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1.
BMC Musculoskelet Disord ; 23(1): 40, 2022 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-34996409

RESUMO

BACKGROUND: Intraoperative proximal femoral fractures (IPFF) are relevant complications during total hip arthroplasty. Fixation using cerclage wires (CW) represents a minimally-invasive technique to address these fractures through the same surgical approach. The goal of treatment is to mobilise the patient as early as possible, which requires high primary stability. This study aimed to compare different cerclage wire configurations fixing IPFF with regard to biomechanical primary stability. METHODS: Standardised IPFF (type II, Modified Mallory Classification) were created in human fresh frozen femora and were fixed either by two or three CW (1.6 mm, stainless steel). All cadaveric specimens (n = 42) were randomised to different groups (quasi-static, dynamic) or subgroups (2 CW, 3 CW) stratified by bone mineral density determined by Dual Energy X-ray Absorptiometry. Using a biomechanical testing setup, quasi-static and dynamic cyclic failure tests were carried out. Cyclic loading started from 200 N to 500 N at 1 Hz with increasing peak load by 250 N every 100 cycles until failure occurred or maximum load (5250 N) reached. The change of fracture gap size was optically captured. RESULTS: No significant differences in failure load after quasi-static (p = 0.701) or dynamic cyclic loading (p = 0.132) were found between the experimental groups. In the quasi-static load testing, all constructs resisted 250% of the body weight (BW) of their corresponding body donor. In the dynamic cyclic load testing, all but one construct (treated by 3 CW) resisted 250% BW. CONCLUSIONS: Based on this in vitro data, both two and three CW provided sufficient primary stability according to the predefined minimum failure load (250% BW) to resist. The authors recommend the treatment using two CW because it reduces the risk of vascular injury and shortens procedure time.


Assuntos
Artroplastia de Quadril , Fraturas do Fêmur , Artroplastia de Quadril/efeitos adversos , Fenômenos Biomecânicos , Fios Ortopédicos , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Humanos
2.
BMC Surg ; 22(1): 10, 2022 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-34998369

RESUMO

BACKGROUND: Implant-based breast reconstruction is easy to be performed but has flaws that an unnatural appearance might be presented when no sufficient coverage existing. While autologous tissue reconstruction also has disadvantages like donor site scar and skin patch effect. There is a demand for a new method to obtain natural and aesthetic appearance while surmounting drawbacks of conventional breast reconstruction surgery. METHODS: A retrospective review of thirty-one patients undergoing tissue expander (TE)/implant two-stage breast reconstruction with latissimus dorsi muscle flap (LDMF) transfer through endoscopic approach in Peking University Third Hospital from April 2016 to August 2020 was performed. The LDMF harvest time, drain time, and complications were reviewed. The 3D volume was obtained to assess the volume symmetry of bilateral breasts. The BREAST-Q reconstruction module was used to evaluate the satisfaction. RESULTS: The mean endoscopic LDMF harvest time was 90.4 min. In the mean follow-up of 11.2 months, there were no severe capsular contracture happened. The reconstructed side achieved good volume symmetry to the contralateral side (P = 0.256). Based on the evaluation of the BREAST-Q scores, the outcome of Satisfaction with Breasts was excellent or good in 87.1% of the cases. CONCLUSIONS: The novel type of two-stage breast reconstruction protocol, which includes tissue expansion followed by implant insertion with endoscopy-assisted LDMF transfer, could effectively reduce visible scars, avoid the patch effect, while require short time for LDMF harvest and present low incidence of complications. It is a promising method for breast reconstruction because it achieves good outcomes in the mastectomy patients.


Assuntos
Neoplasias da Mama , Mamoplastia , Músculos Superficiais do Dorso , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mastectomia , Estudos Retrospectivos , Expansão de Tecido
3.
BMC Gastroenterol ; 22(1): 13, 2022 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-34998372

RESUMO

BACKGROUND: Neuroendocrine tumors (NETs) arise from neuroendocrine cells and are extremely rare in the biliary tract. Currently, there are no guidelines for the diagnosis and treatment of biliary NETs. We presented a case with NETs G1 of the hilar bile duct and the challenges for her treatment. CASE PRESENTATION: A 24-year-old woman was presented to our department with painless jaundice and pruritus, and the preoperative diagnosis was Bismuth type II hilar cholangiocarcinoma. She underwent Roux-en-Y hepaticojejunostomy with excision of the extrahepatic biliary tree and radical lymphadenectomy. Unexpectedly, postoperative pathological and immunohistochemical examination indicated a perihilar bile duct NETs G1 with the microscopic invasion of the resected right hepatic duct. Then the patient received 3 cycles of adjuvant chemotherapy (Gemcitabine and tegafur-gimeracil-oteracil potassium capsule). At present, this patient has been following up for 24 months without recurrence or disease progression. CONCLUSION: We know little of biliary NETs because of its rarity. There are currently no guidelines for the diagnosis and treatment of biliary NETs. We reported a case of perihilar bile duct NETs G1 with R1 resection, as far as we know this is the first report. More information about biliary NETs should be registered.


Assuntos
Neoplasias dos Ductos Biliares , Ductos Biliares Extra-Hepáticos , Tumor de Klatskin , Tumores Neuroendócrinos , Adulto , Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares Intra-Hepáticos , Feminino , Humanos , Tumores Neuroendócrinos/cirurgia , Adulto Jovem
4.
J Foot Ankle Res ; 15(1): 2, 2022 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-34998420

RESUMO

BACKGROUND: Ankle fractures are common fractures in trauma surgery. Several studies have compared gait patterns between affected patients and control groups. However, no one used the Heidelberg Foot Measurement Method in combination with statistical parametric mapping of the entire gait cycle in this patient cohort. We sought to identify possible mobility deficits in the tibio-talar joint and medial arch in patients after ankle fractures as a sign of stiffness and pain that could result in a pathological gait pattern. We focused on the tibio-talar flexion as it is the main movement in the tibio-talar joint. Moreover, we examined the healing progress over time. METHODS: Fourteen patients with isolated ankle fractures were included prospectively. A gait analysis using the Heidelberg Foot Measurement Method was performed 9 and 26 weeks after surgery to analyse the tibio-talar dorsal flexion, the foot tibia dorsal flexion, the subtalar inversion and the medial arch as well as the cadence, the walking speed and the ground reaction force. The American Orthopedic Foot & Ankle Society ankle hindfoot score was used to obtain clinical data. Results were compared to those from 20 healthy participants. Furthermore, correlations between the American Orthopedic Foot & Ankle Society hindfoot score and the results of the gait analysis were evaluated. RESULTS: Statistical parametric mapping showed significant differences for the Foot Tibia Dorsal Flexion for patients after 9 weeks (53-75%: p = 0.001) and patients after 26 weeks (58-70%: p = 0.011) compared to healthy participants, respectively. Furthermore, significant differences regarding the tibio-talar dorsal flexion for patients 9 weeks after surgery (15-40%: p < 0.001; 56,5-70%: p = 0.007; 82-88%: p = 0.033; 97-98,5%: p = 0.048) as well as patients after 26 weeks (62,5-65%: p = 0.049) compared to healthy participants, respectively. There were no significant differences looking at the medial arch and the subtalar inversion. Moreover, significant differences regarding the ground reaction force were found for patients after 9 weeks (0-17%: p < 0.001; 21-37%: p < 0.001; 41-54%: p < 0.001; 60-64%: p = 0.013) as well as patients after 26 weeks (0-1,5%: p = 0.046; 5-15%: p < 0.001; 27-33%: p = 0.001; 45-49%: p = 0.005; 57-59%: p = 0.049) compared to healthy participants, respectively. In total, the range of motion in the tibio-talar joint and the medial arch was reduced in affected patients compared to healthy participants. Patients showed significant increase of the range of motion between 9 and 26 weeks. CONCLUSIONS: This study shows, that patients affected by ankle fractures show limited mobility in the tibio-talar joint and the medial arch when compared to healthy participants. Even though the limitation of motion remains at least over a period of 26 weeks, a significant increase can be recognized over time. Furthermore, if we look at the absolute values, the patients' values tend to get closer to those of the control group. TRIAL REGISTRATION: This study is registered at the German Clinical Trials Register ( DRKS00023379 ).


Assuntos
Fraturas do Tornozelo , Análise da Marcha , Fraturas do Tornozelo/cirurgia , Articulação do Tornozelo/cirurgia , Fenômenos Biomecânicos , Marcha , Humanos , Resultado do Tratamento
5.
Clin Nucl Med ; 47(2): e170-e171, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-35006116

RESUMO

ABSTRACT: A 70-year-old man with histopathologically proven prostate carcinoma (Gleason, 5 + 5; prostate-specific antigen level, 6.2 µg/mL) was referred for an 18F-PSMA-1007 PET/CT scan. The scan revealed bilateral PSMA uptake in the prostate, representing the primary tumor, but no evidence of PSMA-positive lymph nodes. However, a left-sided ventral pleural thickening showed focal PSMA uptake. Lesion biopsy showed no signs of malignancy, and prostatectomy was performed. The 1-year follow-up CT thorax showed growth of approximately 20% of the pleural lesion. Subsequently, video-assisted thoracic surgery of the lesion was performed. Histopathology showed a solitary fibrous tumor, a rare mesenchymal tumor.


Assuntos
Carcinoma , Neoplasias da Próstata , Idoso , Ácido Edético , Radioisótopos de Gálio , Humanos , Masculino , Oligopeptídeos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Próstata , Prostatectomia , Neoplasias da Próstata/cirurgia
6.
BMJ Case Rep ; 15(1)2022 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-34980641

RESUMO

We present a case of an elderly and comorbid patient who was scheduled to undergo a hip fracture fixation using an intramedullary nail. Unfortunately, this was delayed by 3 weeks as the patient was unfit to undergo this procedure. She was placed onto the traction table and intraoperatively sustained a superior and inferior pubic rami fracture while attempting reduction on the traction table. Closed-reduction techniques using traction tables and perineal posts are not without morbidity. Risk factors such as osteoporosis and delayed-fixation should be accounted for when managing this complex and often frail group of patients.


Assuntos
Fixação Intramedular de Fraturas , Fraturas do Quadril , Ossos Pélvicos , Idoso , Pinos Ortopédicos , Feminino , Fixação de Fratura , Fraturas do Quadril/diagnóstico por imagem , Fraturas do Quadril/cirurgia , Humanos , Tração
7.
Korean J Radiol ; 23(1): 42-51, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34983092

RESUMO

OBJECTIVE: This study aimed to investigate the direction of tissue contraction after microwave ablation in ex vivo bovine liver models. MATERIALS AND METHODS: Ablation procedures were conducted in a total of 90 sites in ex vivo bovine liver models, including the surface (n = 60) and parenchyma (n = 30), to examine the direction of contraction of the tissue in the peripheral and central regions from the microwave antenna. Three commercially available 2.45-GHz microwave systems (Emprint, Neuwave, and Surblate) were used. For surface ablation, the lengths of two overlapped square markers were measured after 2.5- and 5-minutes ablations (n = 10 ablations for each system for each ablation time). For parenchyma ablation, seven predetermined distances between the markers were measured on the cutting plane after 5- and 10-minutes ablations (n = 5 ablations for each system for each ablation time). The contraction in the radial and longitudinal directions and the sphericity index (SI) of the ablation zones were compared between the three systems using analysis of variance. RESULTS: In the surface ablation experiment, the mean longitudinal contraction ratio and SI from a 5-minutes ablation using the Emprint, Neuwave, and Surblate systems were 28.92% and 1.04, 20.10% and 0.53, and 24.90% and 0.45, respectively (p < 0.001). A positive correlation between longitudinal contraction and SI was noted, and a similar radial contraction was observed. In the parenchyma ablation experiment, the mean longitudinal contraction ratio and SI from a 10-minutes ablation using the three pieces of equipment were 38.60% and 1.06, 32.45% and 0.61, and 28.50% and 0.50, respectively (p < 0.001). There was a significant difference in the longitudinal contraction properties, whereas there was no significant difference in the radial contraction properties. CONCLUSION: The degree of longitudinal contraction showed significant differences depending on the microwave ablation equipment, which may affect the SI of the ablation zone.


Assuntos
Técnicas de Ablação , Ablação por Cateter , Ablação por Radiofrequência , Animais , Bovinos , Humanos , Fígado/cirurgia , Micro-Ondas
8.
Korean J Radiol ; 23(1): 68-76, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34983095

RESUMO

OBJECTIVE: Percutaneous portal vein (PV) stent placement can be an effective treatment for symptoms associated with portal hypertension. This study aimed to evaluate the effect of PV stenting on the overall survival (OS) in patients with malignant PV stenosis. MATERIALS AND METHODS: Two groups of patients with malignant PV stenosis were compared in this retrospective study involving two institutions. A total of 197 patients who underwent PV stenting between November 2016 and August 2019 were established as the stent group, whereas 29 patients with PV stenosis who were treated conservatively between July 2013 and October 2016 constituted the no-stent group. OS was compared between the two groups before and after propensity score matching (PSM). Risk factors associated with OS were evaluated using the Cox proportional hazards model. Procedure-associated adverse events were also evaluated. RESULTS: The stent group finally included 100 patients (median age, 65 [interquartile range, 58-71] years; 64 male). The no-stent group included 22 patients (69 [61-75] years, 13 male). Stent placement was successful in 95% of attempted cases, and the 1- and 2-year stent occlusion-free survival rate was 56% (95% confidence interval, 45%-69%) and 44% (32%-60%), respectively. The median stent occlusion-free survival time was 176 (interquartile range, 70-440) days. OS was significantly longer in the stent group than in the no-stent group (median 294 vs. 87 days, p < 0.001 before PSM, p = 0.011 after PSM). The 1- and 3-year OS rates before PSM were 40% and 11%, respectively, in the stent group. The 1-year OS rate after PSM was 32% and 5% in the stent and no-stent groups, respectively. Anemia requiring transfusion (n = 2) and acute thrombosis necessitating re-stenting (n = 1) occurred in three patients in the stent group within 1 week. CONCLUSION: Percutaneous placement of a PV stent may be effective in improving OS in patients with malignant PV stenosis.


Assuntos
Veia Porta , Stents , Idoso , Constrição Patológica/cirurgia , Humanos , Masculino , Pontuação de Propensão , Estudos Retrospectivos , Resultado do Tratamento
9.
BMJ Case Rep ; 15(1)2022 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-34983807

RESUMO

Congenital granular cell epulis is a congenital growth rarely found on the gingiva of neonates. These remarkably large tumours present in an infant's mouth may impede with feeding, respiration or adequate mouth closure. Recognition of this entity and prompt treatment are essential for preventing any difficulties for the neonate. This is a case report of a 35-day-old female neonate who presented with a single exophytic lesion in the maxillary alveolar ridge. The differential diagnosis, management regimens and complications of this condition are reviewed. The lesion was excised under intravenous sedation and subjected to histopathological analysis. Based on the microscopic findings, the diagnosis of congenital granular cell epulis was confirmed. Clinicians including paediatricians, sonographers, dentists and surgical pathologists should be able to timely recognise and intervene such tumours as they may be potentially harmful to the infant.


Assuntos
Neoplasias Gengivais , Tumor de Células Granulares , Processo Alveolar , Diagnóstico Diferencial , Feminino , Gengiva , Neoplasias Gengivais/diagnóstico , Neoplasias Gengivais/cirurgia , Tumor de Células Granulares/diagnóstico , Tumor de Células Granulares/cirurgia , Humanos , Maxila
10.
BMJ Case Rep ; 15(1)2022 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-34983809

RESUMO

A 61-year-old woman developed neorectal prolapse after laparoscopic low anterior resection, total mesorectal excision with partial intersphincteric resection and handsewn coloanal anastomosis for rectal cancer. She presented with a 3 cm full thickness reducible prolapse, with associated anal pain and bleeding. A perineal stapled prolapse resection was performed to address the rectal prolapse, with satisfactory results.


Assuntos
Laparoscopia , Neoplasias Retais , Prolapso Retal , Canal Anal/cirurgia , Anastomose Cirúrgica , Feminino , Humanos , Pessoa de Meia-Idade , Períneo/cirurgia , Prolapso , Neoplasias Retais/cirurgia , Prolapso Retal/cirurgia , Reto/cirurgia , Resultado do Tratamento
11.
BMJ Case Rep ; 15(1)2022 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-34983812

RESUMO

Primary splenic diffuse large B-cell lymphoma (PS-DLBCL) is a relatively rare malignancy, and there are no optimal approaches for diagnosis and management. There are less invasive splenic biopsies that effectively obviate diagnostic and elective splenectomies. We report a man in his 50s with 2-day history of pain in the abdomen and who was found to have a splenic mass on PET-CT. A CT-guided core needle splenic biopsy confirmed the diagnosis of PS-DLBCL. He was managed with six cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) alone, without splenectomy. The patient attained complete remission, and he is disease free at 6 years of follow-up.


Assuntos
Linfoma Difuso de Grandes Células B , Esplenectomia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Ciclofosfamida/uso terapêutico , Doxorrubicina/uso terapêutico , Humanos , Linfoma Difuso de Grandes Células B/diagnóstico , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Linfoma Difuso de Grandes Células B/cirurgia , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Prednisona/uso terapêutico , Rituximab/uso terapêutico , Vincristina/uso terapêutico
12.
BMJ Case Rep ; 15(1)2022 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-34983813

RESUMO

Multiligament injury of the knee usually occurs as a result of high-energy trauma causing tibiofemoral dislocation. These are rare but potentially limb-threatening injuries, frequently involving nerve or arterial damage and often leading to severe complex instability. Management generally favours surgical reconstruction of the affected ligaments, with controversy regarding optimal treatment. We present a severe multiligament knee injury (Schenk classification KD-IV involving both cruciate and both collateral ligaments) in a competitive showjumper. A combined arthroscopic/open technique of single-stage surgical repair and suture augmentation was used, repairing all affected ligaments. The patient made an excellent recovery, returning to work after 12 weeks and riding after 22 weeks. After 5-year follow-up, she has regained her previous level of competition without subsequent injury. Multiligament repair with suture augmentation is a viable approach to the management of knee dislocation injuries. We propose that this could provide superior outcomes to traditional reconstruction techniques using autograft or synthetic reconstruction.


Assuntos
Lesões do Ligamento Cruzado Anterior , Ligamentos Colaterais , Luxação do Joelho , Traumatismos do Joelho , Lesões do Ligamento Cruzado Anterior/cirurgia , Feminino , Humanos , Luxação do Joelho/cirurgia , Traumatismos do Joelho/cirurgia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Transplante Autólogo , Resultado do Tratamento
13.
J Orthop Traumatol ; 23(1): 1, 2022 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-34985595

RESUMO

BACKGROUND: Ulna shortening osteotomy (USO) for ulnar impaction syndrome (UIS) aims to improve pain and function by unloading the ulnar carpus. Previous studies often lack validated patient-reported outcomes or have small sample sizes. The primary objective of this study was to investigate patient-reported pain and hand function at 12 months after USO for UIS. Secondary objectives were to investigate the active range of motion, grip strength, complications, and whether outcomes differed based on etiology. MATERIALS AND METHODS: We report on 106 patients with UIS who received USO between 2012 and 2019. In 44 of these patients, USO was performed secondary to distal radius fracture. Pain and function were measured with the Patient Rated Wrist/Hand Evaluation (PRWHE) before surgery and at 3 and 12 months after surgery. Active range of motion and grip strength were measured before surgery and at 3 and 12 months after surgery. Complications were scored using the International Consortium for Health Outcome Measurement Complications in Hand and Wrist conditions (ICHAW) tool. RESULTS: The PRWHE total score improved from a mean of 64 (SD = 18) before surgery to 40 (22) at 3 months and 32 (23) at 12 months after surgery (P < 0.001; effect size Cohen's d = -1.4). There was no difference in the improvement in PRWHE total score (P = 0.99) based on etiology. Also, no clinically relevant changes in the active range of motion were measured. Independent of etiology, mean grip strength improved from 24 (11) before surgery to 30 (12) at 12 months (P = 0.001). Sixty-four percent of patients experienced at least one complication, ranging from minor to severe. Of the 80 complications in total, 50 patients (47%) had complaints of hardware irritation, of which 34 (32%) had their hardware removed. Six patients (6%) needed refixation because of nonunion. CONCLUSION: We found beneficial outcomes in patients with UIS that underwent USO, although there was a large variance in the outcome and a relatively high number of complications (which includes plate removals). Results of this study may be used in preoperative counseling and shared decision-making when considering USO. LEVEL OF EVIDENCE: Therapeutic III.


Assuntos
Ulna , Articulação do Punho , Humanos , Osteotomia , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento , Ulna/cirurgia , Articulação do Punho/cirurgia
14.
BMC Musculoskelet Disord ; 23(1): 45, 2022 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-35027035

RESUMO

OBJECTIVE: To evaluate the impact of body mass index (BMI) on the mid-term clinical outcomes and survival in patients receiving a mobile-bearing unicompartmental knee arthroplasty (UKA). METHODS: We retrospectively collected data from 355 patients who underwent UKA from June 2006 to June 2015, with a mean follow-up of 106.5 ± 22.5 months. Patients were assigned into four groups based on their BMI before surgery: normal weight group (BMI 18.5 ~ 22.9 kg/m2), overweight group (23 ~ 24.9 kg/m2), obesity group (25 ~ 29.9 kg/m2), and severe obesity group (≥ 30 kg/m2). The knee society score (KSS), knee society function score (KSFS), hospital for special surgery score (HSS), and range of motion (ROM) were assessed before the operation and at the last follow-up. The femorotibial angle (FTA) was assessed after the operation immediately and at the last follow-up. Kaplan-Meier survival analysis was performed among the four groups. RESULTS: The KSS, KSFS, and HSS in all groups were markedly improved compared with the preoperative values (p<0.001), but the ROM score was not significantly different (p>0.05). There were significant differences in KSS (p<0.001) and HSS (p = 0.004) across the four BMI groups, and these differences were due to the severe obesity group. All groups exhibited an inclination of knee varus deformity at the last follow-up (p < 0.05). Moreover, no marked difference in the implant survival rate was found among the different groups (p = 0.248), or in the survival curves (p = 0.593). CONCLUSIONS: BMI does not influence the implant survival rate. The postoperative functional and quality-of-life scores were significantly improved in all groups. Obese (BMI ≥30 kg/m2) individuals should not be excluded from UKA.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho , Artroplastia do Joelho/efeitos adversos , Índice de Massa Corporal , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
15.
BMC Musculoskelet Disord ; 23(1): 43, 2022 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-35027036

RESUMO

BACKGROUND: Magnetic resonance imaging (MRI) is widely used for the evaluation of knee injuries, however, the accuracy of MRI in classifying multiple ligament knee injuries (MLKIs) remains unknown. This study aimed to investigate the accuracy of MRI in diagnosing and classifying acute traumatic MLKIs, we hypothesize that MRI had high accuracy in detecting and classifying MLKIs. METHODS: The clinical data of 97 patients who were diagnosed with acute traumatic MLKIs and managed by multi-ligament reconstruction between 2012 and 2020 were retrospectively reviewed. The MR images were read by two experienced radiologists and results were compared with intraoperative findings, which were considered as the reference for the identification of injured structures. The value of MRI in detecting injuries of anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), lateral collateral ligament (LCL), and meniscus was evaluated by calculating the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and kappa coefficients analysis. The value of MRI in classifying MLKIs was evaluated by calculating the agreement between MRI and intraoperative findings. RESULTS: For detecting the specific injured structures in MLKIs, MRI had high sensitivity (90.7% for ACL, 90.4% for PCL, and moderate specificity (63.6% for ACL, 50% for PCL) in detecting cruciate ligament injuries, moderate sensitivity (79.1% for MCL, 55.6% for LCL) and specificity (46.7% for MCL, 68.4% for LCL) in detecting collateral ligament injuries, fair sensitivity (61.5%) and low specificity (39.4%) in the diagnosis of injuries to the meniscus. For classifying the MIKIs, MRI had a moderate agreement with intraoperative findings in classifying KD-V (kappa value = 0.57), poor agreement in the KD-I (kappa value = 0.39) and KD-IIIM (kappa value = 0.31), meaningless in the KD-II and KD-IIIL (kappa value < 0). The overall agreement between MRI and intraoperative findings in classifying MLKIs was poor (kappa value = 0.23). CONCLUSIONS: MRI is valuable in early detection and diagnosis of acute MLKIs, however, the accuracy of MRI in classifying MLKIs is limited. The management of MLKIs should be based on intraoperative findings, physical examinations, and comprehensive imaging results.


Assuntos
Lesões do Ligamento Cruzado Anterior , Traumatismos do Joelho , Ligamento Cruzado Posterior , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Lesões do Ligamento Cruzado Anterior/cirurgia , Humanos , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/cirurgia , Imageamento por Ressonância Magnética , Ligamento Cruzado Posterior/diagnóstico por imagem , Ligamento Cruzado Posterior/cirurgia , Estudos Retrospectivos
16.
BMC Ophthalmol ; 22(1): 23, 2022 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-35031016

RESUMO

BACKGROUND: Peripheral iridectomy (PI), routinely performed during glaucoma filtration surgery, may contribute to scarring. This study aims to determine whether PI alters the concentrations of VEGF-A and TGF-ß isoforms in the rabbit aqueous humour. METHODS: Anterior chamber paracentesis (ACP) was performed in both eyes of six New Zealand white rabbits, with additional surgical PI performed in the right eyes. Eyes were examined on postoperative days (PODs) 1, 7, 30 and 60 by means of the tonopen, slit-lamp biomicroscopy, and bead-based cytokine assays for TGF-ß and VEGF-A concentrations in the aqueous humor. RESULTS: ACP caused a significant reduction in intraocular pressure (IOP) from mean preoperative 11.47 ± 1.01 mmHg to 5.67 ± 1.63 mmHg on POD 1 while PI did not cause further IOP reduction. Limbal conjunctival vasculature appeared slightly increased on POD 1 in both ACP and PI eyes with PI also causing mild bleeding from damaged iris vessels. Two PI eyes developed fibrinous anterior chamber reaction and/ or peripheral anterior synechiae. Aqueous VEGF-A levels were not significantly different between eyes treated with ACP and PI. Aqueous TGF-ß concentrations distributed in the ratio of 4:800:1 for TGF-ß1:TGF-ß2:TGF-ß3 respectively. While aqueous TGF-ß2 was not significantly induced by either procedure at any time point, TGF-ß1 and TGF-ß3 were significantly induced above baseline levels by PI on POD 1. CONCLUSION: PI increases the risk of inflammation. The combined induction of aqueous TGF-ß1 and TGF-ß3 by PI in glaucoma surgery may impact surgery success in glaucoma subtypes sensitive to these isoforms.


Assuntos
Humor Aquoso , Fator A de Crescimento do Endotélio Vascular , Animais , Pressão Intraocular , Iridectomia , Iris/cirurgia , Coelhos
17.
BMC Musculoskelet Disord ; 23(1): 48, 2022 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-35031030

RESUMO

BACKGROUND: The ideal acetabular position for optimizing hip joint biomechanics in periacetabular osteotomy (PAO) remains unclear. We aimed to determine the relationship between acetabular correction in the coronal plane and joint contact pressure (CP) and identify morphological factors associated with residual abnormal CP after correction. METHODS: Using CT images from 44 patients with hip dysplasia, we performed three patterns of virtual PAOs on patient-specific 3D hip models; the acetabulum was rotated laterally to the lateral center-edge angles (LCEA) of 30°, 35°, and 40°. Finite-element analysis was used to calculate the CP of the acetabular cartilage during a single-leg stance. RESULTS: Coronal correction to the LCEA of 30° decreased the median maximum CP 0.5-fold compared to preoperatively (p <  0.001). Additional correction to the LCEA of 40° further decreased CP in 15 hips (34%) but conversely increased CP in 29 hips (66%). The increase in CP was associated with greater preoperative extrusion index (p = 0.030) and roundness index (p = 0.038). Overall, virtual PAO failed to normalize CP in 11 hips (25%), and a small anterior wall index (p = 0.049) and a large roundness index (p = 0.003) were associated with residual abnormal CP. CONCLUSIONS: The degree of acetabular correction in the coronal plane where CP is minimized varied among patients. Coronal plane correction alone failed to normalize CP in 25% of patients in this study. In patients with an anterior acetabular deficiency (anterior wall index < 0.21) and an aspherical femoral head (roundness index > 53.2%), coronal plane correction alone may not normalize CP. Further studies are needed to clarify the effectiveness of multiplanar correction, including in the sagittal and axial planes, in optimizing the hip joint's contact mechanics.


Assuntos
Luxação Congênita de Quadril , Luxação do Quadril , Acetábulo/diagnóstico por imagem , Acetábulo/cirurgia , Luxação do Quadril/diagnóstico por imagem , Luxação do Quadril/cirurgia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Humanos , Osteotomia , Estudos Retrospectivos , Resultado do Tratamento
18.
BMC Musculoskelet Disord ; 23(1): 49, 2022 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-35031036

RESUMO

BACKGROUND: Femoral neck fractures in young people are usually Pauwels Type III fractures. The common treatment method are multiple parallel cannulated screws or dynamic hip screw sliding compression fixation. Due to the huge shear stress, the rate of complications such as femoral head necrosis and nonunion is still high after treatment. The aim of our study was to compare the stabilities of two fixation methods in fixating pauwels type III femoral neck fractures. METHODS: All biomimetic fracture samples are fixed with three cannulated screws combined with a medial buttress plate. There were two fixation groups for the buttress plate and proximal fracture fragment: Group A, long screw (40 mm); Group B, short screw (6 mm). Samples were subjected to electrical strain measurement under a load of 500 N, axial stiffness was measured, and then the samples were axially loaded until failure. More than 5 mm of displacement or synthetic bone fracture was considered as construct failure. RESULTS: There were no significant differences in failure load (P = 0.669), stiffness (P = 0.842), or strain distribution (P > 0.05) between the two groups. CONCLUSIONS: Unicortical short screws can provide the same stability as long screws for Pauwels Type III Femoral Neck Fractures.


Assuntos
Fraturas do Colo Femoral , Adolescente , Fenômenos Biomecânicos , Placas Ósseas , Parafusos Ósseos , Fraturas do Colo Femoral/diagnóstico por imagem , Fraturas do Colo Femoral/cirurgia , Fixação Interna de Fraturas , Humanos , Estresse Mecânico
19.
J Med Case Rep ; 16(1): 13, 2022 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-35031059

RESUMO

BACKGROUND: Fenestration of the cervical segment of the internal carotid artery is a very rare finding, and its origin is still not fully understood. Explanations of its genesis range from dissections leading to the fenestration to the more common interpretation as a developmental vascular variant. However, most reported cases were symptomatic and presented with dissections, where even endovascular treatment of the fenestration of the cervical segment of the internal carotid artery became necessary. Here we report a case of a fenestration of the cervical segment of the internal carotid artery suffering a transitory ischemic attack and local pain in absence of any sign of dissection. CASE PRESENTATION: A 62-year-old Caucasian male patient was admitted to our institution because of an episode of amaurosis fugax, initially accompanied with headache. Magnetic resonance imaging revealed an intact fenestration of the cervical segment of the internal carotid artery on the symptomatic side. With antiplatelet therapy, all symptoms vanished within 2 months of the initial event. CONCLUSIONS: Our findings support the interpretation of a fenestration of the cervical segment of the internal carotid artery as a developmental vascular variant, but also suggest a substantial risk for dissection and ischemic stroke. Even in case of an accidental finding, clinicians should be aware of this. At least in this case, antiplatelet therapy seemed beneficial.


Assuntos
Dissecação da Artéria Carótida Interna , Ataque Isquêmico Transitório , Acidente Vascular Cerebral , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Dissecação da Artéria Carótida Interna/diagnóstico por imagem , Humanos , Ataque Isquêmico Transitório/etiologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia
20.
Maturitas ; 156: 18-24, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35033229

RESUMO

OBJECTIVES: To determine predictive factors for the cure of stress urinary incontinence (SUI) or persisting or de novo overactive bladder syndrome (OAB) after a mid-urethral sling procedure (MUS) for women with SUI, especially for menopausal women. STUDY DESIGN: All women who had consecutively received MUS for SUI between January 2008 and July 2019 in a tertiary referral center were reviewed. MAIN OUTCOME MEASURES: Multivariable Cox proportional hazards model or logistic regression analysis was used to assess the predictors of cure and persisting or de novo OAB after MUS. RESULTS: A total of 385 women had undergone MUS, of whom 265 (68.8%) were menopausal. The multivariable Cox proportional hazards model revealed that age (hazard ratio = 1.04), and preoperative detrusor overactivity (hazard ratio = 2.26) were independent predictors of persisting/recurrent SUI. Among the 216 women with preoperative OAB, 109 (50.5%) experienced resolution of their OAB after MUS; and among 169 women without preoperative OAB, twenty-five (14.8%) women developed de novo OAB after MUS (p < 0.0001). Preoperative OAB (hazard ratio = 3.97), small voided volume (hazard ratio = 0.83), and preoperative detrusor overactivity (hazard ratio = 1.62) were predictors of postoperative OAB. In addition, six (1.6%) women had mesh extrusion. Parity (odds ratio = 2.08) was the sole predictor of mesh extrusion. Menopause (hazard ratio = 1.69) was a predictor of postoperative OAB in the univariate analysis. However, menopause was not a predictor of cure or OAB in the multivariable analysis. CONCLUSIONS: Age and preoperative detrusor overactivity were independent predictors of persisting/recurrent SUI. In addition, preoperative OAB, small voided volume, and preoperative detrusor overactivity were predictors of postoperative OAB. These findings could serve as a guide for preoperative consultation for MUS.


Assuntos
Slings Suburetrais , Bexiga Urinária Hiperativa , Incontinência Urinária por Estresse , Feminino , Humanos , Menopausa , Paridade , Gravidez , Slings Suburetrais/efeitos adversos , Resultado do Tratamento , Bexiga Urinária Hiperativa/complicações , Incontinência Urinária por Estresse/cirurgia , Urodinâmica
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