Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 52.766
Filtrar
1.
J Am Acad Orthop Surg ; 28(20): e878-e887, 2020 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-33030854

RESUMO

The talus is unique in having a tenuous vascular supply and 57% of its surface covered by articular cartilage. Fractures of the head, neck, or body regions have the potential to compromise nearby joints and impair vascular inflow, necessitating surgical treatment with stable internal fixation in many cases. The widely preferred approach for many talar neck and body fractures is a dual anterior incision technique to achieve an anatomic reduction, with the addition of a medial malleolar osteotomy as needed to visualize the posterior talar body. Percutaneous screw fixation has also demonstrated success in certain patterns. Despite this modern technique, osteonecrosis and osteoarthritis remain common complications. A variety of new treatments for these complications have been proposed, including vascularized autograft, talar replacement, total ankle arthroplasty, and improved salvage techniques, permitting some patients to return to a higher level of function than was previously possible. Despite these advances, functional outcomes remain poor in a subset of severely injured patients, making further research imperative.


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Procedimentos Ortopédicos/métodos , Tálus/lesões , Tornozelo/cirurgia , Artroplastia de Substituição , Autoenxertos/irrigação sanguínea , Parafusos Ósseos , Fraturas Ósseas/complicações , Humanos , Osteoartrite/etiologia , Osteoartrite/terapia , Osteonecrose/etiologia , Osteonecrose/terapia , Osteotomia/métodos , Prognóstico , Recuperação de Função Fisiológica , Tálus/irrigação sanguínea
2.
Bone Joint J ; 102-B(9): 1113-1121, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862675

RESUMO

AIMS: We conducted a systematic review and meta-analysis to compare the mortality, morbidity, and functional outcomes of cemented versus uncemented hemiarthroplasty in the treatment of intracapsular hip fractures, analyzing contemporary and non-contemporary implants separately. METHODS: PubMed, Medline, EMBASE, CINAHL, and Cochrane Library were searched to 2 February 2020 for randomized controlled trials (RCTs) comparing the primary outcome, mortality, and secondary outcomes of function, quality of life, reoperation, postoperative complications, perioperative outcomes, pain, and length of hospital stay. Relative risks (RRs) and mean differences (with 95% confidence intervals (CIs)) were used as summary association measures. RESULTS: A total of 18 studies corresponding to 16 non-overlapping RCTs with a total of 2,819 intracapsular hip fractures were included. Comparing contemporary cemented versus uncemented hemiarthroplasty, RRs (95% CIs) for mortality were 1.32 (0.44 to 3.99) perioperatively, 1.01 (0.48 to 2.10) at 30 days, and 0.90 (0.71 to 1.15) at one year. The use of contemporary cemented hemiarthroplasty reduced the risk of intra- and postoperative periprosthetic fracture. There were no significant differences in the risk of other complications, function, pain, and quality of life. There were no significant differences in perioperative outcomes except for increases in operating time and overall anaesthesia for contemporary cemented hemiarthroplasty with mean differences (95% CIs) of 6.67 (2.65 to 10.68) and 4.90 (2.02 to 7.78) minutes, respectively. The morbidity and mortality outcomes were not significantly different between non-contemporary cemented and uncemented hemiarthroplasty. CONCLUSION: There are no differences in the risk of mortality when comparing the use of contemporary cemented with uncemented hemiarthroplasty in the management of intracapsular hip fractures. Contemporary cemented hemiarthroplasty is associated with a substantially lower risk of intraoperative and periprosthetic fractures. Cite this article: Bone Joint J 2020;102-B(9):1113-1121.


Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Cimentos para Ossos , Hemiartroplastia/efeitos adversos , Fraturas do Quadril/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Humanos , Complicações Pós-Operatórias/mortalidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Resultado do Tratamento
3.
Zhongguo Gu Shang ; 33(8): 716-20, 2020 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-32875760

RESUMO

OBJECTIVE: To study and compare the effect of indwelling drainage tube and extubation time on occult hemorrhage and functional recovery after total hip arthroplasty(THA). METHODS: From July 2017 to June 2018, 123 patients who underwent THA in our hospital for the first time were selected as the subjects of study. According to whether the drainage tube was retained or not and the time of extubation, they were divided into three groups:in group A, 41 patients (24 males, 17 females, age 53 to 77 years) did not put drainage tube after THA;in group B, 41 patients were removed 24 hours after THA, 26 males and 15 females, aged 55 to 74 years;in group C, 41 patients were removed 48 hours after THA, 25 males and 16 females, aged 52 to 75 years. The VAS score of pain 72 hours after THA, the total and recessive blood loss, the time of starting functional exercise, and the incidence of postoperative limb swelling were recorded. All the patients were followed up for one year after discharge. Harris hip score was used to evaluate the degree of hip function recovery one year after operation. RESULTS: The occult blood loss of group A, B and C were(513.6±25.3), (521.7±33.4), (519.3±29.8) ml, respectively, with no significant difference(P>0.05). There was no significant difference in blood loss in operation among the three groups(P>0.05). In group B and C, the postoperative apparent blood loss was more than that in group A (P<0.05). There was no significant difference in VAS scores of the three groups before and 72 hours after operation (P>0.05). The time of getting out of bed in group A was shorter than that in group B and C (P<0.05), and that in group B was shorter than that in group C(P<0.05). The Harris hip score at 1 year after operationof the three groups was significantly higher than that of before operation (P<0.05). There was no significant difference in Harris hip score before and after operation among three groups (P>0.05). There was no significant difference in the incidence of complications among three groups (P>0.05). CONCLUSION: Whether the drainage tube is left or not and the time of extubation have no significant effect on the latent blood loss and functional recovery after THA, but without drainage tube after THA can reduce the apparent blood loss, patients can get out of bed at 6 hours after THA, which is more conducive to the recovery and nursing of patients.


Assuntos
Artroplastia de Quadril , Idoso , Extubação , Drenagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Resultado do Tratamento
4.
Acta Biomed ; 91(3): e2020014, 2020 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-32921710

RESUMO

BACKGROUND AND AIM: Isolation of subjects with active severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is a pivotal preventive measure in the ongoing coronavirus disease 2019 (COVID-19) pandemic. A growing number of studies reported cases of recurrent SARS-CoV-2 RNA positivity following disease recovery, which were identified with a critical literature search and then meta-analyzed in this article. MATERIALS AND METHODS: A digital search was performed in Medline and Web of Science, using the keywords "coronavirus disease 2019" OR "COVID-19" OR "severe acute respiratory disease 2" OR "SARS-CoV-2" AND "recurrence" OR "repositivization" OR "retesting", without date or language restrictions. Recovery was defined as resolution of symptoms, with at least two consecutive negative molecular tests. RESULTS: A total number of 17 studies, with 5,182 COVID-19 patients, were included. SARS-CoV-2 recurrent RNA positivity in recovered COVID-19 patients ranged between 7-23% across the studies, with follow-up testing between 1-60 days. The estimated cumulative rate of SARS-CoV-2 recurrent RNA positivity was 12% (95% confidence interval, 12-13%; I2, 74%). CONCLUSIONS: Repeated molecular testing on respiratory tracts specimens at 1 and 2 months after recovery from COVID-19 is strongly advisable for early identification, isolation and clinical management of subjects with SARS-CoV-2 recurrent RNA positivity.


Assuntos
Betacoronavirus/genética , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , RNA Viral/análise , Recuperação de Função Fisiológica , Infecções por Coronavirus/virologia , Humanos , Pneumonia Viral/virologia
5.
Tokai J Exp Clin Med ; 45(3): 152-155, 2020 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-32901906

RESUMO

BACKGROUND: Temporomandibular joint (TMJ) dislocation can be categorized into three groups: acute, habitual or recurrent, and long-standing. Long-standing TMJ dislocation refers to a condition that persists for more than one month without reduction. Long-standing dislocation of the TMJ is rare and the most challenging and difficult to treat of the three. CASE REPORT: The present case study relates to a 53-year-old woman with long-standing TMJ dislocation of a year's duration who presented for treatment. Due to this condition, she was unable to take food orally, and nutrition was managed by gastrostomy tube feeding. She also suffered from schizophrenia and had been admitted to a closed hospital. Bilateral mandibular condylectomy was performed, restoring oral function. However, post-reduction, an open bite remained, restricting the types of food that she could eat. Additional intermaxillary fixation and intermaxillary traction would have been required for an optimal outcome, but they were not possible for this patient. CONCLUSION: Despite an inability to provide comprehensive treatment, due to patient-related factors, occlusal and masticatory functions were restored to adequate levels following bilateral condylectomy alone. This enabled oral feeding and improved her quality of life.


Assuntos
Ingestão de Alimentos , Luxações Articulares/cirurgia , Côndilo Mandibular/cirurgia , Mastigação , Boca/fisiopatologia , Recuperação de Função Fisiológica , Articulação Temporomandibular/cirurgia , Feminino , Humanos , Luxações Articulares/fisiopatologia , Pessoa de Meia-Idade , Qualidade de Vida , Articulação Temporomandibular/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
6.
Nat Commun ; 11(1): 4504, 2020 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-32908131

RESUMO

The strategies concerning modification of the complex immune pathological inflammatory environment during acute spinal cord injury remain oversimplified and superficial. Inspired by the acidic microenvironment at acute injury sites, a functional pH-responsive immunoregulation-assisted neural regeneration strategy was constructed. With the capability of directly responding to the acidic microenvironment at focal areas followed by triggered release of the IL-4 plasmid-loaded liposomes within a few hours to suppress the release of inflammatory cytokines and promote neural differentiation of mesenchymal stem cells in vitro, the microenvironment-responsive immunoregulatory electrospun fibers were implanted into acute spinal cord injury rats. Together with sustained release of nerve growth factor (NGF) achieved by microsol core-shell structure, the immunological fiber scaffolds were revealed to bring significantly shifted immune cells subtype to down-regulate the acute inflammation response, reduce scar tissue formation, promote angiogenesis as well as neural differentiation at the injury site, and enhance functional recovery in vivo. Overall, this strategy provided a delivery system through microenvironment-responsive immunological regulation effect so as to break through the current dilemma from the contradiction between immune response and nerve regeneration, providing an alternative for the treatment of acute spinal cord injury.


Assuntos
Microambiente Celular/imunologia , Sistemas de Liberação de Medicamentos/instrumentação , Fator de Crescimento Neural/administração & dosagem , Regeneração Nervosa/efeitos dos fármacos , Traumatismos da Medula Espinal/terapia , Tecidos Suporte , Animais , Diferenciação Celular/efeitos dos fármacos , Diferenciação Celular/imunologia , Preparações de Ação Retardada/administração & dosagem , Modelos Animais de Doenças , Liberação Controlada de Fármacos , Feminino , Humanos , Concentração de Íons de Hidrogênio , Interleucina-4/administração & dosagem , Lipossomos , Células-Tronco Mesenquimais/efeitos dos fármacos , Células-Tronco Mesenquimais/fisiologia , Fator de Crescimento Neural/farmacocinética , Regeneração Nervosa/imunologia , Ratos , Recuperação de Função Fisiológica/imunologia , Medula Espinal/citologia , Medula Espinal/efeitos dos fármacos , Medula Espinal/imunologia , Traumatismos da Medula Espinal/imunologia
7.
Artigo em Russo | MEDLINE | ID: mdl-32929922

RESUMO

OBJECTIVE: To evaluate the effectiveness of comprehensive rehabilitation using cellex in post-stroke patients in the late recovery period and the period of residual disorders in a prospective long-term study. MATERIAL AND METHODS: Clinical examination and comprehensive rehabilitation treatment of 115 patients, aged 27-69 years (mean 50,47±11,20 years), with ischemic stroke and stroke in the carotid territory (n=78, 67,8%) and hemorrhagic stroke (n=37, 32, 2%) was carried out in the inpatient Department of GBU «NORCI¼. Patients who received rehabilitation measures were divided into two groups depending on the medication. The main study group consisted of 56 patients (48,7%) who received a course of cellex in the rehabilitation complex, the comparison group (n=59, 51,6%) underwent treatment without medication. RESULTS AND CONCLUSION: The complex multi-course rehabilitation treatment using cellex in patients in the late recovery period and in the period of consequences of ischemic stroke, who have speech and motor disorders, is highly effective, and demonstrate good results despite the age of the disease.


Assuntos
Transtornos Motores , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Adulto , Idoso , Feminino , Humanos , Hemorragias Intracranianas , Pessoa de Meia-Idade , Estudos Prospectivos , Recuperação de Função Fisiológica , Resultado do Tratamento
8.
J Bras Nefrol ; 42(2 suppl 1): 22-31, 2020 Aug 26.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32877495

RESUMO

We produced this document to bring pertinent information to the practice of nephrology, as regards to the renal involvement with COVID-19, the management of acute kidney injury cases, and practical guidance on the provision of dialysis support.As information on COVID-19 evolves at a pace never before seen in medical science, these recommendations, although based on recent scientific evidence, refer to the present moment. The guidelines may be updated when published data and other relevant information become available.


Assuntos
Lesão Renal Aguda/terapia , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Terapia de Substituição Renal/normas , Dispositivos de Acesso Vascular/normas , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/etiologia , Brasil/epidemiologia , Tomada de Decisão Clínica , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/prevenção & controle , Cuidados Críticos , Humanos , Rim/efeitos dos fármacos , Nefrologia/normas , Doenças Profissionais/prevenção & controle , Pandemias/prevenção & controle , Equipamento de Proteção Individual , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/prevenção & controle , Recuperação de Função Fisiológica , Terapia de Substituição Renal/métodos , Respiração Artificial/efeitos adversos , Sociedades Médicas
9.
Medicine (Baltimore) ; 99(39): e22330, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991444

RESUMO

RATIONALE: Widely applied in the treatment of severe ankle arthritis (AA), ankle distraction arthroplasty (ADA) can avoid not only the ankle range of motion loss but also ankle fusion. However, the clinical outcomes of ADA for severe AA are poorly understood. This study aims to present our clinical outcomes of severe AA treated by ADA. PATIENT CONCERNS: A 53-year-old man suffered right ankle sprain 10 years ago, endured right ankle pain and limited movement for 6 years. DIAGNOSIS: The patient was diagnosed as severe AA. INTERVENTIONS: He received ankle distraction arthroplasty. No adjuvant procedures were performed. The visual analog scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) score, the short-form (SF)-36 physical component summary (PCS) score and ankle activity score (AAS) were recorded to access the clinical outcomes pre- and postoperatively. Moreover, ankle joint space distance was evaluated on weight-bearing radiographs. OUTCOMES: The patient derived effective pain relief and restored a satisfactory range of movement. There was a 13-month follow-up period after frame removal. The AOFAS score improved from 56 preoperatively to 71 postoperatively. The VAS score decreased from 6 prior to surgery to 1 after surgery. The SF-36 PCS was 47.2 and 71.8 pre- and postoperative, respectively. The AAS scores were improved from 3.4 preoperatively to 7.3 postoperatively. LESSONS: ADA is reliable to achieve pain relief, functional recovery, and serve AA resolution. Besides, it is an alternative to ankle arthrodesis or total ankle arthroplasty in selected patients with severe AA.


Assuntos
Traumatismos do Tornozelo/complicações , Articulação do Tornozelo/patologia , Artrite/cirurgia , Osteogênese por Distração/efeitos adversos , Assistência ao Convalescente , Traumatismos do Tornozelo/fisiopatologia , Articulação do Tornozelo/diagnóstico por imagem , Artroplastia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Osteogênese por Distração/instrumentação , Radiografia/métodos , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Índice de Gravidade de Doença , Resultado do Tratamento , Escala Visual Analógica , Suporte de Carga
10.
Vasc Health Risk Manag ; 16: 331-341, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32982262

RESUMO

Purpose: Physiological tests may aid in diagnosing median arcuate ligament syndrome (MALS). MALS is a symptomatic compression of the celiac artery causing symptoms similar to chronic mesenteric ischemia (CMI) of atherosclerotic etiology. Simultaneous use of visible light spectroscopy (VLS) and laser doppler flowmetry (LDF) during upper endoscopy may detect microcirculatory changes in these patients. Patients and Methods: In a single-center, prospective comparative cohort, 25 patients were evaluated for MALS. Patients with a consensus diagnosis of MALS (n=15) underwent a gastroscopy assisted, transmucosal microcirculatory assessment with LDF and VLS. Results were compared to individuals with normal intestinal circulation (n=38) evaluated with duplex ultrasonography, and to patients with chronic mesenteric ischemia (n=32). Treatment response was evaluated clinically at 1, 3, 6, and 12 months, and with ultrasound, VLS and LDF at three months. Health-related quality of life (QoL) was assessed with Euroqol (EQ-5D-5L), preoperatively, and 12 months postoperatively. Results: Preoperative mean transmucosal oxygen saturation was significantly lower in patients with MALS (SO2 76±6), as compared to healthy individuals (SO2 81±4), p=0.02. An overall significant improvement in SO2 after surgical decompression of the celiac artery was found (SO2 81±3.7, p=0.05). Eleven (92%) patients with clinical improvement after laparoscopic decompression had a definitive diagnosis of MALS. Median follow-up was 18 months (4-24 months). Four of the five dimensions investigated with EQ-5D-5L improved. Conclusion: VLS detected a significantly lower baseline transmucosal SO2 in patients with MALS as compared to control subjects with normal intestinal circulation. An improvement in SO2 after laparoscopic decompression was found, supporting a possible ischemic etiology in our patient population.


Assuntos
Artéria Celíaca/fisiopatologia , Duodeno/irrigação sanguínea , Gastroscopia , Fluxometria por Laser-Doppler , Síndrome do Ligamento Arqueado Mediano/diagnóstico , Microcirculação , Circulação Esplâncnica , Estômago/irrigação sanguínea , Adulto , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo , Estudos de Casos e Controles , Descompressão Cirúrgica , Feminino , Humanos , Laparoscopia , Masculino , Síndrome do Ligamento Arqueado Mediano/fisiopatologia , Síndrome do Ligamento Arqueado Mediano/cirurgia , Isquemia Mesentérica/diagnóstico , Isquemia Mesentérica/fisiopatologia , Oclusão Vascular Mesentérica/diagnóstico , Oclusão Vascular Mesentérica/fisiopatologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Qualidade de Vida , Recuperação de Função Fisiológica , Análise Espectral , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
11.
Medicine (Baltimore) ; 99(37): e22229, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925800

RESUMO

BACKGROUND: Since the outbreak of COVID-19, the number of COVID-19 patients has been on the rise. With the improvement of diagnosis and treatment level in various countries, more and more patients have recovered. Baduanjin exercise is a traditional Chinese health care method with a long history, easy-to-learn, and remarkable effect. It is not subject to the constraints of the field and can be practiced at any time. It can be used as an alternative therapy for COVID-19 rehabilitation patients. At present, there are no relevant articles for systematic review. METHODS: We will retrieve a randomized controlled trial of Baduanjin exercise for COVID-19 from the beginning to July 2020. The following databases are areas of concern: Published randomized Cochrane Central Register of Controlled Trials (Central), PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and Wan-fang Database-controlled trials in Chinese and English related to Baduanjin exercise and COVID-19 were included. The main result was the effect of Baduanjin exercise on the quality of life in patients recovering from COVID-19. Secondary results to accompany symptoms (such as muscle pain, cough, sputum, runny nose, sore throat, chest tightness, shortness of breath, difficulty breathing, fatigue, headache, nausea, vomiting, anorexia, diarrhea), disappearance rate, 2 consecutive (not on the same day) COVID-19 negative rate of nucleic acid test results, the quality of life improved, improve CT images, the average hospitalization time, severe form of common clinical cure rate and mortality. RESULTS: The results of this study will provide researchers in the field of COVID-19 with a current synthesis of high-quality evidence. CONCLUSION: The conclusion of this study will provide evidence for judging whether Baduanjin exercise is an effective intervention for the quality of life of rehabilitative patients. PROSPERO REGISTRATION NUMBER: CRD42020199443.


Assuntos
Infecções por Coronavirus , Terapia por Exercício/métodos , Pandemias , Pneumonia Viral , Qualidade de Vida , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Infecções por Coronavirus/reabilitação , Humanos , Medicina Tradicional Chinesa/métodos , Metanálise como Assunto , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Pneumonia Viral/reabilitação , Recuperação de Função Fisiológica , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Resultado do Tratamento
12.
Orthop Clin North Am ; 51(4): 453-459, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32950214

RESUMO

Psychosocial health may influence the outcomes after total knee arthroplasty (TKA). We investigated the hypothesis that multimodal therapy influences the quality of life and function in patients diagnosed with osteoarthritis of the knee joint. Secondly, in patients who then proceed to have TKA post-multimodal therapy, does the response to the multimodal therapy influence the overall functional outcome of surgery? Patients diagnosed with osteoarthritis of the knee were enrolled in the study and prospectively followed-up. A total of 526 patients were enrolled and available for the study. All participants were enrolled for 12 classes of 60-minute duration over 6-weeks. Apart from an exercise program, the class also included physiotherapist-led education and a 'weight management' lecture by a dietitian. In summary, the multimodal therapy program improved the SF-12, OKS, pain scores (visual analogue scale) and WOMAC scores significantly. The multimodal therapy protocol can optimize patients' psychological scores prior to TKA and may enhance ultimate functional outcome.


Assuntos
Artroplastia do Joelho/reabilitação , Osteoartrite do Joelho/reabilitação , Artroplastia do Joelho/psicologia , Terapia Combinada , Humanos , Osteoartrite do Joelho/cirurgia , Recuperação de Função Fisiológica
13.
Int Heart J ; 61(5): 1075-1078, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32921664

RESUMO

Pulmonary valve stenosis (PVS) accounts for approximately 10% of all congenital heart defects. Echocardiography and right heart catheterization are the gold standards for diagnosis of PVS and for assessing disease severity and responsiveness to treatment.Recently, cardiac magnetic resonance imaging (cMRI) has been established as an important tool to comprehensively evaluate cardiac structure and function; however, research into the usefulness of cMRI for PVS management is limited. Here, we describe a case of a 59-year-old female with isolated, severe PVS who was successfully treated with balloon pulmonary valvuloplasty (BPV) followed by sequential cMRI at 1 and 12 months. Exertional dyspnea and elevated plasma BNP concentration were observed 1 month after BPV; however, echocardiographic findings did not indicate recurrent stenosis or increased pulmonary valve regurgitation but an increase in mitral E/e'. cMRI demonstrated improved systolic forward flow and RV function with enlargement of LV volume, and the rapid increase in LV preload might be associated with the transient deterioration in symptoms and BNP level, which both gradually improved within 3 months after BPV. cMRI further depicted that a reduced RV mass index and increased RV cardiac output were achieved gradually during the follow-up period.In conclusion, cMRI in combination with echocardiography was sufficiently informative to follow-up this PVS patient both before and after BPV. cMRI is easily reproducible in adult patients; therefore, cMRI should be recommended for long-term follow-up in adult PVS patients.


Assuntos
Valvuloplastia com Balão/métodos , Ecocardiografia , Imagem por Ressonância Magnética , Estenose da Valva Pulmonar/diagnóstico por imagem , Estenose da Valva Pulmonar/cirurgia , Recuperação de Função Fisiológica , Técnicas de Imagem Cardíaca , Débito Cardíaco , Dispneia/fisiopatologia , Feminino , Humanos , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Período Pós-Operatório , Estenose da Valva Pulmonar/congênito , Estenose da Valva Pulmonar/fisiopatologia , Índice de Gravidade de Doença , Função Ventricular Direita
14.
Plast Reconstr Surg ; 146(4): 819-829, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32970003

RESUMO

BACKGROUND: Multilevel dysvascular injury of the hand can be treated with replantation or revision amputation. The authors compared both modalities regarding functional outcomes, patient-reported outcomes, and required resources, as relevant studies are scarce. METHODS: In this retrospective review of consecutive case series (replantation, n = 8; revision amputation, n = 11), clinical results and functional outcomes (including grip strength, range of motion, sensory recovery, and grip or pinch ability) were assessed. Patient-reported outcomes, required hospital resources, and treatment cost until 1 year after surgery were compared between both groups. RESULTS: Six patients used passive prostheses, two used body-powered prostheses, and three did not use a prosthesis in the revision amputation group. All patients in the replantation group could grip objects and had restored hands, with protective sensory recovery and substantial wrist motion, whereas six patients in the revision amputation group were unable to grip or pinch objects. Replantation was associated with superior patient-reported outcomes, but required more hospital resources and treatment costs. CONCLUSIONS: This study suggests that in the treatment of multilevel dysvascular injury of the hand, the surgical method should be chosen on a case-by-case basis. For better functional and patient-reported outcomes, replantation is preferred. Revision amputation can be performed in the absence of sufficient hospital resources and to reduce treatment cost. These findings can aid in the preoperative counseling of patients with multilevel dysvascular injury of the hand. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Traumatismos da Mão/cirurgia , Mãos/irrigação sanguínea , Mãos/cirurgia , Reoperação , Reimplante/métodos , Adulto , Idoso , Amputação/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
15.
Ann Hematol ; 99(11): 2529-2538, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32948913

RESUMO

INTRODUCTION: Since the 1970s outcome of aplastic anemia (AA) patients has improved significantly due to the introduction of immunosuppressive therapy (IST) and allogeneic hematopoietic transplantation (HCT). However, patients may suffer from persistent disease, relapse, clonal evolution, graft-versus-host disease and other late effects. Here, we analyse very long-term outcome of all AA patients at our institution comparing not only survival, but also response status and complications. METHODS: Patient charts of all 302 AA patients treated between 1973 and 2017 at the University Hospital Basel, Switzerland, were retrospectively analysed. RESULTS: First line treatment was IST in 226 (75%) and HCT in 76 (25%) patients. Overall survival at 30 years was similar in patients treated initially by HCT and IST (44% (±14%), and 40% (± 9%) respectively, with better results in more recent years. Partial and no response occurred more frequently after IST, relapse incidence after IST was 24 %, whereas non-engraftment and graft failure was documented in 15 patients (19 %) after HCT. Clonal evolution to myelodysplastic syndrome / acute myeloid leukemia was 16 % at 25 years in IST patients, 1.3 % in HCT patients, iron overload (18 versus 4 %, p = 0.002) and cardiovascular events (11 versus 1 %, p=0.011) occured significantly more often in IST than HCT treated patients. The majority of long-term survivors, 96% of those alive at 25 years, were in complete remission at last follow up, irrespective of the initial treatment modality. CONCLUSION: Very long term survivors after AA are those with stable hematopoietic recovery.


Assuntos
Anemia Aplástica , Hematopoese , Transplante de Células-Tronco Hematopoéticas , Imunossupressão , Recuperação de Função Fisiológica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aloenxertos , Anemia Aplástica/mortalidade , Anemia Aplástica/terapia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
Khirurgiia (Mosk) ; (7): 12-17, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32736458

RESUMO

OBJECTIVE: To determine the value of membrane protective effect in intestine and liver cells for the effectiveness of minimally invasive surgery for acute peritonitis. MATERIAL AND METHODS: Patients with acute peritonitis undergoing laparoscopic (n=60) and open (n=50) surgery are analyzed. Functional characteristics of liver and bowel, disorders of homeostasis were evaluated in early postoperative period. RESULTS: Reduced negative impact of surgical aggression on the state of liver and intestine is essential to improve treatment outcomes in patients with acute peritonitis undergoing minimally invasive surgery. Fast recovery of intestine inevitably results reduced release of endotoxins while restoration of liver function is associated with rapid elimination of these toxins. These processes prevent severe intoxication and facilitate accelerated recovery. Functional restoration of liver and bowel is associated with reduced oxidative stress during laparoscopic operations. It is also important because peritonitis causes activation of free-radical processes per se. Therefore, an additional source of oxidative phenomena is extremely undesirable in these cases. CONCLUSION: Laparoscopic surgery for acute peritonitis minimizes surgical aggression and is associated with more favorable recovery of liver and bowel function. Undoubtedly, these findings should be considered to choose surgical approach in this severe category of patients.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Peritonite/cirurgia , Doença Aguda , Membrana Celular/metabolismo , Membrana Celular/patologia , Membrana Celular/fisiologia , Humanos , Mucosa Intestinal/metabolismo , Intestinos/patologia , Intestinos/fisiopatologia , Laparoscopia/efeitos adversos , Laparotomia/efeitos adversos , Fígado/metabolismo , Fígado/patologia , Fígado/fisiopatologia , Estresse Oxidativo/fisiologia , Peritonite/metabolismo , Peritonite/fisiopatologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Recuperação de Função Fisiológica , Toxinas Biológicas/biossíntese , Toxinas Biológicas/metabolismo
17.
Khirurgiia (Mosk) ; (7): 97-101, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32736472

RESUMO

Mine-explosive trauma is one of the most serious types of combat lesion and injuries in peacetime. We report a patient with mine-explosive trauma of the lower limbs followed by injury of the vascular bundle. Well-coordinated work of a multidisciplinary team of specialists at all stages of treatment is presented. The management was effective to save patient's life, avoid amputation and restore lower limb function.


Assuntos
Traumatismos por Explosões/cirurgia , Traumatismos da Perna/cirurgia , Salvamento de Membro/métodos , Extremidade Inferior/cirurgia , Lesões do Sistema Vascular/cirurgia , Humanos , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/lesões , Equipe de Assistência ao Paciente , Recuperação de Função Fisiológica , Resultado do Tratamento
18.
Dan Med J ; 67(8)2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32741438

RESUMO

INTRODUCTION: Chemosensory loss is a common symptom of coronavirus disease 2019 (COVID-19) and has been associated with a milder clinical course in younger patients. Whereas several studies have confirmed this association, knowledge about the improvement and recovery of olfactory and gustatory loss is lacking. The aim of this study was to investigate the temporal dynamics of improvement and recovery from sudden olfactory and gustatory loss in patients with confirmed and suspected COVID-19. METHODS: Subjective chemosensory function, symptoms of COVID-19, COVID-19 tests results, demographics and medical history were collected through a questionnaire. RESULTS: Among the 109 study participants, 95 had a combined olfactory and gustatory loss, five participants had isolated olfactory loss and nine participants has isolated taste loss. The mean age of participants was 39.4 years and 25% of participants were under the age of 30 years. Young age was not associated with a higher recovery rate. After a mean time of > 30 days since the chemosensory loss, participants reported relatively low recovery and improvement rates. For participants with olfactory loss, only 44% had fully recovered, whereas 28% had not yet experienced any improvement of symptoms. After gustatory loss, 50% had fully recovered, whereas 20% had not yet experienced any improvement. Olfactory and gustatory deficits were predominantly quantitative and mainly included complete loss of both olfactory and gustatory function. CONCLUSIONS: Chemosensory loss was frequent in young individuals and persisted beyond a month after symptom onset, often without any improvement during this time. FUNDING: The author wishes to acknowledge research salary funding from Arla Foods (Viby, Denmark) and the Central Region Denmark. The sponsors had no say, roles or responsibilities in relation to the study, including (but not limited to) the study design, data collection, management and analysis. TRIAL REGISTRATION: not relevant.


Assuntos
Ageusia , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus , Transtornos do Olfato , Pandemias , Pneumonia Viral , Adulto , Ageusia/diagnóstico , Ageusia/etiologia , Ageusia/reabilitação , Técnicas de Laboratório Clínico/métodos , Técnicas de Laboratório Clínico/estatística & dados numéricos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Dinamarca/epidemiologia , Autoavaliação Diagnóstica , Feminino , Humanos , Masculino , Transtornos do Olfato/diagnóstico , Transtornos do Olfato/etiologia , Transtornos do Olfato/reabilitação , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Recuperação de Função Fisiológica , Inquéritos e Questionários , Avaliação de Sintomas/métodos , Avaliação de Sintomas/estatística & dados numéricos
19.
Medicine (Baltimore) ; 99(32): e21459, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769874

RESUMO

BACKGROUND: Assessing the effectiveness and safety of Tai Chi for coronavirus disease 2019 (COVID-19) in recovery period is the main purpose of this systematic review protocol. METHODS: The following electronic databases will be searched from inception to April 2020: MEDLINE, Ovid, EMBASE, the Cochrane Library, the Allied and Complementary Medicine Database, Chinese National Knowledge Infrastructure, Chinese Biomedical Literature Database, VIP Database and Wanfang Database. In addition, Clinical trial registries, like the Chinese Clinical Trial Registry, the Netherlands National Trial Register and ClinicalTrials.gov, will be searched for ongoing trials with unpublished data. No language restrictions will be applied. The primary outcome will be the time of disappearance of main symptoms (including fever, asthenia, cough disappearance rate, and temperature recovery time), and serum cytokine levels. The secondary outcome will be the accompanying symptoms (such as myalgia, expectoration, stuffiness, runny nose, pharyngalgia, anhelation, chest distress, dyspnea, crackles, headache, nausea, vomiting, anorexia, diarrhea) disappear rate, negative COVID-19 results rate on 2 consecutive occasions (not on the same day), CT image improvement, average hospitalization time, occurrence rate of common type to severe form, clinical cure rate, and mortality. Two independent reviewers will conduct the study selection, data extraction and assessment. Review manager software V.5.3 will be used for the assessment of risk of bias and data synthesis. RESULTS: The results will provide a high-quality synthesis of current evidence for researchers in this subject area. CONCLUSION: The conclusion of the study will provide an evidence to judge whether Tai Chi is effective and safe for COVID-19 in recovery period. ETHICS AND DISSEMINATION: This protocol will not evaluate individual patient information or infringe patient rights and therefore does not require ethical approval. Results from this review will be disseminated through peer-reviewed journals and conference reports.PROSPERO registration number CRD42020181456.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/reabilitação , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Pneumonia Viral/reabilitação , Tai Ji/métodos , China , Feminino , Humanos , Masculino , Recuperação de Função Fisiológica
20.
Medicine (Baltimore) ; 99(32): e21508, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769888

RESUMO

BACKGROUND: The literature lacks studies that confirm whether the improved radiographic alignment that can be achieved with computer-navigated total knee arthroplasty (TKA) improves patients' activities of daily living or the durability of total knee prostheses. Thus, in this protocol, we designed a randomized controlled trial to compare implant alignment, functional scores, and survival of the implant using computer-assisted surgery versus a conventional surgical technique. METHODS: This prospective, blinded randomized controlled trial was conducted at our single hospital. This study was approved by the ethics committee of Jiaxing Second Hospital. The patient inclusion criteria were age 20 to 80 years' old, a body mass index of ≤35 kg/m, and consented for primary knee arthroplasty performed through a medial parapatellar approach by the senior author. We randomized consented study participants on a 1:1 ratio to 1 of 2 study groups using a computer-generated list of random numbers in varying block sizes. The primary outcome in this study was the Knee Injury and Osteoarthritis Outcome Score. Secondary outcomes were the Knee Society Score, Western Ontario and McMaster Universities Osteoarthritis Index, complications, and range of motion together with alignment and rotational positioning of the implant. Statistical significance was defined as a P value of ≤0.05. CONCLUSIONS: Authors hypothesized that computer-assisted surgery in primary TKA improves implant alignment, functional scores, and survival of the implant compared to the conventional technique.


Assuntos
Artroplastia do Joelho/métodos , Osteoartrite do Joelho/cirurgia , Cirurgia Assistida por Computador/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/efeitos adversos , China , Feminino , Humanos , Prótese do Joelho/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Método Simples-Cego , Cirurgia Assistida por Computador/efeitos adversos , Resultado do Tratamento , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA