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1.
Orthop Clin North Am ; 51(1): 97-108, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739884

RESUMO

Osteochondritis dissecans (OCD) of the capitellum is a relatively rare condition, with a higher incidence in adolescents who participate in repetitive overhead sports. The surgical treatment approach for this uncommon problem has varied from microfracture, loose body removal, abrasion chrondroplasty, lesion fixation, osteochondral allograft transplantation surgery, and osteochondral autologous transplantation surgery. The purpose of this study is to present the authors' preferred surgical technique for the treatment of unstable OCD lesions of the capitellum with osteochondral autologous transplantation surgery using autograft from the ipsilateral knee.


Assuntos
Cartilagem Articular/cirurgia , Articulação do Cotovelo/cirurgia , Úmero/cirurgia , Osteocondrite Dissecante/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adolescente , Criança , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/patologia , Feminino , Fraturas de Estresse , Humanos , Úmero/diagnóstico por imagem , Úmero/patologia , Úmero/transplante , Incidência , Articulação do Joelho/cirurgia , Imagem por Ressonância Magnética , Masculino , Osteocondrite Dissecante/diagnóstico por imagem , Osteocondrite Dissecante/epidemiologia , Osteocondrite Dissecante/patologia , Radiografia , Esportes , Transplante Autólogo/métodos , Resultado do Tratamento
2.
Medicine (Baltimore) ; 98(50): e18376, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852148

RESUMO

RATIONALE: Medial collateral ligament (MCL) injury is a common sports injury. The damage mainly occurs in ligament fibers, but MCL avulsion fracture is extremely rare and only a few reports have been published. PATIENT CONCERNS: Herein, we present a healthy 21-year-old man with an avulsion fracture of the MCL of the right knee sustained during snowboarding. DIAGNOSIS: Clinical and radiographic findings confirmed the presence of an avulsion fracture at the proximal attachment of the MCL, combined with complete anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) rupture. INTERVENTIONS: The patient underwent single-stage ACL, PCL reconstruction, and MCL repair. OUTCOMES: Two weeks after the surgery, the patient developed heterotopic ossification (HO) at the medial side of the knee, HO tended to be stable and mature at the 3-month follow-up examination. One year after the operation, the patient's knee was fully functional, stable, and pain free. LESSONS: Femoral attachment avulsion fracture of the MCL is in contrast to common isolated MCL injuries. Early surgical repair is advocated for the greatest benefit. Orthopedic surgeons should keep the potential complication HO in mind and develop rational strategies for HO prevention and treatment.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Fratura Avulsão/cirurgia , Ligamento Colateral Médio do Joelho/cirurgia , Ligamento Cruzado Posterior/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Ligamento Colateral Médio do Joelho/diagnóstico por imagem , Ligamento Colateral Médio do Joelho/lesões , Ligamento Cruzado Posterior/diagnóstico por imagem , Ligamento Cruzado Posterior/lesões , Amplitude de Movimento Articular , Transplante Autólogo/métodos , Adulto Jovem
3.
Braz J Cardiovasc Surg ; 34(5): 610-614, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31719012

RESUMO

In cases of aortic valve disease, prosthetic valves have been increasingly used for valve replacement, however, there are inherent problems with prostheses, and their quality in the so-called Third World countries is lower in comparison to new-generation models, which leads to shorter durability. Recently, transcatheter aortic valve replacement has been explored as a less invasive option for patients with high-risk surgical profile. In this scenario, aortic valve neocuspidization (AVNeo) has emerged as another option, which can be applied to a wide spectrum of aortic valve diseases. Despite the promising results, this procedure is not widely spread among cardiac surgeons yet. Spurred on by the last publications, we went on to write an overview of the current practice of state-of-the-art AVNeo and its results.


Assuntos
Valva Aórtica/cirurgia , Anuloplastia da Valva Cardíaca/métodos , Glutaral/uso terapêutico , Doenças das Valvas Cardíacas/cirurgia , Pericárdio/transplante , Transplante Autólogo/métodos , Humanos , Reoperação , Resultado do Tratamento
4.
Anticancer Res ; 39(10): 5605-5610, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31570456

RESUMO

BACKGROUND/AIM: We analyzed the process of healing at osteotomy sites and timing of achievement of full weight-bearing in sarcoma patients who underwent hemicortical or intercalary reconstruction using the extracorporeal irradiated autologous bone graft technique. PATIENTS AND METHODS: We studied 10 patients who had undergone tumor resection and reconstruction with hemicortical extracorporeal irradiated autologous bone graft at mid-shaft femur or tibia. The control group consisted of 30 patients who received the reconstruction using intercalary bone graft. RESULTS: Full weight-bearing was achieved in all 10 patients at a median time of 4.8 months. Function was excellent in all patients. When comparing the clinical outcome among the patients who received intercalary and hemicortical grafts, the duration to full weight-bearing achievement in patients who received hemicortical graft was shorter than that in those with intercalary graft. CONCLUSION: Early full weight-bearing may be achieved in patients undergoing hemicortical resection and reconstruction using extracorporeal irradiated autologous bone graft.


Assuntos
Neoplasias Ósseas/patologia , Neoplasias Ósseas/cirurgia , Sarcoma/patologia , Sarcoma/cirurgia , Neoplasias de Tecidos Moles/patologia , Neoplasias de Tecidos Moles/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Transplante Ósseo/métodos , Osso e Ossos/patologia , Osso e Ossos/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia , Transplante Autólogo/métodos , Resultado do Tratamento
5.
Transplant Proc ; 51(9): 3120-3123, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31611118

RESUMO

BACKGROUND: In living-donor liver transplantation (LDLT), successful microsurgical arterial reconstruction is essential but quite challenging. Dissection of the hepatic artery extending to the celiac trunk is a rare complication during liver transplantation. Kazakhstan is an area in which deceased donor grafts are not sufficient for several reasons, and the availability of graft vessels is limited. METHODS: We herein report the case of a 65-year-old patient who underwent LDLT due to hepatitis B + D virus-coinfected liver cirrhosis complicated by hepatic artery dissection extending to the celiac trunk. Because of massive gastric collateral varices, direct anastomosis to the supraceliac aorta was not possible. Therefore, extra-anatomic jump graft reconstruction was performed from the right iliac artery to the graft's hepatic artery using an autologous graft vein (great saphenous vein). RESULTS: The patient's postoperative period was uneventful. The patient was discharged at 27 days post-transplantation. At the time of writing, the follow-up period is 8 months after transplantation, and the recipient maintains a normal liver function. CONCLUSION: When there is no other option for arterial reconstruction, this method is a feasible option for performing extra-anatomic jump graft reconstruction.


Assuntos
Transplante de Fígado/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Veia Safena/transplante , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Idoso , Aneurisma Dissecante/cirurgia , Feminino , Artéria Hepática/patologia , Humanos , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Transplante Autólogo/métodos
7.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 30(5): 233-237, sept.-oct. 2019. ilus
Artigo em Inglês | IBECS | ID: ibc-183877

RESUMO

Vertebral hemangiomas are relatively common, but those causing spinal cord compression are rare. A 19-year-old male presented with thoracic back pain. The neurologic examination was normal and radiological examinations demonstrated an aggressive vertebral hemangioma centered within the T11 vertebral body. Damaged vertebral bone and soft tissue components of the mass were observed in the epidural space. Surgery was performed using a new technique involving radiofrequency ablation, injection of a hemostatic agent (FLOSEAL, Baxter, USA), and bone autograft placement in the affected vertebral body. There were no complications intra- or postoperatively, and the patient's back pain resolved completely during the postsurgical period. Bleeding is a serious issue in cases of aggressive vertebral hemangioma. This new technique provides improved bleeding control and strengthens the affected vertebra through autograft placement


Los hemangiomas vertebrales son relativamente comunes, pero los que causan la compresión de la médula espinal son raros. Un hombre de 19 años presentó dolor de espalda torácica. El examen neurológico fue normal y los exámenes radiológicos demostraron un hemangioma vertebral agresivo centrado en el cuerpo vertebral T11. Se observaron componentes óseos y vertebrales dañados de la masa en el espacio epidural. La cirugía se realizó utilizando una nueva técnica que incluía ablación por radiofrecuencia, inyección de un agente hemostático (FLOSEAL, Baxter, EE. UU.) Y colocación de autoinjerto de hueso en el cuerpo vertebral afectado. No hubo complicaciones intra y postoperatorias, y el dolor de espalda del paciente se resolvió completamente durante el período posquirúrgico. El sangrado es un problema grave en los casos de hemangioma vertebral agresivo. Esta nueva técnica proporciona un mejor control de la hemorragia y fortalece la vértebra afectada a través de la colocación del autoinjerto


Assuntos
Humanos , Masculino , Adulto Jovem , Hemangioma/diagnóstico por imagem , Hemangioma/cirurgia , Ablação por Radiofrequência/métodos , Hemostáticos/administração & dosagem , Transplante Autólogo/métodos , Medula Espinal/patologia , Dor nas Costas/etiologia , Espaço Epidural/diagnóstico por imagem , Espaço Epidural/cirurgia
8.
Bone Joint J ; 101-B(9): 1151-1159, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31474143

RESUMO

AIMS: We analyzed the long-term outcomes of patients observed over ten years after resection en bloc and reconstruction with extracorporeal irradiated autografts. PATIENTS AND METHODS: This retrospective study included 27 patients who underwent resection en bloc and reimplantation of an extracorporeal irradiated autograft. The mean patient age and follow-up period were 31.7 years (9 to 59) and 16.6 years (10.3 to 24.3), respectively. The most common diagnosis was osteosarcoma (n = 10), followed by chondrosarcoma (n = 6). The femur (n = 13) was the most frequently involved site, followed by the tibia (n = 7). There were inlay grafts in five patients, intercalary grafts in 15 patients, and osteoarticular grafts in seven patients. Functional outcome was evaluated with the Musculoskeletal Tumor Society (MSTS) scoring system. RESULTS: There were no recurrences in the irradiated autograft and the autograft survived in 24 patients (88.9%). Major complications included nonunion (n = 9), subchondral bone collapse (n = 4), and deep infection (n = 4). Although 34 revision procedures were performed, 25 (73.5%) and four (11.8%) of these were performed less than five years and ten years after the initial surgery, respectively. The mean MSTS score at the last follow-up was 84.3% (33% to 100%). CONCLUSION: Considering long-term outcomes, extracorporeal irradiated autograft is an effective method of reconstruction for malignant musculoskeletal tumours Cite this article: Bone Joint J 2019;101-B:1151-1159.


Assuntos
Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/cirurgia , Osso e Ossos/cirurgia , Salvamento de Membro/métodos , Reimplante , Transplante Autólogo/métodos , Adolescente , Adulto , Autoenxertos/efeitos da radiação , Osso e Ossos/efeitos da radiação , Criança , Seguimentos , Sobrevivência de Enxerto , Humanos , Pessoa de Meia-Idade , Radioterapia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Recuperação de Função Fisiológica , Estudos Retrospectivos , Transplante Autólogo/efeitos adversos , Adulto Jovem
9.
Rev. bras. cir. plást ; 34(3): 414-418, jul.-sep. 2019. ilus
Artigo em Inglês, Português | LILACS | ID: biblio-1047171

RESUMO

O aumento do dorso nasal nas rinoplastias é foco de estudo de diversos trabalhos que buscam as melhores fontes de enxerto e técnicas cirúrgicas. A utilização de cartilagem já é consagrada para este fim, a partir do septo nasal, da concha auricular ou dos arcos costais. Nos últimos anos, têm-se buscado meios para reduzir a palpabilidade e dispersibilidade dos enxertos cartilaginosos. Assim, são descritos materiais sintéticos, como o SURGICEL®; e, autólogos, representados pelas fáscias. A fáscia temporal é mais amplamente utilizada, porém requer uma nova incisão cirúrgica, aumentando o tempo e a morbidade da cirurgia. É também descrito o uso de fáscia lata e fáscia reto abdominal, comparativamente mais espessas e menos flexíveis. Em muitos casos de rinoplastia fazse necessária a retirada da cartilagem costal, o que permite a coleta de fáscia do músculo peitoral maior pela mesma incisão cirúrgica. Dessa forma, descrevemos a utilização da fáscia do músculo peitoral maior envolvendo cartilagem costal picada, em uma rinoplastia estruturada com aumento do dorso.


Increasing the nasal dorsum in rhinoplasty is the focus of several studies that seek the best graft sources and surgical techniques. The use of cartilage from the nasal septum, ear shell, or costal arches is already established for this purpose. In recent years, methods have been sought to reduce the palpability and dispersibility of cartilaginous grafts. Thus, synthetic materials such as SURGICEL® and autologous materials such as fascia have been explored. Temporal fascia are more widely used but require a new surgical incision, increasing surgical time and morbidity. Also described is the use of fascia lata and rectus abdominis fascia, which are comparatively thicker and less flexible. In many rhinoplasty procedures, it is necessary to remove the costal cartilage, which allows the collection of fascia from the major chest muscles through the same surgical incision. Thus, we describe the use of major chest muscle fascia and chopped costal cartilage in structured rhinoplasty to increase the dorsum.


Assuntos
Humanos , Feminino , Adulto , História do Século XXI , Próteses e Implantes , Rinoplastia , Transplante Autólogo , Fáscia , Cartilagem Costal , Sobrevivência de Enxerto , Próteses e Implantes/efeitos adversos , Rinoplastia/efeitos adversos , Rinoplastia/métodos , Transplante Autólogo/efeitos adversos , Transplante Autólogo/métodos , Transplantes/cirurgia , Fáscia/anatomia & histologia , Fáscia/transplante , Cartilagem Costal/cirurgia , Cartilagem Costal/citologia
10.
Rev. bras. cir. plást ; 34(3): 368-377, jul.-sep. 2019. ilus, tab
Artigo em Inglês, Português | LILACS | ID: biblio-1047157

RESUMO

Introdução: Com o objetivo de obter lipoenxerto autógeno e injetável de tecido ressecado em dermolipectomias, este estudo propõe um novo método para colheita e processamento do tecido adiposo, através de um dispositivo fragmentador específico. O principal objetivo foi estabelecer uma análise comparativa das características de qualidade e viabilidade do novo lipofragmentado em relação ao já conhecido lipoaspirado, amplamente aceito como fonte viável de lipoenxerto. Ensaios in vivo e in vitro foram delineados para avaliar o comportamento biológico das amostras, a fim de orientar novos e possíveis estudos em humanos com aplicações clínicas. Métodos: Uma paciente pós-bariátrica que foi submetida a dermolipectomia abdominal teve sua peça cirúrgica ressecada e dividida em quatro partes que foram submetidas a Lipoaspiração e Lipofragmentação, sem e com infiltração prévia. Todas as amostras foram submetidas a centrifugação e então distribuídas para os ensaios que envolveram avaliação histológica, imunohistoquímica, citometria de fluxo, cultura celular e ainda a injeção de xenoenxerto no dorso de 10 ratos Wistar, retirados após seis semanas para avaliação de massa, volume e características histológicas. Resultados: As amostras de gordura fragmentada, seca e infiltrada, mostraram características estruturais e comportamento biológico semelhantes aos das amostras de lipoaspirado. Conclusões: A fragmentação da gordura transformou o tecido celular subcutâneo das dermolipectomias em uma nova variante de lipoenxerto injetável e viável, com características biológicas semelhantes àquelas do lipoaspirado tradicional. Embora ainda preliminares, nossos resultados embasam a realização de novas investigações buscando otimizar a técnica com vistas ao aprimoramento da enxertia gordurosa e suas possíveis aplicações na medicina regenerativa.


Introduction: Aiming to obtain autogenous and injectable lipografts from resected tissues in dermolipectomies, this study proposes a new method for harvesting and processing adipose tissue through a specific fragmenting device. The main objective was to establish a comparative analysis of the quality and viability characteristics of the new lipofragmentation technique and those of the well-known liposuction technique, widely accepted as a viable source of fat grafting. In vivo and in vitro assays were designed to evaluate the biological behavior of the samples to guide new and possible human studies with clinical applications. Methods: A post-bariatric patient who underwent abdominal dermolipectomy had her surgical specimen resected, which was divided into four parts that underwent liposuction and lipofragmentation, with and without prior infiltration. All samples were centrifuged and distributed for assays with assessments involving histological analysis, immunohistochemistry, flow cytometry, cell culture, and xenograft injection on the back of 10 Wistar rats, which was evaluated after six weeks for mass, volume, and histological features. Results: The structural characteristics and biological behaviors of fragmented, dry, and infiltrated fat samples were similar to those of liposuction samples. Conclusions: Fat fragmentation transformed the subcutaneous cellular tissue of dermolipectomies into a new, viable injectable lipograft variant, with biological characteristics similar to those of traditional liposuction. Although still preliminary, our results support further investigations to optimize the technique and improve fat grafting and its possible applications in regenerative medicine.


Assuntos
Humanos , Feminino , Adulto , Ratos , História do Século XXI , Manejo de Espécimes , Cirurgia Plástica , Transplante Autólogo , Bioprótese , Tecido Adiposo , Procedimentos Cirúrgicos Reconstrutivos , Sobrevivência de Enxerto , Manejo de Espécimes/métodos , Cirurgia Plástica/métodos , Transplante Autólogo/métodos , Bioprótese/normas , Tecido Adiposo/anatomia & histologia , Procedimentos Cirúrgicos Reconstrutivos/métodos
11.
Plast Reconstr Surg ; 144(3): 369e-377e, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31461004

RESUMO

BACKGROUND: As breast reconstructive microsurgeons increase their available flap techniques with experience, the need for stacked and multiple flaps may generate an improved aesthetic outcome. The authors present their institutional experience of using single versus stacked free flap breast reconstruction. METHODS: ONE THOUSAND SEVENTY: flaps were performed on 509 patients from 2010 to 2018 by two senior surgeons at a single university hospital. Three hundred eighty-eight flaps were either stacked profunda artery perforator (PAP) flaps, four-flap flaps [bilateral PAP plus bilateral deep inferior epigastric perforator (DIEP) flap], or double-pedicle DIEP/superficial inferior epigastric perforator flaps. Six hundred eighty-two flaps were either unilateral or bilateral DIEP or PAP flap (one flap per breast). Demographics, patient comorbidities, and flap complications were compared between the two groups. RESULTS: Of the 509 patients, 359 underwent single DIEP or PAP flap (one flap per breast) and 150 patients underwent stacked free flaps. The stacked flap group had statistically lower body mass index, higher rates of radiation therapy, longer procedure time, smaller flaps, higher deep venous thrombosis rates, and higher take-back rates compared with the single flap group. There were no statistical differences in the rates of flap loss (2.2 percent in stacked flaps versus 1.1 percent in single flaps), wound complication, hematoma, or pulmonary embolism. CONCLUSIONS: Autologous breast reconstruction is the gold standard for natural and durable breast reconstruction, often giving superior aesthetic outcomes and higher patient satisfaction. However, the true success of autologous breast reconstruction is limited to the amount of tissue available to provide total breast reconstruction. This study shows that stacked flap breast reconstruction is safe and has similar complication rates as single-flap breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Mamoplastia/métodos , Microcirurgia/métodos , Satisfação do Paciente , Retalho Perfurante/transplante , Complicações Pós-Operatórias/epidemiologia , Mama/cirurgia , Neoplasias da Mama/cirurgia , Artérias Epigástricas/transplante , Estética , Feminino , Humanos , Mamoplastia/efeitos adversos , Mastectomia/efeitos adversos , Pessoa de Meia-Idade , Duração da Cirurgia , Retalho Perfurante/irrigação sanguínea , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Transplante Autólogo/efeitos adversos , Transplante Autólogo/métodos , Resultado do Tratamento
12.
Plast Reconstr Surg ; 144(3): 433e-443e, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31461029

RESUMO

BACKGROUND: Pediatric calvarial reconstruction is challenging because of the unique anatomical and growth considerations in this population. Comparative studies evaluating current cranioplasty materials are lacking. This review addresses the knowledge gap in pediatric cranioplasty outcomes with emphasis on current materials used. METHODS: A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Outcome data comparing fresh bone, banked bone, titanium, poly(methyl methacrylate), and polyetheretherketone were abstracted. RESULTS: Twenty studies met the authors' selection criteria. The mean patient age ranged from 4 to 17.4 years. Autologous cranioplasty was performed in 439 patients, and 201 patients underwent alloplastic reconstruction. Fresh bone grafts and titanium mesh were associated with the lowest infection rates (0.4 percent and 3.3 percent, respectively; p < 0.001), graft failures (2.9 percent and 3.3 percent, respectively; p < 0.001), and surgical-site occurrence rates (8.8 percent and 6.7 percent, respectively; p < 0.001). Banked bone flaps had the highest overall complication rates (51 percent; p < 0.001), bone resorption (39.7 percent; p < 0.001), and failure rates (40.2 percent; p < 0.001), whereas polyetherether ketone had the highest rates of infection (16.1 percent; p < 0.001). CONCLUSIONS: Based on the available evidence to date, fresh bone grafts and titanium mesh demonstrated the lowest surgical-site infection, surgical-site occurrence, and graft failure rates. Banked bone flaps had the highest overall surgical-site complications and graft failures. Pediatric cranioplasty outcomes studies are needed to evaluate current and novel cranioplasty materials.


Assuntos
Transplante Ósseo/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Próteses e Implantes/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Adolescente , Fatores Etários , Transplante Ósseo/métodos , Criança , Pré-Escolar , Craniotomia , Humanos , Cetonas/efeitos adversos , Polietilenoglicóis/efeitos adversos , Polimetil Metacrilato/efeitos adversos , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos , Titânio/efeitos adversos , Transplante Autólogo/efeitos adversos , Transplante Autólogo/métodos , Resultado do Tratamento
13.
Plast Reconstr Surg ; 144(3): 463e-470e, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31461044

RESUMO

BACKGROUND: Pedal fat grafting is a safe, minimally invasive approach to treat pedal fat pad atrophy. Prior randomized controlled trials demonstrate that the fat as measured directly under the metatarsal heads disappears between 2 and 6 months after fat grafting, despite patients having relief for 2 years. The authors aim to use magnetic resonance imaging to further assess three-dimensional volume of fat in the foot after autologous fat grafting to help explain the mechanism for improved pain. METHODS: A prospective study was performed using magnetic resonance imaging before and at 6 months after pedal fat grafting to assess changes in the three-dimensional morphology of the fat. RESULTS: Seventeen patients (six men and 11 women) underwent injections with a mean volume of 5.8 cc per foot. At 6 months, patients demonstrated increased tissue thickness (p = 0.008) and volume (p = 0.04). Improvements were seen in pain (p < 0.05) and activity (p < 0.05). Foot pressures and forces were significantly decreased and positively correlated with increased fat pad volume (p < 0.05). CONCLUSIONS: Pedal fat grafting significantly increases metatarsal fat pad volume. The distribution of the fat may contribute to lasting clinical relief in these patients. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Tecido Adiposo/transplante , Autoenxertos/diagnóstico por imagem , Dor Musculoesquelética/cirurgia , Tecido Adiposo/diagnóstico por imagem , Tecido Adiposo/patologia , Atrofia/complicações , Atrofia/diagnóstico por imagem , Atrofia/cirurgia , Avaliação da Deficiência , Feminino , , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/etiologia , Medição da Dor , Período Pós-Operatório , Período Pré-Operatório , Estudos Prospectivos , Transplante Autólogo/métodos , Resultado do Tratamento
14.
Arch Orthop Trauma Surg ; 139(11): 1607-1615, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31363834

RESUMO

PURPOSE: To clinically evaluate an arthroscopic autologous chondrocyte implantation (ACI) technique with an in situ crosslinking matrix for the treatment of full thickness cartilage defects of the knee and to present histological results of a graft cartilage biopsy obtained after 1.5 years. METHODS: Fifteen cases of arthroscopic autologous chondrocyte implantation in the knee performed between November 2011 and October 2012 were included in the study. Medical charts and operational reports were screened and the patients were contacted after 0.8 ± 0.3 years (0.4-1.3) and 4.3 ± 0.3 years (4.0-4.8) to asses subjective IKDC and re-operation. The Tegner activity scale was collected at the second follow-up time point. Subjective IKDC response rates were assessed at both follow-up time points. RESULTS: The first and second follow-up was completed by all 15 patients (100%). The subjective IKDC scores showed a significant improvement (pre-operative 44.5 ± 15.9, first follow-up 71.1 ± 15.9, p < 0.001, second follow-up 72.6 ± 17.3, p < 0.001). The overall response rate was 66.7% (n = 10) at follow-up one and two. There were no significant differences in pre-injury (4, range 1-9) and follow-up two (4, range 2-7) Tegner activity scales (p = n.s.). Two patients required re-operation in the index knee, not related to the ACI procedure. No complication related to the ACI or the implantation technique occurred. The histological results showed excellent cartilage regeneration. CONCLUSION: Arthroscopic ACI using an in situ crosslinking matrix is a safe and reliable treatment option for full-thickness cartilage defects of the knee.


Assuntos
Artroscopia/métodos , Condrócitos/transplante , Articulação do Joelho , Transplante Autólogo/métodos , Doenças das Cartilagens/cirurgia , Humanos , Articulação do Joelho/citologia , Articulação do Joelho/cirurgia
15.
Cient. dent. (Ed. impr.) ; 16(2): 155-160, mayo-ago. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-183728

RESUMO

Las extracciones dentarias producen una pérdida ósea en sentido horizontal y vertical, que conllevan alteraciones funcionales para los pacientes, y dificultan la colocación de implantes dentales para los profesionales. Para minimizar esta pérdida ósea, se utilizan diferentes materiales de injerto, entre los cuales destaca el injerto autógeno, por cumplir las características de osteogénesis, osteoconducción y osteoinducción. En el año 2010 se describe por primera vez la utilización de dentina como material de injerto autógeno, demostrando que este material puede ser una alternativa terapéutica al resto de materiales de injerto, al permitir la osteoconducción y la osteoinducción, y mostrar la formación de hueso nuevo en un 46-87% del área con injerto de dentina autógena, 3 meses después de su utilización. La última revisión sistemática publicada en el año 2018, concluyó que los implantes colocados en áreas regeneradas en zonas en las que se empleó dentina como material de injerto, presentaron tasas de supervivencia del 97,7% después de 1 año de seguimiento, sugiriendo este nuevo material como una alternativa con resultados prometedores, aunque son necesarios más estudios al respecto


Subsequent to tooth extraction, a reduction of the length and width of alveolar ridge can be observed. It causes functional alterations to patiens, and problems to proper insertion of dental implants. In order to prevent this bone atrophy, different graft materials can be used, being considered autogenous graft the best because allows osteogenesis, osteoconduction and osteoinduction. In 2010 it was first published the use of autogenous dentine as a graft material, showing it could be an ideal graft material, as a material with excellent osteoconduction and osteoinduction. Besides, this graft material is slowly absorbed and replaced by new bone, in 46-87% of the áreas grafted with dentine, 3 months after regeneration. Last systematic review published in 2018 concluded dental implants inserted in regenerated areas with autogenous dentine had survival rates of 97,7% for over a year follow-up, so this new material is considered an alternative with good results, but there are necessary more studies with long term follow-up


Assuntos
Humanos , Animais , Cirurgia Bucal/instrumentação , Transplante Autólogo/métodos , Osteogênese , Regeneração Óssea , Dentina/metabolismo , Dentina Secundária/crescimento & desenvolvimento , Dentinogênese/fisiologia , Odontoblastos/fisiologia
16.
World Neurosurg ; 131: e312-e320, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31351936

RESUMO

OBJECTIVE: The use of autologous bone for cranioplasty offers superior cosmesis and cost-effectiveness compared with synthetic materials. The choice between 2 common autograft storage mechanisms (subcutaneous vs. frozen) remains controversial and dictated by surgeon preference. We compared surgical outcomes after autologous bone cranioplasty between patients with cryopreserved and subcutaneously stored autografts. METHODS: Ten-year retrospective comparative analysis of patients undergoing cranioplasty with autologous bone stored subcutaneously or frozen at a tertiary academic medical center. RESULTS: Ninety-four patients were studied, with 34 (36.2%) bone flaps stored subcutaneously and 59 (62.8%) frozen. The 2 groups were similar in demographics, comorbidities, and craniectomy indication, with only body mass index and race differing statistically. The mean operation time was greater within the subcutaneous group (P < 0.001), which also had a greater number of ventriculoperitoneal shunt (VPS) placements (P = 0.02). There were no significant differences in complications, readmissions, unplanned reoperations, or length of stay between the 2 groups. VPS placement during cranioplasty increased length of stay (P < 0.001), and placement prior to cranioplasty increased both length of stay (P = 0.009) and incidence of hospital-acquired infection (P = 0.03). CONCLUSIONS: Subcutaneous and frozen storage of autologous bone result in similar surgical risk profiles. Cryopreservation may be preferred because of shorter operation time and avoidance of complications with the abdominal pocket, whereas the portability of subcutaneous storage remains favorable for patients undergoing cranioplasty at a different institution. VPS placement prior to cranioplasty should be avoided, if possible, due to the increased risk of hospital-acquired infection.


Assuntos
Abdome/cirurgia , Transplante Ósseo/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Crânio/transplante , Tela Subcutânea/cirurgia , Retalhos Cirúrgicos , Preservação de Tecido/métodos , Adulto , Osso e Ossos , Edema Encefálico/cirurgia , Lesões Encefálicas Traumáticas/cirurgia , Craniotomia , Infecção Hospitalar/epidemiologia , Criopreservação , Feminino , Humanos , Hemorragias Intracranianas/cirurgia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Acidente Vascular Cerebral/cirurgia , Transplante Autólogo/métodos , Derivação Ventriculoperitoneal/estatística & dados numéricos
17.
Acta Neurol Scand ; 140(5): 320-327, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31297793

RESUMO

OBJECTIVES: To determine whether treatment with autologous hematopoietic stem cell transplantation (HSCT) can induce sustained complete remission in patients with multiple sclerosis (MS). MATERIAL AND METHODS: Case series of patients with relapsing-remitting MS (n = 10) treated at a single center between 2004 and 2007 and followed up for 10 years. The patients were treated with a BEAM/ATG conditioning regimen (n = 9) or a cyclophosphamide/ATG conditioning regimen (n = 1) followed by infusion of unmanipulated autologous hematopoietic stem cells. The primary endpoint was sustained complete remission. Sustained complete remission was defined as "no evidence of disease activity-4," sustained for a period of at least 5 years without any ongoing disease-modifying treatment. Furthermore, MS was considered as "resolved" if intrathecal IgG production and cerebrospinal fluid neurofilament light levels were normalized as well. RESULTS: Five out of 10 patients were in sustained complete remission at the end of the study. In three of them, MS was resolved. CONCLUSIONS: Our data demonstrate that sustained complete remission after autologous HSCT for MS is possible.


Assuntos
Transplante de Células-Tronco Hematopoéticas/métodos , Esclerose Múltipla Recidivante-Remitente/terapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Condicionamento Pré-Transplante/métodos , Transplante Autólogo/métodos , Resultado do Tratamento
18.
Medicine (Baltimore) ; 98(29): e16222, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335672

RESUMO

RATIONALE: HIV-related lymphoma, especially non-Hodgkin lymphoma, is one of the most common malignant tumors in HIV/acquired immune deficiency syndrome (AIDS) patients. Autologous hematopoietic stem cell transplantation (AHSCT) for the patients with Burkitt lymphoma (BL) is needed to be further explored. PATIENT CONCERNS: A 57-year-old man was hospitalized with intermittent pain on upper abdomen and melena for >1 month. DIAGNOSIS: HIV antibody testing was positive. The upper gastrointestinal endoscopy was performed and histopathology and immunohistochemistry revealed BL. INTERVENTIONS: Highly effective antiretroviral therapy and sixth cycles of chemotherapy were administered, followed by autologous hematopoietic stem cell transplantation. OUTCOMES: The patient has had tumor-free survival for >6 years with normal CD4+ T cell counts and HIV viral load below the lowest detection LESSONS:: The patient was treated with AHSCT followed complete remission after chemotherapy and achieved long-term disease-free survival. AHSCT may be a promising way for clinical cure of HIV-related BL.


Assuntos
Terapia Antirretroviral de Alta Atividade/métodos , Linfoma de Burkitt , Infecções por HIV , Transplante de Células-Tronco Hematopoéticas/métodos , Condicionamento Pré-Transplante/métodos , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Linfoma de Burkitt/complicações , Linfoma de Burkitt/patologia , Linfoma de Burkitt/cirurgia , Intervalo Livre de Doença , Endoscopia Gastrointestinal/métodos , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Transplante Autólogo/métodos , Resultado do Tratamento , Carga Viral/métodos
19.
Plast Reconstr Surg ; 144(2): 178e-188e, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31348332

RESUMO

BACKGROUND: The sensory recovery of the breast remains an undervalued aspect of autologous breast reconstruction. The aim of this study was to evaluate the effect of nerve coaptation on the sensory recovery of the breast following DIEP flap breast reconstruction and to assess the associations of length of follow-up and timing of the reconstruction. METHODS: A prospective comparative study was conducted of all patients who underwent either innervated or noninnervated DIEP flap breast reconstruction and returned for follow-up between September of 2015 and July of 2017. Nerve coaptation was performed to the anterior cutaneous branch of the third intercostal nerve. Semmes-Weinstein monofilaments were used for sensory testing of the native skin and flap skin. RESULTS: A total of 48 innervated DIEP flaps in 36 patients and 61 noninnervated DIEP flaps in 45 patients were tested at different follow-up time points. Nerve coaptation was significantly associated with lower monofilament values in all areas of the reconstructed breast (adjusted difference, -1.2; p < 0.001), which indicated that sensory recovery of the breast was significantly better in innervated compared with noninnervated DIEP flaps. For every month of follow-up, the mean monofilament value decreased by 0.083 in innervated flaps (p < 0.001) and 0.012 in noninnervated flaps (p < 0.001). Nerve coaptation significantly improved sensation in both immediate and delayed reconstructions. CONCLUSIONS: This study demonstrated that nerve coaptation in DIEP flap breast reconstruction is associated with a significantly better sensory recovery in all areas of the reconstructed breast compared with noninnervated flaps. The length of follow-up was significantly associated with the sensory recovery.


Assuntos
Tecido Adiposo/inervação , Mamoplastia/métodos , Transtornos das Sensações/etiologia , Retalhos Cirúrgicos/inervação , Centros Médicos Acadêmicos , Tecido Adiposo/transplante , Adulto , Idoso , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Estudos de Coortes , Feminino , Seguimentos , Rejeição de Enxerto , Sobrevivência de Enxerto , Humanos , Angiografia por Ressonância Magnética/métodos , Mamoplastia/efeitos adversos , Mastectomia/métodos , Pessoa de Meia-Idade , Regeneração Nervosa/fisiologia , Países Baixos , Cuidados Pré-Operatórios , Estudos Prospectivos , Recuperação de Função Fisiológica , Medição de Risco , Transtornos das Sensações/fisiopatologia , Retalhos Cirúrgicos/transplante , Fatores de Tempo , Transplante Autólogo/métodos
20.
BioDrugs ; 33(4): 401-409, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31302863

RESUMO

Three prospective controlled clinical trials and numerous small series and case reports have confirmed that durable, drug-free remission in systemic sclerosis is possible via an autologous hematopoietic stem cell transplantation. Similar results have been seen in other autoimmune diseases. The exact mechanism by which this immune "reset" was achieved in some but not all cases remains elusive, but includes major reduction of autoreactive immune competent cells, re-establishment of T- and B cell regulatory networks and normalization of tissue niche function, particularly vascular. Some aspects regarding mobilization, conditioning and graft manipulation still remain open, but clearly a significant toxicity is associated with all effective regimens at present, and therefore patient selection remains a key issue. In the hematology/oncology arena, major efforts are being made to reduce genotoxic and other collateral toxicity induced by current mobilization and conditioning protocols, which may also translate to autoimmune disease. These include developments in rapid mobilization and antibody drug conjugate conditioning technology. If effective, such low-toxicity regimens might be applied to autoimmune disease at an earlier stage before chronicity of autoimmunity has been established, thus changing the therapeutic paradigm.


Assuntos
Doença Enxerto-Hospedeiro/prevenção & controle , Transplante de Células-Tronco Hematopoéticas/métodos , Imunoconjugados/uso terapêutico , Escleroderma Sistêmico/terapia , Condicionamento Pré-Transplante/métodos , Ensaios Clínicos Controlados como Assunto , Doença Enxerto-Hospedeiro/imunologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Estudos Prospectivos , Escleroderma Sistêmico/imunologia , Transplante Autólogo/efeitos adversos , Transplante Autólogo/métodos , Transplante Homólogo/efeitos adversos , Transplante Homólogo/métodos , Resultado do Tratamento
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