RESUMO
The objective of this study was to demonstrate the effectiveness of the single transphyseal screw technique in foals diagnosed with carpal valgus deviation. This study included 22 thoroughbred animals of both sexes, with a mean age of 30 days. All animals had a carpal valgus deviation >5° with irregular development of the distal epiphysis of the radius. All animals were surgically treated to correct the carpal valgus deviation by creating a bridge using a single transphyseal screw. Surgical intervention was performed for 40 limbs, comprising 19 right and 21 left thoracic limbs. This corresponded to four animals with carpal valgus deviation >5° in only one of the limbs and 18 with the deviation in both limbs. It was observed that 38/40 treated limbs (95%) achieved normal angulation according to the literature, i.e., angulation between 0° and 5°. No statistical differences were observed between the affected limbs. The single transphyseal screw technique can be used for the correction of carpal valgus deviation in foals. It is indicated in animals with an average age of 30 days (20-55 days), as its main advantages are rapid application, simple execution, and limited trans- and post-surgical complications, making it an effective procedure in thoroughbred foals with carpal valgus angular deviation.
O objetivo do presente estudo foi demonstrar a viabilidade da aplicação da técnica de parafuso único transfiseal em potros, com diagnóstico de desvio valgo do carpo. Foram selecionados 22 animais, da raça PSI, com idade média de 30 dias, de ambos os sexos. Todos os animais apresentavam desvio valgo do carpo acima de cinco graus, com desenvolvimento irregular da epífise distal do rádio. Os animais foram submetidos à cirurgia corretiva para o desvio valgo do carpo por meio da realização de ponte com um único parafuso transfiseal. Foram submetidos à intervenção cirúrgica 40 membros, divididos entre membros torácicos direito e esquerdo 19 e 21, respectivamente, que corresponderam a quatro animais com desvio acima de 5 graus valgo do carpo em apenas um dos membros e 18 animais com o procedimento nos dois membros. Observou-se que 38 dos 40 membros tratados, ou seja, 95%, retornaram a uma angulação considerada normal, entre zero e cinco graus Dois animais apresentaram infecção do implante, de maneira que eles reduziram a angulação, porém não o suficiente para enquadrá-los na angulação normal estabelecida pela literatura. Não houve diferença estatística entre os membros acometidos. A técnica de aplicação do único parafuso transfiseal pode ser indicada para correção do desvio valgo do carpo em potros. Deve ser indicada em animais com idade média de 30 dias (20 a 55 dias de vida), por ter como principais vantagens aplicação rápida, execução simples e com limitadas intercorrências trans e pós-cirúrgicas.
Assuntos
Animais , Próteses e Implantes/veterinária , Doenças dos CavalosRESUMO
Background Complex percutaneous coronary intervention (PCI) is associated with higher ischemic risk, which can be mitigated by long-term dual antiplatelet therapy (DAPT). However, concomitant high bleeding risk (HBR) may be present, making it unclear whether short- or long-term DAPT should be prioritized. Objectives This study investigated the effects of ischemic (by PCI complexity) and bleeding (by PRECISE-DAPT [PRE dicting bleeding Complications in patients undergoing stent Implantation and Sub sequent Dual Anti Platelet Therapy] score) risks on clinical outcomes and on the impact of DAPT duration after coronary stenting. Methods Complex PCI was defined as ≥3 stents implanted and/or ≥3 lesions treated, bifurcation stenting and/or stent length >60 mm, and/or chronic total occlusion revascularization. Ischemic and bleeding outcomes in high (≥25) or non-high (<25) PRECISE-DAPT strata were evaluated based on randomly allocated duration of DAPT. Results Among 14,963 patients from 8 randomized trials, 3,118 underwent complex PCI and experienced a higher rate of ischemic, but not bleeding, events. Long-term DAPT in non-HBR patients reduced ischemic events in both complex (absolute risk difference: −3.86%; 95% confidence interval: −7.71 to +0.06) and noncomplex PCI strata (absolute risk difference: −1.14%; 95% confidence interval: −2.26 to −0.02), but not among HBR patients, regardless of complex PCI features. The bleeding risk according to the Thrombolysis In Myocardial Infarction scale was increased by long-term DAPT only in HBR patients, regardless of PCI complexity. Conclusions Patients who underwent complex PCI had a higher risk of ischemic events, but benefitted from long-term DAPT only if HBR features were not present. These data suggested that when concordant, bleeding, more than ischemic risk, should inform decision-making on the duration of DAPT. (AU)