Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 726
Filtrar
1.
J Med Internet Res ; 23(3): e23970, 2021 03 16.
Artigo em Inglês | MEDLINE | ID: mdl-33608248

RESUMO

BACKGROUND: The unprecedented COVID-19 pandemic has brought drastic changes to the field of plastic surgery. It is critical for stakeholders in this field to identify the changes in public interest in plastic procedures to be adequately prepared to meet the challenges of the pandemic. OBJECTIVE: The aim of this study is to examine tweets related to the public interest in plastic procedures during the COVID-19 pandemic and to help stakeholders in the field of plastic surgery adjust their practices and sustain their operations during the current difficult situation of the pandemic. METHODS: Using a web crawler, 73,963 publicly accessible tweets about the most common cosmetic surgical and minimally invasive plastic procedures were collected. The tweets were grouped into three phases, and the tweeting frequencies and Google Trends indices were examined. Tweeting frequency, sentiment, and word frequency analyses were performed with Python modules. RESULTS: Tweeting frequency increased by 24.0% in phase 2 and decreased by 9.1% in phase 3. Tweets about breast augmentation, liposuction, and abdominoplasty ("tummy tuck") procedures consecutively increased over the three phases of the pandemic. Interest in Botox and chemical peel procedures revived first when the lockdown was lifted. The COVID-19 pandemic was associated with a negative impact on public sentiment about plastic procedures. The word frequency pattern significantly changed after phase 1 and then remained relatively stable. CONCLUSIONS: According to Twitter data, the public maintained their interest in plastic procedures during the COVID-19 pandemic. Stakeholders should consider refocusing on breast augmentation, liposuction, and abdominoplasty procedures during the current phase of the pandemic. In the case of a second wave of COVID-19, stakeholders should prepare for a temporary surge of Botox and chemical peel procedures.


Assuntos
/epidemiologia , Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Mídias Sociais/estatística & dados numéricos , /virologia , Controle de Doenças Transmissíveis/métodos , Humanos , Pandemias , /isolamento & purificação
2.
Medicine (Baltimore) ; 100(5): e24357, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592883

RESUMO

ABSTRACT: Although it is well recognized that other surgical specialties perform various procedures related to trauma care, there is a lack of analyses focusing on the role of plastic surgical management in trauma centers. This retrospective study was designed to investigate the scope of plastic surgery services in acute trauma care, using clinical data obtained from a single, regional, level I trauma center.This study included patients who presented to a single, regional, level I trauma center between March 1, 2016 and February 28, 2018. Patients with acute trauma to the facial soft tissue and skeleton, soft tissue of the upper and lower limbs, trunk and perineum, and other areas requiring plastic surgical procedures were included in the analysis. Cases requiring consultation for the correction of posttraumatic deformity or secondary deformity and trauma sequelae, such as scars, were excluded. Data on patients' demographics and detailed surgical procedures were acquired from electronic medical records. The reviewed cases were categorized by the primary anatomical region requiring surgery and the primary procedure performed.A total of 1544 patients underwent surgery, and 2217 procedures were recorded during the 2-year study period. In 2016, 1062 procedures on 690 patients, and, in 2017, 1155 procedures on 787 patients were registered. The average age of the patients who underwent plastic surgical procedure due to a trauma-related cause was 38.4 years (range, 2 days to 91 years), and 1148 patients (77.7%) were male. The head and neck region was the most commonly observed anatomical area that was operated on. The facial bone requiring the largest degree of surgical intervention was the mandible, followed by the zygomatic bone, nasal bones, orbital floor, and maxilla. Microsurgical procedures, such as flap surgery and microsurgery, were performed in 121 cases. The most commonly elevated free flap was the ALT flap (n = 69).Plastic surgeons play various roles in level I trauma centers, such as in the management of facial injury, performing limb-saving free tissue transfers, and complex wound reconstruction with flaps or skin grafts. Thus, plastic surgeons are an essential part of trauma centers.


Assuntos
Utilização de Instalações e Serviços/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Cirurgia Plástica/estatística & dados numéricos , Centros de Traumatologia/estatística & dados numéricos , Ferimentos e Lesões/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica/estatística & dados numéricos , República da Coreia , Estudos Retrospectivos , Adulto Jovem
3.
Plast Reconstr Surg ; 147(1): 239-247, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33370072

RESUMO

SUMMARY: The current status of the plastic surgeon in the medical liability spectrum and ways to avoid litigation are explored by using pooled national data from the Medical Professional Liability Association, private information from Applied Medico-Legal Solutions RRG, and a detailed literature search. The medical liability system in the United States costs $55.6 billion, or 2.4 percent of total health care spending. Plastic surgery accounts for 3.31 percent of reported claims and 3.16 percent of paid claims. Total payments for plastic surgeons represent 1.75 percent of the total paid for all specialties. Malpractice awards are relatively light for plastic surgeons. Nevertheless, they still have a 15 percent chance per year of being sued. However, 93 percent of cases will close with a dismissal or a settlement, and only 7 percent will go to trial. Of these, the plastic surgeon will prevail in 79 percent. Most importantly, 75 percent of all cases will result in no payment. To minimize the chances of a lawsuit, plastic surgeons should maintain excellent communication with their patients and participate in shared decision-making. They should take a leadership role and buy in to the performance of perioperative checklists, embrace patient education, and actively participate in Maintenance of Certification. They should be transparent in their dealings with patients by preoperatively declaring their policies on revisions, refunds, complications, and payments. Plastic surgeons must maintain complete and accurate medical records and participate in hospital-based programs of prophylaxis. They should be aware that postoperative infection is the single costliest adverse outcome and proactively deal with it.


Assuntos
Responsabilidade Legal/economia , Erros Médicos/prevenção & controle , Complicações Pós-Operatórias/economia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Cirurgia Plástica/economia , Lista de Checagem/normas , Comunicação , Tomada de Decisão Compartilhada , Humanos , Consentimento Livre e Esclarecido/legislação & jurisprudência , Consentimento Livre e Esclarecido/normas , Erros Médicos/economia , Erros Médicos/legislação & jurisprudência , Erros Médicos/estatística & dados numéricos , Educação de Pacientes como Assunto/legislação & jurisprudência , Educação de Pacientes como Assunto/normas , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Guias de Prática Clínica como Assunto , Procedimentos Cirúrgicos Reconstrutivos/economia , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Cirurgiões/economia , Cirurgiões/legislação & jurisprudência , Cirurgiões/normas , Cirurgiões/estatística & dados numéricos , Cirurgia Plástica/normas , Cirurgia Plástica/estatística & dados numéricos , Estados Unidos
4.
Plast Reconstr Surg ; 147(1): 135e-153e, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33370073

RESUMO

SUMMARY: The Affordable Care Act's provisions have affected and will continue to affect plastic surgeons and their patients, and an understanding of its influence on the current American health care system is essential. The law's impact on pediatric plastic surgery, craniofacial surgery, and breast reconstruction is well documented. In addition, gender-affirmation surgery has seen exponential growth, largely because of expanded insurance coverage through the protections afforded to transgender individuals by the Affordable Care Act. As gender-affirming surgery continues to grow, plastic surgeons have the opportunity to adapt and diversify their practices.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Patient Protection and Affordable Care Act/legislação & jurisprudência , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Cirurgia de Readequação Sexual/estatística & dados numéricos , Feminino , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde/tendências , Disparidades em Assistência à Saúde/economia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/tendências , Humanos , Cobertura do Seguro/economia , Cobertura do Seguro/tendências , Masculino , Medicaid/economia , Medicaid/estatística & dados numéricos , Patient Protection and Affordable Care Act/economia , Procedimentos Cirúrgicos Reconstrutivos/economia , Procedimentos Cirúrgicos Reconstrutivos/tendências , Cirurgia de Readequação Sexual/economia , Cirurgia de Readequação Sexual/tendências , Fatores Socioeconômicos , Estados Unidos , Seguro de Saúde Baseado em Valor/economia , Seguro de Saúde Baseado em Valor/estatística & dados numéricos
7.
J Pediatr Orthop ; 40(8): e690-e696, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32776771

RESUMO

PURPOSE: The debate on the treatment of type IIa supracondylar humerus fractures has yet to be resolved. The purpose of this study was to assess the factors associated with successful closed reduction and immobilization and to assess the efficacy of a novel radiographic "hourglass" angle measurement in the management of type IIa supracondylar humerus fractures within the pediatric population. METHODS: An institutional review board-approved retrospective review of all children who underwent closed reduction and casting or splinting of an isolated type IIa supracondylar humerus fractures treated at 2 pediatric hospitals from January 1, 2009 to August 31, 2016. Analyzed radiographic parameters included Baumann angle (BA), humerocondylar angle (HCA), perpendicular distance (PD) from the anterior humeral line to the capitellum, and the hourglass angle (HGA). These parameters were measured on injury radiographs (XR), postreduction XR, and at the first and final follow-up XR. The success of closed reduction was defined as maintenance of an acceptable reduction without a secondary procedure. The interobserver reliability was calculated. RESULTS: There were 77 elbows treated with closed reduction and long-arm cast or splint immobilization. Of those closed reductions, 76.62% of elbows (59/77) maintained their reduction alignment and did not require surgical treatment for percutaneous pinning. In this series, the BA was not significantly different following closed reduction ([INCREMENT]1.04 degrees; P=0.081); however, the PD ([INCREMENT]1.89 mm), HGA ([INCREMENT]7.38 degrees), and HCA ([INCREMENT]5.07 degrees) had significant improvement following closed reduction (P<0.001 for all). The use of procedural sedation during reduction was strongly associated with success, 83.05% (49/59) with sedation compared with 55.56% (10/18) success without sedation (P=0.025). Furthermore, fractures that underwent a secondary procedure had 6.20 degrees less HGA following a closed reduction (P=0.016) and required additional follow-up visits (P=0.0037). The success of type IIa supracondylar humerus fractures did not significantly differ based on sex (P=0.5684), laterality (P=0.6975), mechanism of injury (P>0.9999), location of care-emergency department versus clinic (P=0.1160), or type of fracture immobilization (P=0.7411). The mean HGA in normal elbows was 177.8 degrees. The interobserver reliability for HCA was poor [intraclass correlation coefficient (ICC)=0.342]; fair for BA (ICC=0.458); and excellent for both PD and HGA (ICC=0.769 and 0.805, respectively) (P<0.001 for all). CONCLUSIONS: Improved and acceptable radiographic parameters were achieved by a closed reduction in the majority of minimally displaced type IIa fractures treated by closed reduction and immobilization in this series. HCA upon presentation was significantly greater in successful cases, and failure to improve and maintain HGA and PD following closed reduction was associated with loss of reduction. Procedural sedation during reduction was strongly associated with success. The HGA and PD were consistent parameters used to determine effective management of type IIa fractures. This study adds support for a nonoperative closed reduction under sedation with immobilization of selected type IIa supracondylar humerus fractures.


Assuntos
Fixação Intramedular de Fraturas , Fraturas do Úmero , Úmero , Criança , Cotovelo/cirurgia , Feminino , Fixação Intramedular de Fraturas/efeitos adversos , Fixação Intramedular de Fraturas/métodos , Humanos , Fraturas do Úmero/diagnóstico , Fraturas do Úmero/cirurgia , Úmero/diagnóstico por imagem , Úmero/cirurgia , Masculino , Radiografia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento
8.
Orbit ; 39(6): 460-462, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32808834

RESUMO

In March 2020, at the outset of the current pandemic, ESOPRS issued detailed advice on the appropriate procedures that practicing oculoplastic surgeons should consider to limit the transmission of COVID-19, with this information updated in April 2020. This paper highlights the threat to training opportunities for future generations of oculoplastic surgeons, adjustments in healthcare delivery, modifications of scientific activity, and the possible role of telemedicine in oculoplastics.


Assuntos
Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos Eletivos/normas , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Cirurgia Plástica/estatística & dados numéricos , Infecções por Coronavirus/prevenção & controle , Europa (Continente) , Feminino , Humanos , Controle de Infecções/organização & administração , Masculino , Saúde do Trabalhador , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Segurança do Paciente , Pneumonia Viral/prevenção & controle , Procedimentos Cirúrgicos Reconstrutivos/educação , Medição de Risco , Sociedades Médicas
9.
Plast Reconstr Surg ; 146(2): 371-379, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740590

RESUMO

BACKGROUND: As a component of the Maintenance of Certification process from 2003 to 2019, the American Board of Plastic Surgery tracked 20 common plastic surgery operations. By evaluating the data collected over 16 years, the authors are able to examine the practice patterns of pediatric/craniofacial surgeons in the United States. METHODS: Cumulative tracer data for cleft palate repair was reviewed as of April of 2014 and September of 2019. Evidence-based medicine articles were reviewed. Results were tabulated in three categories: pearls, or topics that were covered in both the tracer data and evidence-based medicine articles; topics that were covered by evidence-based medicine articles but not collected in the tracer data; and topics that were covered in tracer data but not addressed in evidence-based medicine articles. RESULTS: Two thousand eight hundred fifty cases had been entered as of September of 2019. With respect to pearls, pushback, von Langenbeck, and Furlow repairs all declined in use, whereas intravelar veloplasty increased. For items not in the tracer, the quality of studies relating to analgesia is among the highest of all areas of study regarding cleft palate repair. In terms of variables collected by the tracer but not studied, in 2019, 41 percent of patients received more than 1 day of antibiotics. CONCLUSIONS: This article provides a review of cleft palate tracer data and summarizes the research in the field. Review of the tracer data enables cleft surgeons to compare their outcomes to national norms and provides an opportunity for them to consider modifications that may enhance their practice.


Assuntos
Fissura Palatina/cirurgia , Medicina Baseada em Evidências/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Medicina Baseada em Evidências/métodos , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Cirurgiões/legislação & jurisprudência , Cirurgiões/estatística & dados numéricos , Cirurgia Plástica/legislação & jurisprudência , Cirurgia Plástica/estatística & dados numéricos , Resultado do Tratamento , Estados Unidos , Adulto Jovem
10.
Niger Postgrad Med J ; 27(3): 237-241, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32687125

RESUMO

Context: Although congenital hand anomalies are among the more common musculoskeletal anomalies worldwide, we do not know its prevalence in our practice. Aims: The aim of the study was to determine the pattern of congenital hand anomalies presenting to our tertiary plastic surgery outpatient service in South-Western Nigeria. Materials and Methods: This is a cross-sectional retrospective analysis of outpatient cases of congenital hand anomalies presenting over a 10-year period. Descriptive and inferential statistics were performed using frequencies, Student's t-test and Chi-square as appropriate. The data were analysed using IBM SPSS Statistics 23.0. The statistical significance value was set at P < 0.05. Results: One hundred and twenty-two cases were identified. The highest number of cases was seen in the year 2012, 23 patients (19.3%). There was a male preponderance of 66 patients (55.1%). Thirty-two patients (26.2%) presented as neonates and 36 (29.5%) as infants. Bilateral anomalies were seen in 67 patients (54.9%). The most common anomaly was failure of differentiation, 88 patients (72.1%) followed by duplication, 26 patients (21.3%). Syndactyly with 43 patients (35.2%) was the most common anomaly under failure of differentiation. No significant associations were found between the type of anomaly and gender or laterality. Conclusions: Syndactyly was the most common congenital hand anomaly in this study. There was a preponderance of bilateral involvement in both syndactyly and polydactyly.


Assuntos
Deformidades Congênitas da Mão/diagnóstico , Deformidades Congênitas da Mão/cirurgia , Polidactilia/diagnóstico , Polidactilia/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Centro Cirúrgico Hospitalar/estatística & dados numéricos , Sindactilia/diagnóstico , Sindactilia/cirurgia , Adolescente , Adulto , Distribuição por Idade , Criança , Pré-Escolar , Estudos Transversais , Deformidades Congênitas da Mão/epidemiologia , Humanos , Lactente , Recém-Nascido , Masculino , Anormalidades Musculoesqueléticas/epidemiologia , Nigéria/epidemiologia , Polidactilia/epidemiologia , Estudos Retrospectivos , Distribuição por Sexo , Cirurgia Plástica , Sindactilia/epidemiologia , Adulto Jovem
11.
Hand Surg Rehabil ; 39(5): 454-458, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32619686

RESUMO

Since the first cases were detected in China in December 2019, the COVID-19 pandemic has spread rapidly, collapsing many healthcare systems, and forcing them to adapt. Hand surgery has been indirectly affected by this scenario. This article aims to provide an overview on how Spanish hand surgeons have modified their daily practice. Based on a survey conducted nationwide, we observed a decrease in the number of emergency cases and cancellation of elective cases, shift to a more conservative treatment approach, use of personal protective equipment, and decrease in the number of outpatient visits and tests. Without definitive evidence at this point, knowing how we have dealt with the situation so far will help us adopt the needed measures to ensure both the patient's and surgeon's safety and manage available resources in future pandemics.


Assuntos
Infecções por Coronavirus/epidemiologia , Traumatismos da Mão/cirurgia , Procedimentos Ortopédicos/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Padrões de Prática Médica , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Tratamento de Emergência/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde , Humanos , Pandemias , Espanha/epidemiologia
12.
J Urol ; 204(6): 1326-1332, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32614254

RESUMO

PURPOSE: We sought to determine the number of cases to achieve competency and proficiency in tubularized incised plate technique for distal hypospadias repair using cumulative sum analysis. MATERIALS AND METHODS: From 2001 to 2015 we reviewed all distal tubularized incised plate repairs performed by a single surgeon since independent practice. Data for 450 consecutive cases included age, meatal location, presence of curvature, operative time, occurrence of complications and followup duration. A cumulative sum analysis cohort chart was used to determine trends in complication rate and operative time during the evaluation period. In order to account for surgical experience with time, the highest peak, plateau, and down trends in operative time and complication rate were identified on the plot and set as the transition points between learning (phase 1), competence (phase 2) and proficiency (phase 3). RESULTS: Based on the cumulative sum analysis learning curve, the competence phase with plateau of operative time and complication rate commences beyond the 127th case, and the proficiency phase with notable decline in operative time and complication rate was noted beyond the 234th case. When comparing case characteristics and surgical outcomes between phases and learning curve, the proficiency phase involved younger patients and more severe degree of distal hypospadias being repaired using the tubularized incised plate approach with fewer complications related to meatal stenosis and fewer cosmetic complications. CONCLUSIONS: In our study competency in distal hypospadias tubularized incised plate repair was reached beyond the 127th case, while proficiency was attained beyond the 234th case.


Assuntos
Hipospadia/cirurgia , Curva de Aprendizado , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Cirurgiões/estatística & dados numéricos , Procedimentos Cirúrgicos Urológicos Masculinos/estatística & dados numéricos , Competência Clínica , Seguimentos , Humanos , Lactente , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/educação , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Cirurgiões/educação , Resultado do Tratamento , Uretra/anormalidades , Uretra/cirurgia , Estreitamento Uretral/epidemiologia , Estreitamento Uretral/etiologia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Procedimentos Cirúrgicos Urológicos Masculinos/educação , Procedimentos Cirúrgicos Urológicos Masculinos/métodos
14.
Plast Reconstr Surg ; 146(1): 171-182, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32590661

RESUMO

BACKGROUND: Health-related quality of life is decreased in burn survivors, with scars implicated as a cause. The authors aim to characterize the use of reconstructive surgery following hospitalization and determine whether patient-reported outcomes change over time. The authors hypothesized improvement in health-related quality of life following reconstructive surgery. METHODS: Adult burn survivors undergoing reconstructive surgery within 24 months after injury were extracted from a prospective, longitudinal database from 5 U.S. burn centers (Burn Model System). Surgery was classified by problem as follows: scar, contracture, and open wound. The authors evaluated predictors of surgery using logistic regression. Short Form-12/Veterans RAND 12 health survey outcomes at 6, 12, and 24 months were compared at follow-up intervals and matched with nonoperated participants using propensity score matching. RESULTS: Three hundred seventy-two of 1359 participants (27.4 percent) underwent one or more reconstructive operation within 24 months of injury. Factors that increased the likelihood of surgery included number of operations during index hospitalization (p < 0.001), hand (p = 0.001) and perineal involvement (p = 0.042), and range-of-motion limitation at discharge (p < 0.001). Compared to the physical component scores of peers who were not operated on, physical component scores increased for participants undergoing scar operations; however, these gains were only significant for those undergoing surgery more than 6 months after injury (p < 0.05). Matched physical component scores showed nonsignificant differences following contracture operations. Mental component scores were unchanged or lower following scar and contracture surgery. CONCLUSIONS: Participants requiring more operations during index admission were more likely to undergo reconstructive surgery. There were improvements in Short Form-12/Veterans RAND 12 scores for those undergoing scar operations more than 6 months after injury, although contracture operations were not associated with significant differences in Short Form-12/Veterans RAND 12 scores.


Assuntos
Queimaduras , Qualidade de Vida , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Adulto , Queimaduras/psicologia , Queimaduras/reabilitação , Queimaduras/cirurgia , Cicatriz/psicologia , Feminino , Nível de Saúde , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Estudos Prospectivos , Adulto Jovem
17.
J Plast Reconstr Aesthet Surg ; 73(7): 1348-1356, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32499187

RESUMO

The Covid 19 epidemic has modified the way that plastic surgeons can treat their patients. At our hospital all elective surgery was canceled and only the more severe cases were admitted. The outpatient department activity has been reduced also. We present the number and diagnoses of patients, treated as in- and out-patients, during seven weeks from the onset of the epidemic, comparing our activity from the lockdown of elective surgery with the numbers and diagnoses observed during the same weeks of last year. Finally we underline the importance of using telemedicine and web-based tools to transmit images of lesions that need the surgeon's evaluation, and can be used by the patient to keep in touch with a doctor during the distressing time of delay of the expected procedure.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Acesso aos Serviços de Saúde/organização & administração , Controle de Infecções/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Procedimentos Cirúrgicos Reconstrutivos , Centros de Atenção Terciária/organização & administração , Adolescente , Adulto , Assistência ao Convalescente/métodos , Assistência ao Convalescente/organização & administração , Assistência ao Convalescente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/organização & administração , Assistência Ambulatorial/estatística & dados numéricos , Criança , Pré-Escolar , Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Emergências , Feminino , Seguimentos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Lactente , Controle de Infecções/organização & administração , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Telemedicina/métodos , Telemedicina/organização & administração , Telemedicina/estatística & dados numéricos , Centros de Atenção Terciária/estatística & dados numéricos , Adulto Jovem
18.
J Plast Reconstr Aesthet Surg ; 73(7): 1357-1404, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32475734

RESUMO

Charles Moore in The Telegraph recently described the NHS as 'lumbering'.1 Far from this description, it has been our experience that the NHS has rapidly transformed across specialties in order to respond to the unprecedented global crisis of COVID-19. We describe here the multiple ways in which the plastic surgery trauma service at Salisbury District Hospital swiftly adapted over a two-week period in March 2020. Our aim is to deliver a tailored trauma service whilst adhering to the same high standards of patient care established prior to the COVID-19 pandemic. It is our view that many of these changes will be positive enduring practices for the future.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Acesso aos Serviços de Saúde/organização & administração , Controle de Infecções/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Procedimentos Cirúrgicos Reconstrutivos , Centros de Traumatologia/organização & administração , Ferimentos e Lesões/cirurgia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Telemedicina/organização & administração , Centros de Traumatologia/estatística & dados numéricos , Reino Unido , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/terapia
19.
J Urol ; 204(5): 1048-1053, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32420797

RESUMO

PURPOSE: We aimed to compare the Society for Fetal Urology and anteroposterior pelvic diameter classification systems in predicting the time to resolution of isolated hydronephrosis. MATERIALS AND METHODS: We retrospectively reviewed isolated hydronephrosis cases prenatally detected and postnatally diagnosed between 1994 and 2018. Other urinary tract anomalies and vesicoureteral reflux were excluded. Baseline grades for both systems were collected. Anteroposterior pelvic diameter was classified as grade 1 to 4 over a scale of 5 mm. Resolution was defined by an anteroposterior pelvic diameter of less than 5 mm with Society for Fetal Urology grade I hydronephrosis. Time to resolution was analyzed using Kaplan-Meier curves. RESULTS: The study population consisted of 831 patients (1,028 renal units). Median followup was 26 months (range 6 to 260), and 559 units (54.3%) reached resolution during a median followup of 9 months (1 to 133). Resolution rates at 48 months were 81.7%, 65.6%, 37.6% and 5.2% for Society for Fetal Urology grades I through IV disease and 80.0%, 41.2%, 13.1% and 2.5% for anteroposterior pelvic diameter grades 1 through 4, respectively. Discrepancies between these grades were present in 481 units (46.8%). Society for Fetal Urology grades II to IV categorized as anteroposterior pelvic diameter grade 1 showed a superior cumulative rate of resolution (84.7%) vs anteroposterior pelvic diameter grades 2 to 4 categorized as Society for Fetal Urology grade I (53.2%, log-rank test p <0.001). CONCLUSIONS: Hydronephrosis cases with anteroposterior pelvic diameter grades 2 to 4 but categorized as Society for Fetal Urology grade I have an inferior cumulative rate of resolution than vice versa. Society for Fetal Urology grades have little influence on resolution when anteroposterior pelvic diameter is less than 10 mm. Therefore, anteroposterior pelvic diameter is more useful in predicting the time to resolution.


Assuntos
Feto/anormalidades , Hidronefrose/diagnóstico , Pelve Renal/diagnóstico por imagem , Índice de Gravidade de Doença , Adolescente , Criança , Pré-Escolar , Feminino , Feto/diagnóstico por imagem , Seguimentos , Humanos , Hidronefrose/congênito , Hidronefrose/cirurgia , Lactente , Recém-Nascido , Pelve Renal/anormalidades , Pelve Renal/cirurgia , Masculino , Gravidez , Prognóstico , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Remissão Espontânea , Estudos Retrospectivos , Fatores de Tempo , Ultrassonografia Pré-Natal , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos , Adulto Jovem
20.
Tunis Med ; 98(1): 49-54, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32395777

RESUMO

AIM: Various materials for reconstruction of bone defects in orbital floor fractures have been developed and clinically applied. The aim of this study is to evaluate the contribution of using the Polypropylene mesh as a reconstructive material for orbital floor mean-size defects. METHODS: We retrospectively reviewed the clinical charts of 40 patients who underwent post traumatic orbital floor reconstructive surgery. The selection criterias were : unilateral Blow-out orbital floor fracture with a defect size less then 2 cm² and the presence of diplopia, orbital tissue incarceration or enophtalmous ≥ 2mm. RESULTS: A male predominance was observed (82.5%) with a mean age of 31.3 years. The main injury etiology was vehicle accidents (62.5%). Preoperatively, diplopia (62.5%) and enophtalmous (50%) were predominant. The diagnosis of fracture was confirmed by the computed tomography. The orbital floor was explored via a transconjunctival approach in the majority of cases (92.5%). The reconstruction was made with polypropylene mesh. No infection or exposure of the material had happened. Postoperatively, diplopia remained in 36% of cases, enophtalmos in 15% of cases and infraorbital nerve hypoesthesia in 33.3% of cases. CONCLUSIONS: In this study, we found that since the availibility, the non resorbable character, the easy manipulation and the stability of the postoperative results which are similar to those of other studies, the Polypropylene mesh could be introduced in the reconstruction of the mean-size orbital floor fractures.


Assuntos
Procedimentos Cirúrgicos Oftalmológicos/métodos , Fraturas Orbitárias/cirurgia , Polipropilenos/uso terapêutico , Procedimentos Cirúrgicos Reconstrutivos/métodos , Telas Cirúrgicas , Diplopia/epidemiologia , Diplopia/etiologia , Diplopia/cirurgia , Traumatismos Oculares/complicações , Traumatismos Oculares/epidemiologia , Traumatismos Oculares/cirurgia , Humanos , Procedimentos Cirúrgicos Oftalmológicos/estatística & dados numéricos , Órbita/lesões , Fraturas Orbitárias/epidemiologia , Fraturas Orbitárias/etiologia , Polipropilenos/química , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...