Assuntos
Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/prevenção & controle , Fosforilcolina/análogos & derivados , Pressão/efeitos adversos , Valsartana/administração & dosagem , Animais , Modelos Animais de Doenças , Quimioterapia Combinada , Glicogênio Sintase Quinase 3 beta/metabolismo , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/patologia , Sistema de Sinalização das MAP Quinases/efeitos dos fármacos , Masculino , Camundongos Endogâmicos C57BL , Tamanho do Órgão , Fosforilcolina/administração & dosagem , Proteínas Proto-Oncogênicas c-akt/metabolismo , Transdução de Sinais/efeitos dos fármacos
7.
Am J Otolaryngol ; 41(4): 102480, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32291181

RESUMO

OBJECTIVES: Tracheostomy-related pressure injuries (TRPI) have been demonstrated to occur in approximately 10% of tracheostomy patients. In this study, we present TRPI outcomes after implementation of a standardized tracheostomy care protocol. METHODS: A tracheostomy care protocol was developed by an interdisciplinary quality improvement program and implemented on July 1, 2016. The protocol was designed to minimize factors that contribute to the development of TRPI. Rates of TRPI over the subsequent 20 months were compared to the year before implementation. RESULTS: 9 out of 85 patients (10.6%) developed TRPI in the pre-protocol cohort compared to 0 of 137 (0%) in the post-protocol cohort, which was a statistically significant decrease by Fisher's exact test with a p-value of 0.0001. Pearson's correlation coefficient demonstrated a negative correlation between age and post-operative day of diagnosis (r = -0.641, p = 0.063), indicating that older patients develop TRPI more quickly. CONCLUSIONS: Interdisciplinary peri-operative tracheostomy care protocols can be effective in decreasing rates of TRPI.


Assuntos
Assistência Perioperatória/métodos , Pressão/efeitos adversos , Traqueostomia/efeitos adversos , Traqueostomia/métodos , Úlcera/etiologia , Úlcera/prevenção & controle , Estudos de Coortes , Humanos
8.
Medicine (Baltimore) ; 99(9): e19323, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118762

RESUMO

BACKGROUND: Low intra-abdominal pressure (IAP) and deep neuromuscular blockade (NMB) are frequently used in laparoscopic abdominal surgery to improve surgical space conditions and decrease postoperative pain. The evidence supporting operations using low IAP and deep NMB is open to debate. METHODS: The feasibility of the routine use of low IAP +deep NMB during laparoscopic surgery was examined. A meta-analysis is conducted with randomized controlled trials (RCTs) to compare the influence of low IAP + deep NMB vs. low IAP + moderate NMB, standard IAP +deep NMB, and standard IAP + moderate NMB during laparoscopic procedures on surgical space conditions, the duration of surgery and postoperative pain. RCTs were identified using the Cochrane, Embase, PubMed, and Web of Science databases from initiation to June 2019. Our search identified 9 eligible studies on the use of low IAP + deep NMB and surgical space conditions. RESULTS: Low IAP + deep NMB during laparoscopic surgery did not improve the surgical space conditions when compared with the use of moderate NMB, with a mean difference (MD) of -0.09 (95% confidence interval (CI): -0.55-0.37). Subgroup analyses showed improved surgical space conditions with the use of low IAP + deep NMB compared with low IAP + moderate NMB, (MD = 0.63 [95% CI:0.06-1.19]), and slightly worse conditions compared with the use of standard IAP + deep NMB and standard IAP + moderate NMB, with MDs of -1.13(95% CI:-1.47 to 0.79) and -0.87(95% CI:-1.30 to 0.43), respectively. The duration of surgery did not improve with low IAP + deep NMB, (MD = 1.72 [95% CI: -1.69 to 5.14]), and no significant reduction in early postoperative pain was found in the deep-NMB group (MD = -0.14 [95% CI: -0.51 to 0.23]). CONCLUSION: Low IAP +deep NMB is not significantly more effective than other IAP +NMB combinations for optimizing surgical space conditions, duration of surgery, or postoperative pain in this meta-analysis. Whether the use of low IAP + deep NMB results in fewer intraoperative complications, enhanced quality of recovery or both after laparoscopic surgery should be studied in the future.


Assuntos
Cavidade Abdominal/fisiopatologia , Bloqueio Neuromuscular/efeitos adversos , Pressão/efeitos adversos , Cavidade Abdominal/irrigação sanguínea , Humanos , Complicações Intraoperatórias , Laparoscopia/métodos , Bloqueio Neuromuscular/métodos
10.
Ergonomics ; 63(5): 618-628, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32167025

RESUMO

There is a lack of data and guidance on soft exoskeleton pressure contact with the body. The purpose of this research was to study the relationship between circumferential loading at the knee and discomfort/pain, to inform the design of soft exoskeletons/exosuits. The development of discomfort and pain was studied during standing and walking with circumferential compression using a pneumatic cuff. Our results show higher tolerance for intermittent than continuous compression during standing. Discomfort was triggered at pressures ranging from 13.7 kPa (continuous compression) to 30.4 kPa (intermittent compression), and pain at 52.9 kPa (continuous compression) to 60.6 kPa (intermittent compression). During walking, cyclic compression caused an increase in discomfort with time. Higher cuff inflation pressures caused an earlier onset and higher end intensities of discomfort than lower pressures. Cyclic cuff inflation of 10 kPa and 20 kPa was reasonably well tolerated. Practitioner summary Soft exoskeleton compression of the knee was simulated during static and dynamic compression cycles. The results can be used to understand how users tolerate pressure at the knee, and also to understand the levels at which discomfort and pain are experienced. Abbreviations: BMI: body mass index; DDT: discomfort detection threshold; EndVAS: end of experiment rating on visual analog discomfort scale; PDT: pain detection threshold; SD: standard deviation; SE: standard error; TSP: temporal summation of pain; VAS: visual analogue scale.


Assuntos
Desenho de Equipamento , Exoesqueleto Energizado , Articulação do Joelho/fisiologia , Limiar da Dor , Pressão/efeitos adversos , Adulto , Idoso , Fenômenos Biomecânicos , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Posição Ortostática , Caminhada
11.
Pain Physician ; 23(2): 219-227, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32214304

RESUMO

BACKGROUND: A method for assessing dynamic muscle hyperalgesia (dynamic pressure algometry) has been developed and applied in tension-type and migraine headaches. OBJECTIVES: To investigate differences in dynamic pressure pain assessment over the trigeminal area between men with cluster headache (CH) and headache-free controls, and the association between dynamic and static pressure pain sensitivity. STUDY DESIGN: A case-control study. SETTING: Tertiary urban hospital. METHODS: Forty men with episodic CH and 40 matched controls participated. Dynamic pressure pain sensitivity was assessed with a dynamic pressure algometry set consisting of 8 rollers with different fixed levels (500, 700, 850, 1,350, 1,550, 2,200, 3,850, and 5,300 g). Each roller was moved at a speed of 0.5 cm/sec over a diagonal line covering the temporalis muscle from an anterior to posterior direction. The dynamic pressure threshold (DPT; load level of the first painful roller) and the pain intensity perceived at the DPT level (roller-evoked pain) were assessed. Static pressure pain thresholds (PPT) were also assessed with a digital pressure algometer applied statically over the mid-muscle belly of the temporalis. Patients were assessed in a remission phase, at least 3 months from the last cluster attack, and without preventive medication. RESULTS: Side-to-side consistency between DPTs (r = 0.781, P < 0.001), roller-evoked pain on DPT (r = 0.586; P < 0.001), and PPTs (r = 0.874; P < 0.001) were found in men with CH. DPT was moderately, bilaterally, and side-to-side associated with PPTs (0.663 > r > 0.793, all P < 0.001). Men with CH had bilateral lower DPT and PPT and reported higher levels of roller-evoked pain (all P < 0.001) than headache-free controls. LIMITATIONS: Only men with episodic CH were included. CONCLUSIONS: This study supports that a dynamic pressure algometry is as valid as a static pressure algometry for assessing pressure pain sensitivity in patients with CH. Assessing both dynamic and static pain sensitivity may provide new opportunities for differentiated diagnostics. KEY WORDS: Cluster headache, dynamic pressure pain, pressure pain threshold.


Assuntos
Cefaleia Histamínica/diagnóstico , Hiperalgesia/diagnóstico , Medição da Dor/métodos , Dor/diagnóstico , Pressão/efeitos adversos , Músculo Temporal/patologia , Adulto , Estudos de Casos e Controles , Cefaleia Histamínica/complicações , Humanos , Hiperalgesia/etiologia , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Limiar da Dor/fisiologia
12.
Mil Med ; 185(Suppl 1): 256-262, 2020 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-32074328

RESUMO

OBJECTIVE: Infection as sequelae to explosion-related injury is an enduring threat to our troops. There are limited data on the effects of blast on antibiotic pharmacokinetics (PK), pharmacodynamics (PD), and efficacy. The observational study presented here is our Institute's first attempt to address this issue by combining our existing interdepartmental blast, infection modeling, and in vivo PK/PD capabilities and was designed to determine the PK effects of blast on the first-line antibiotic, cefazolin, in an in vivo mouse model. METHODS: A total of 160 male BALB/c mice were divided to sham and blast (exposed to blast overpressure of 19 psi) in two biological replicates. At 1 hour after blast/sham exposure, the animals received IV injection of cefazolin (328 mg/kg). Animals were euthanized at 3 minutes, 10 minutes, 15 minutes, 30 minutes, 1 hour, 3 hours, 6 hours, or 10 hours after the injection. Plasma and liver were analyzed for concentration of cefazolin using mass-spectrometry. RESULTS: We observed increases in the concentration of cefazolin in the plasma and liver of blast exposed animals at later time points and increase in elimination half-life. CONCLUSION: Our results indicate that blast-induced physiologic changes significantly influence cefazolin PK and suggest that efficacy could be affected in the context of the blast; assessment of efficacy and PD effects require further investigation. Metabolic changes resulting from blast may influence other classes of antibiotics and other therapeutics used with these injuries. Therefore, this may have important treatment considerations in other areas of military medicine.


Assuntos
Antibacterianos/farmacocinética , Traumatismos por Explosões/complicações , Pressão/efeitos adversos , Animais , Antibacterianos/sangue , Antibacterianos/uso terapêutico , Área Sob a Curva , Traumatismos por Explosões/sangue , Traumatismos por Explosões/fisiopatologia , Cefazolina/sangue , Cefazolina/farmacocinética , Cefazolina/uso terapêutico , Modelos Animais de Doenças , Explosões/estatística & dados numéricos , Camundongos , Camundongos Endogâmicos BALB C/lesões , Camundongos Endogâmicos BALB C/fisiologia , Curva ROC
13.
Mil Med ; 185(Suppl 1): 234-242, 2020 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-32074353

RESUMO

INTRODUCTION: There is no dose-response model available for the assessment of the risk of tympanic membrane rupture (TMR), commonly known as eardrum rupture, from exposures to blast from nonlethal flashbangs, which can occur concurrently with temporary threshold shift. Therefore, the objective of this work was to develop a fast-running, lumped parameter model of the tympanic membrane (TM) with probabilistic dose-dependent prediction of injury risk. MATERIALS AND METHODS: The lumped parameter model was first benchmarked with a finite element model of the middle ear. To develop the dose-response curves, TMR data from a historic cadaver study were utilized. From these data, the binary probability response was constructed and logistic regression was applied to generate the respective dose-response curves at moderate and severe eardrum rupture severity. RESULTS: Hosmer-Lemeshow statistical and receiver operation characteristic analyses showed that maximum stored TM energy was the overall best dose metric or injury correlate when compared with total work and peak TM pressure. CONCLUSIONS: Dose-response curves are needed for probabilistic risk assessments of unintended effects like TMR. For increased functionality, the lumped parameter model was packaged as a software library that predicts eardrum rupture for a given blast loading condition.


Assuntos
Traumatismos por Explosões/complicações , Explosões/classificação , Pressão/efeitos adversos , Perfuração da Membrana Timpânica/etiologia , Membrana Timpânica/fisiopatologia , Traumatismos por Explosões/fisiopatologia , Cadáver , Explosões/estatística & dados numéricos , Análise de Elementos Finitos , Humanos , Curva ROC , Medição de Risco/métodos , Membrana Timpânica/lesões , Perfuração da Membrana Timpânica/fisiopatologia
14.
Mil Med ; 185(Suppl 1): 214-226, 2020 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-32074364

RESUMO

INTRODUCTION: This study develops and demonstrates an analysis approach to understand the statistics of cumulative pressure exposure of the brain to repetitive blasts events. MATERIALS AND METHODS: A finite element model of blast loading on the head was used for brain model biomechanical responses. The cumulative pressure exposure fraction (CPEF), ranging from 0.0 to 1.0, was used to characterize the extent and repetition of high pressures. Monte Carlo simulations were performed to generate repetitive blast cumulative exposures. RESULTS: The blast orientation effect is as influential as the blast overpressure magnitudes. A 75° (from the side) blast orientation can produce CPEF values exceeding traumatic brain injury pressure thresholds >0.95 while, for the same blast overpressure, a 0° (front) blast orientation results in a CPEF <0.25. Monte Carlo results for different sequences reflecting notional operational and training environments show that both mean values and standard deviations of CPEF reach the statistically equilibrium state at a finite value of n exposures for each sequence. CONCLUSIONS: Statistical convergence of the brain pressure response metrics versus number of blasts for different exposures characterizes the transitions from "low" to "high" number of blasts and quantitatively highlights the differences between operational and training exposures.


Assuntos
Traumatismos por Explosões/complicações , Encéfalo/fisiologia , Explosões/classificação , Fenômenos Biomecânicos/fisiologia , Traumatismos por Explosões/fisiopatologia , Encéfalo/fisiopatologia , Análise de Elementos Finitos , Humanos , Método de Monte Carlo , Pressão/efeitos adversos
15.
Mil Med ; 185(Suppl 1): 248-255, 2020 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-32074377

RESUMO

INTRODUCTION: The peripheral auditory system and various structures within the central auditory system are vulnerable to blast injuries, and even blast overpressure is at relatively mild traumatic brain injury (TBI) level. However, the extent of hearing loss in relation to blast number and time course of post-blast is not well understood. This study reports the progressive hearing damage measured in chinchillas after multiple blast exposures at mild TBI levels (103-138 kPa or 15-20 psi). MATERIALS AND METHODS: Sixteen animals (two controls) were exposed to two blasts and three blasts, respectively, in two groups with both ears plugged with foam earplugs to prevent the eardrum from rupturing. Auditory brainstem response (ABR) and distortion product otoacoustic emission (DPOAE) were measured in pre- and post-blasts. Immunohistochemical study of chinchilla brains were performed at the end of experiment. RESULTS: Results show that the ABR threshold and DPOAE level shifts in 2-blast animals were recovered after 7 days. In 3-blast animals, the ABR and DPOAE shifts remained at 26 and 23 dB, respectively after 14 days. Variation of auditory cortex damage between 2-blast and 3-blast was also observed in immunofluorescence images. CONCLUSIONS: This study demonstrates that the number of blasts causing mild TBI critically affects hearing damage.


Assuntos
Traumatismos por Explosões/complicações , Perda Auditiva Provocada por Ruído/etiologia , Perda Auditiva/etiologia , Animais , Traumatismos por Explosões/fisiopatologia , Concussão Encefálica/etiologia , Concussão Encefálica/fisiopatologia , Chinchila/lesões , Chinchila/fisiologia , Modelos Animais de Doenças , Potenciais Evocados Auditivos do Tronco Encefálico/fisiologia , Perda Auditiva/fisiopatologia , Perda Auditiva Provocada por Ruído/fisiopatologia , Emissões Otoacústicas Espontâneas/fisiologia , Pressão/efeitos adversos , Membrana Timpânica/lesões , Membrana Timpânica/fisiopatologia
16.
PLoS One ; 15(2): e0228536, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32049971

RESUMO

Recent literature emphasizes the importance of comfort in the design of exosuits and other assistive devices that physically augment humans; however, there is little quantitative data to aid designers in determining what level of force makes users uncomfortable. To help close this knowledge gap, we characterized human comfort limits when applying forces to the shoulders, thigh and shank. Our objectives were: (i) characterize the comfort limits for multiple healthy participants, (ii) characterize comfort limits across days, and (iii) determine if comfort limits change when forces are applied at higher vs. lower rates. We performed an experiment (N = 10) to quantify maximum tolerable force pulling down on the shoulders, and axially along the thigh and shank; we termed this force the comfort limit. We applied a series of forces of increasing magnitude, using a robotic actuator, to soft sleeves around their thigh and shank, and to a harness on their shoulders. Participants were instructed to press an off-switch, immediately removing the force, when they felt uncomfortable such that they did not want to feel a higher level of force. On average, participants exhibited comfort limits of ~0.9-1.3 times body weight on each segment: 621±245 N (shoulders), 867±296 N (thigh), 702±220 N (shank), which were above force levels applied by exosuits in prior literature. However, individual participant comfort limits varied greatly (~250-1200 N). Average comfort limits increased over multiple days (p<3e-5), as users habituated, from ~550-700 N on the first day to ~650-950 N on the fourth. Specifically, comfort limits increased 20%, 35% and 22% for the shoulders, thigh and shank, respectively. Finally, participants generally tolerated higher force when it was applied more rapidly. These results provide initial benchmarks for exosuit designers and end-users, and pave the way for exploring comfort limits over larger time scales, within larger samples and in different populations.


Assuntos
Desenho de Equipamento , Exoesqueleto Energizado , Perna (Membro)/fisiologia , Mialgia/prevenção & controle , Conforto do Paciente , Pressão/efeitos adversos , Ombro/fisiologia , Adulto , Tornozelo/fisiologia , Fenômenos Biomecânicos , Desenho de Equipamento/efeitos adversos , Desenho de Equipamento/métodos , Exoesqueleto Energizado/efeitos adversos , Feminino , Marcha/fisiologia , Humanos , Masculino , Mialgia/etiologia , Conforto do Paciente/métodos , Robótica/instrumentação , Robótica/métodos , Estresse Mecânico , Coxa da Perna/fisiologia , Adulto Jovem
18.
Am J Otolaryngol ; 41(3): 102402, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31982210

RESUMO

PURPOSE: Suspension laryngoscopy is a commonly performed procedure in otolaryngology. During the procedure, the laryngoscope applies direct force to the tongue. Postoperative tongue symptoms include pain, swelling, numbness, taste disturbance, and rarely motor deficits. Duration and magnitude of force applied have previously been associated with post-operative throat and tongue pain, respectively. We sought to correlate postoperative tongue symptoms with magnitude of force applied and/or duration of suspension and investigate any risk factors for tongue morbidity. MATERIALS AND METHODS: A sample of patients undergoing suspension laryngoscopy between 2015 and 2018 were prospectively recruited. Those with preexisting tongue symptoms, disease or surgery were excluded. Patients completed preoperative and postoperative questionnaires evaluating tongue swelling, numbness, motion and taste disturbance. Symptoms were subjectively scored on a visual scale from 0 to 10. Patient demographics, past medical and social history were also recorded. Intraoperative pressures were measured using a spring force scale, positioned between the suspension arm and Mayo stand. Initial and end suspension forces and duration of suspension were recorded. RESULTS: 120 patients met inclusion criteria, of which 63 completed both preoperative and postoperative questionnaires. 6 patients (9.5%) experienced postoperative tongue symptoms. Suspension force and duration of suspension were not significantly predictive of postoperative tongue symptoms. While all symptomatic patients were current or former cigarette smokers, smoking status was not found to be a statistically significant factor. CONCLUSIONS: Neither suspension forces nor duration of suspension were predictive of postoperative tongue morbidity. Further research is needed to evaluate the role of smoking status on postoperative tongue symptoms.


Assuntos
Hipóxia/etiologia , Hipóxia/patologia , Laringoscopia/efeitos adversos , Resultados Negativos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Pressão/efeitos adversos , Doenças da Língua/etiologia , Doenças da Língua/patologia , Língua/patologia , Adulto , Idoso , Fenômenos Biomecânicos , Edema , Feminino , Humanos , Hipóxia/fisiopatologia , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Movimento (Física) , Dor , Complicações Pós-Operatórias/fisiopatologia , Fatores de Risco , Inquéritos e Questionários , Paladar , Língua/fisiopatologia , Doenças da Língua/fisiopatologia , Adulto Jovem
19.
Vet Surg ; 49(4): 741-747, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31916617

RESUMO

OBJECTIVE: To evaluate the efficacy of stents to distribute pressure when incorporated into tension-relieving sutures. STUDY DESIGN: An in vitro study and case report. ANIMAL: One common bottlenose dolphin (Tursiops truncates). METHODS: Three novel silicone stents, a traditional stent, and a control were tested in vitro by using a suture simulator. Stent surface area was measured by using a pressure mapping sensor. Pressure was derived from the measured surface area and the downward force of the suture simulator. Novel silicone stents were also used in the closure of an incision in a bottlenose dolphin. RESULTS: No difference was found in surface area or pressure among the three silicone stents (adjusted P > .05). Silicone stents yielded an average, 2.69 cm2 more surface area and 842.37 kPa less pressure compared with the control as well as 1.67 cm2 more surface area and 110.67 kPa less pressure compared with the traditional stent. The traditional stent yielded 1.02 cm2 more surface area and 731.7 kPa less pressure compared with the control. Incision site and silicone stent assessment performed postoperatively revealed no obvious pressure necrosis. CONCLUSION: Stents improved distribution of suture pressure, and novel silicone stents were more effective compared with traditional stents. Novel silicone stents appear to have preliminary clinical success in vivo. CLINICAL SIGNIFICANCE: Our study provides evidence that stents effectively help distribute suture pressure, and their incorporation might minimize the risk of suture pressure necrosis. Novel silicone stents should be integrated into tension-relieving suture patterns when closing wounds and incisions, particularly in aquatic animals.


Assuntos
Golfinho Nariz-de-Garrafa/cirurgia , Necrose/prevenção & controle , Pressão/efeitos adversos , Stents/veterinária , Suturas/veterinária , Animais , Feminino , Técnicas In Vitro , Necrose/etiologia
20.
Am J Emerg Med ; 38(4): 853.e5-853.e6, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31839516

RESUMO

INTRODUCTION: To the majority of health care professionals, burns present as a challenging and potentially distracting diagnosis. Because of their perceived complexity, they often eclipse other medical problems which can often be life threatening. Pressure related injuries, in rare instances can mimic and be mistaken for full thickness burns. Long lies may cause pressure necrosis of decubitus areas and compartment syndrome of vulnerable areas. Compartment syndrome, is a surgical emergency requiring prompt diagnosis and intervention. It may be missed in the context of a long lie after a collapse and maybe detrimental to patients' prognosis. METHODS: We reviewed cases referred to our Burns unit in the last four months to find cases of pressure related injuries referred as burn wounds. Furthermore, we also performed a literature search to find any similar cases to ours. RESULTS: Two cases, with acute pressure related injuries from long lies had been mistaken for burn wounds, were referred to our unit in the last four months. In one case a missed compartment syndrome resulted in a below elbow amputation. CONCLUSION: Pattern analysis and recognition are very important diagnostic tools in medicine. Detailed history taking and examination cannot be emphasised enough. Training both emergency departments and plastic surgeons in recognising long lie related injuries will decrease possible associated dangers such as missing a compartment syndrome.


Assuntos
Queimaduras/diagnóstico , Erros de Diagnóstico , Lesão por Pressão/diagnóstico , Acidentes por Quedas , Idoso , Queimaduras/patologia , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/patologia , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pressão/efeitos adversos , Lesão por Pressão/patologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...