Results of muscle strength and range of motion after total open knee synovectomy.

AIM OF THE STUDY: Scar tissue formation after synovectomy limits range of motion and causes muscle atrophy. The functional results for patients who underwent total open knee synovectomy often included questionnaires, and assessment of muscle strength was lacking in the literature. Therefore, we aimed to identify the strength and range of motion outcomes for patients who underwent total open synovectomy and to compare the results with the contralateral limb and healthy individuals. METHOD: Knee range of motion and muscle strength were assessed in fourteen patients that underwent total (anterior and posterior) open knee synovectomy and were compared with the contralateral limb and with 14 healthy individuals matched by sex, age, height, and weight. RESULTS: The range of motion of flexion decreased 8.4% compared with the contralateral limb (95% CI - 18.9 to - 4.7, p = 0.002) and 9.9% compared with the control group (95% CI 3.9-14.9, p < 0.01). Knee extension strength decreased by 35% compared with the contralateral limb (95% CI 11.1-77.2, p = 0.01) and 37% compared with the control group (95% CI - 112.4-12.1, p = 0.01). CONCLUSION: Despite the aggressiveness of the surgical procedure, the patients achieved satisfactory functional results.

Treatment alternatives and clinical outcomes of bone filling after benign tumour curettage. A systematic review.

BACKGROUND: Benign and pseudo-neoplastic bone lesions are usually treated by curettage and filling of the cavity. This filling is usually achieved with the use of autologous bone grafts, bone cement, allografts, xenografts, or synthetic bone substitutes. Recently, some authors have suggested that these defects do not require filling for consolidation but the respective rate of complications of each method is not well defined. Therefore, we did a systematic review aiming to answer: (1) Not filling bone cavities after benign bone tumour curettage may increase the rate of fractures? (2) Can the volume of the bone defect in itself be a specific or reliable predictor of fracture? (3) Does the mean functional outcome, recurrence, non-weight bearing time, other postoperative complications or bone consolidation time vary between the methods of filling? PATIENTS AND METHODS: The PubMed (2407 articles) and Latin American and Caribbean Health Sciences Literature (LILACS) (50 articles) databases were reviewed, without restriction considering publication date. After exclusion criteria, 62 articles were selected for data collection. Filling or not filling (UN), methods of filling, fracture rate, bone defect size, mean functional outcome, recurrence, non-weight bearing time, other postoperative complications, consolidation time were the data of interest. RESULTS: The number of patients was 2555 distributed among the different filling methods. Unfilled cavities were associated with higher fracture rate [20/302 (6.62%)] versus 4/189 (2.12%) for allografts, 14/343 (4.08%) for cement filling, 4/247 for autograft (1.62%), and 12/580 (2.07%) for bone substitute. The volume of the bone defect alone is not a specific or reliable predictor of fracture. All filling methods were similar regarding the mean functional outcome, recurrence rate and consolidation time. The bone cement allowed early weight bearing time (mean of weeks): UN: 9.67; autologous bone grafts: 9.8; bone cement: 0.5; allografts: 9.0; synthetic bone substitutes: 9.96. CONCLUSION: Not filling the bone cavity after benign bone tumour curettage is an alternative, but can increase fracture rate, even in small volume bone defects. The use of prophylactic fixation drastically reduces the fracture rate. Filling with cement reduces weight bearing time. There are little differences between the methods used to fill, even compared to not filling the cavity. LEVEL OF EVIDENCE: III; systematic review.

COMPLICATIONS AND COST ANALYSIS OF HEMIPELVECTOMY FOR THE TREATMENT OF PELVIC TUMORS.

OBJECTIVE: Hemipelvectomy is a complex surgery with a high complication rate. Here, we aimed to identify factors related to the onset of complications and calculate their impacts on hospital costs. METHODS: We evaluated 31 consecutive patients who underwent hemipelvectomy between 1999 and 2015. We assessed the clinical and radiographic data to determine the patients' demographic factors, tumor and surgical characteristics, and complications. The individual hospital stays and financial balances were assessed up to 6 months following the index surgery. RESULTS: The overall complication rate was 61% (19/31). Infection was the most prevalent complication (36%). Immediate postoperative death occurred in 5/31 patients (16%); another 5 (16%) died after hospital discharge due to disease progression. Histological grade, previous surgery, and previous radiotherapy were not associated with complications or infection. Acetabular resections, bone reconstruction, and longer operative times were associated with infection, whereas older age, pelvic organ involvement, and comorbidities were associated with immediate postoperative death. Complications and infection were associated with 4.8- and 5.9-fold increases in hospital costs, respectively. CONCLUSIONS: Acetabular resection and bone reconstruction are important factors that increase short-term complication rates, infection rates, and hospital costs. Mortality was associated with older age and adjacent pelvic tumor progression. Level of Evidence: IV, case series.

OBJETIVO: Hemipelvectomia é uma cirurgia complexa associada a alta taxa de complicações. O objetivo foi identificar fatores relacionados a complicações e calcular o impacto sobre os custos hospitalares. MÉTODOS: Avaliamos 31 pacientes consecutivos submetidos à hemipelvectomia entre 1999 e 2015. Analisamos dados clínicos e radiográficos para determinar variáveis demográficas, características do tumor e cirurgia, e complicações. A internação hospitalar individual e o balanço financeiro foram calculados até seis meses após a cirurgia principal. RESULTADOS: A taxa de complicações foi de 61% (19/31). Infecção foi a complicação mais frequente (36%). Morte pós-operatória precoce foi observada em 5/31 pacientes (16%) e outros cinco (16%) morreram após alta hospitalar devido à progressão da doença. Grau histológico, cirurgia e radioterapias prévias não estiveram associadas com complicações ou infecções. Ressecções acetabulares, reconstruções ósseas e maiores tempos cirúrgicos estiveram associados com infecções, enquanto que mais idade, envolvimento de orgão pélvico e comorbidades estiveram associados com morte precoce. Complicações e infecções apresentaram aumento de 4,8-, e 5.9-vezes nos custos hospitalres. CONCLUSÕES: Ressecções acetabulares e reconstrução óssea são fatores importantes que aumentam as complicações, infecções e custos hospitalares. Mortalidade está associada com maior idade e progressão tumoral intrapélvica. Nível de Evidência IV, Série de casos.

Osteointegration of porous absorbable bone substitutes: A systematic review of the literature.

Biomaterials' structural characteristics and the addition of osteoinductors influence the osteointegration capacity of bone substitutes. This study aims to identify the characteristics of porous and resorbable bone substitutes that influence new bone formation. An Internet search for studies reporting new bone formation rates in bone defects filled with porous and resorbable substitutes was performed in duplicate using the PubMed, Web of Science, Scielo, and University of São Paulo Digital Library databases. Metaphyseal or calvarial bone defects 4 to 10 mm in diameter from various animal models were selected. New bone formation rates were collected from the histomorphometry or micro-CT data. The following variables were analyzed: animal model, bone region, defect diameter, follow-up time after implantation, basic substitute material, osteoinductor addition, pore size and porosity. Of 3,266 initially identified articles, 15 articles describing 32 experimental groups met the inclusion criteria. There were no differences between the groups in the experimental model characteristics, except for the follow-up time, which showed a very weak to moderate correlation with the rate of new bone formation. In terms of the biomaterial and structural characteristics, only porosity showed a significant influence on the rate of new bone formation. Higher porosity is related to higher new bone formation rates. The influence of other characteristics could not be identified, possibly due to the large variety of experimental models and methodologies used to estimate new bone formation rates. We suggest the inclusion of standard control groups in future experimental studies to compare biomaterials.

[Effects of intrinsic denervation of the jejunum after extensive enterectomy in the rat bowel syndrome]. / Efeitos da desnervação intrínseca do jejuno após enterectomia extensa na síndrome do intestino curto em ratos.

PURPOSE: To investigate the effects of intrinsic denervation of the jejunum after the extensive intestinal resection in rats. METHODS: Thirty male Wistar rats were distributed into three groups, depending on the experimental procedure: Group C (control), Group R (resection) and Group D (resection plus denervation). The body weight gain and a histomorphometric study of the jejunal mucosa were performed. RESULTS: The mean body weight of the group D animals showed a higher increase when compared to group R (D=312.2+/-21 g and R=196.7+/-36.2g). The number of jejunum myenteric neurons was smaller in group D (344.8+/-34.8 neurons/mm) when compared to other groups (R=909.0+/-55.5 and C=898.5+/-73.3). A hyperplasia of the jejunum mucosal epithelium was observed in the group D but also in the group R (R=7.3+/-3.9 mm2 and D=10.8+/-4.3 mm2), when compared to group C (C=5.8+/-3.0 mm2). The epithelial cell proliferation of the jejunum was higher in group D animals (48.7%) when compared to the other groups (R=31.9% and C=23.6%). CONCLUSIONS: The denervated animals presented an increase the body weight gain and mucosal cell proliferation responses when compared to the control group. This experimental model may provide new strategies for the surgical treatment of the short bowel syndrome.

Complications and cost analysis of hemipelvectomy for the treatment of pelvic tumors / Complicações e análise de custo da hemipelvectomia para o tratamento de tumores da pelve

ABSTRACT Objective: Hemipelvectomy is a complex surgery with a high complication rate. Here, we aimed to identify factors related to the onset of complications and calculate their impacts on hospital costs. Methods: We evaluated 31 consecutive patients who underwent hemipelvectomy between 1999 and 2015. We assessed the clinical and radiographic data to determine the patients' demographic factors, tumor and surgical characteristics, and complications. The individual hospital stays and financial balances were assessed up to 6 months following the index surgery. Results: The overall complication rate was 61% (19/31). Infection was the most prevalent complication (36%). Immediate postoperative death occurred in 5/31 patients (16%); another 5 (16%) died after hospital discharge due to disease progression. Histological grade, previous surgery, and previous radiotherapy were not associated with complications or infection. Acetabular resections, bone reconstruction, and longer operative times were associated with infection, whereas older age, pelvic organ involvement, and comorbidities were associated with immediate postoperative death. Complications and infection were associated with 4.8- and 5.9-fold increases in hospital costs, respectively. Conclusions: Acetabular resection and bone reconstruction are important factors that increase short-term complication rates, infection rates, and hospital costs. Mortality was associated with older age and adjacent pelvic tumor progression. Level of Evidence: IV, case series.

RESUMO Objetivo: Hemipelvectomia é uma cirurgia complexa associada a alta taxa de complicações. O objetivo foi identificar fatores relacionados a complicações e calcular o impacto sobre os custos hospitalares. Métodos: Avaliamos 31 pacientes consecutivos submetidos à hemipelvectomia entre 1999 e 2015. Analisamos dados clínicos e radiográficos para determinar variáveis demográficas, características do tumor e cirurgia, e complicações. A internação hospitalar individual e o balanço financeiro foram calculados até seis meses após a cirurgia principal. Resultados: A taxa de complicações foi de 61% (19/31). Infecção foi a complicação mais frequente (36%). Morte pós-operatória precoce foi observada em 5/31 pacientes (16%) e outros cinco (16%) morreram após alta hospitalar devido à progressão da doença. Grau histológico, cirurgia e radioterapias prévias não estiveram associadas com complicações ou infecções. Ressecções acetabulares, reconstruções ósseas e maiores tempos cirúrgicos estiveram associados com infecções, enquanto que mais idade, envolvimento de orgão pélvico e comorbidades estiveram associados com morte precoce. Complicações e infecções apresentaram aumento de 4,8-, e 5.9-vezes nos custos hospitalres. Conclusões: Ressecções acetabulares e reconstrução óssea são fatores importantes que aumentam as complicações, infecções e custos hospitalares. Mortalidade está associada com maior idade e progressão tumoral intrapélvica. Nível de Evidência IV, Série de casos.

CT-guided percutaneous drilling is a safe and reliable method of treating osteoid osteomas.

Computed tomography (CT)-guided percutaneous drilling is an alternative for osteoid osteoma treatment. This study aims to evaluate the remodeling of the drill orifice. The success rate and complications were also recorded and compared with other treatment methods. Fifteen patients with an average age of fourteen years (ranging from 4 to 25) submitted to CT-guided percutaneous drilling between 2003 and 2009 were retrospectively analyzed according to clinical and radiological criteria. Fourteen cases showed complete alleviation of pain one week after surgery. No relapse was detected even in the subject who continued complaining of pain. All patients were treated with a day-hospital regimen and were discharged with partial weight bearing. Total weight bearing was allowed after one month, and sports were allowed after consolidation, which occurred in all but one case after the third month. One patient, who did not follow our medical advice, returned to sports activities after two weeks and experienced a fracture as a result. Atrophy of the vastus lateralis muscle developed after the procedure in another patient. Our case series suggests that this method is reliable and safe. The level of complexity is comparable with other minimally invasive percutaneous procedures. The cost is low because there is no need to buy probes or other equipment. The negative points include weakening of the bone and the logistical problem of assembling the orthopedic surgeon, radiologist, and anesthesiologist in the tomography room.

Osteointegration of porous absorbable bone substitutes: A systematic review of the literature

Biomaterials' structural characteristics and the addition of osteoinductors influence the osteointegration capacity of bone substitutes. This study aims to identify the characteristics of porous and resorbable bone substitutes that influence new bone formation. An Internet search for studies reporting new bone formation rates in bone defects filled with porous and resorbable substitutes was performed in duplicate using the PubMed, Web of Science, Scielo, and University of São Paulo Digital Library databases. Metaphyseal or calvarial bone defects 4 to 10 mm in diameter from various animal models were selected. New bone formation rates were collected from the histomorphometry or micro-CT data. The following variables were analyzed: animal model, bone region, defect diameter, follow-up time after implantation, basic substitute material, osteoinductor addition, pore size and porosity. Of 3,266 initially identified articles, 15 articles describing 32 experimental groups met the inclusion criteria. There were no differences between the groups in the experimental model characteristics, except for the follow-up time, which showed a very weak to moderate correlation with the rate of new bone formation. In terms of the biomaterial and structural characteristics, only porosity showed a significant influence on the rate of new bone formation. Higher porosity is related to higher new bone formation rates. The influence of other characteristics could not be identified, possibly due to the large variety of experimental models and methodologies used to estimate new bone formation rates. We suggest the inclusion of standard control groups in future experimental studies to compare biomaterials.

O alendronato de sódio na prevenção da osteopenia secundária à imobilização gessada, em ratas: avaliação histomorfométrica / Alendronate sodium to prevent osteopenia caused by cast immobilization in female rats: histomorphometric evaluation

OBJETIVO: Analisar, por meio da histomorfometria, o efeito do alendronato de sódio sobre o trabeculado ósseo de ratos, quando administrado simultaneamente com imobilização gessada. MÉTODOS: Foram utilizados quatro grupos com cinco fêmeas de ratos Wistar: 1) imobilizado; 2) não imobilizado + alendronato; 3) imobilizado + alendronato; e 4) controle. A imobilização foi feita com gesso pelvipodálico aplicado até o membro posterior direito e o alendronato foi administrado em doses semanais. O período de observação foi de 28 dias e realizada histomorfometria da metáfise proximal da tíbia, com análise do número de trabéculas, volume ósseo, espessura trabecular e separação trabecular. RESULTADOS: O grupo imobilizado apresentou volume ósseo menor que os demais grupos. Os animais que receberam alendronato semanal, tanto imobilizados, quanto não imobilizados, apresentaram volume ósseo maior que o controle. A espessura trabecular no grupo imobilizado foi menor do que nos grupos controle e não imobilizado que recebeu alendronato, mas não apresentou diferença significativa em relação ao imobilizado com alendronato. O grupo imobilizado apresentou separação trabecular maior que os demais grupos. Os grupos não imobilizado, sem imobilização que recebeu alendronato e imobilizado que recebeu alendronato apresentaram aumento no número de trabéculas em relação ao grupo imobilizado. CONCLUSÃO: A imobilização empregada efetivamente levou à osteopenia, verificada pela diminuição de todos os principais parâmetros histomorfométricos estudados. Estas alterações foram prevenidas pela administração concomitante de alendronato sódico, exceto com relação à espessura trabecular. O alendronato de sódio foi capaz de aumentar os parâmetros morfométricos, mesmo em animais não imobilizados.

OBJECTIVE: Using histomorphometric means to analyze the effect of alendronate sodium on the bone trabeculate of rats administered concomitantly with cast immobilization. METHODS: Female Wistar rats were distributed in four groups with five animals each: 1) cast-immobilized; 2) no immobilization + alendronate; 3) cast-immobilized + alendronate; and 4) control. Immobilization was done with pelvipodalic cast applied till the right hind limb and alendronate was administered in weekly doses. The observation period was 28 days and histomorphometric evaluations were performed in the proximal tibial metaphysis, analyzing the number of trabeculae, bone volume, trabecular thickness, and trabecular separation. RESULTS: The immobilized group presented less bone volume than the other groups. The animals receiving alendronate every week, whether or not immobilized, presented a greater bone volume than the control group. Trabecular thickness in the immobilized group was less than in the control and in the non-immobilized groups that received alendronate, but had no significant difference when compared to the immobilized with alendronate group. The immobilized group presented greater trabecular separation than the other groups. In the non-immobilized groups, the non-immobilized group that received alendronate and the immobilized group that received alendronate presented an increased number of trabeculae when compared to the immobilized group. CONCLUSION: The immobilization used led to osteopenia, as confirmed by the decrease in all of the main histomorphometric parameters studied. Such changes were prevented with the concomitant administration of alendronate sodium, exception being made to the trabecular thickness. Alendronate sodium was able to increase morphometric parameters, even in non-immobilized animals.

Efeitos da desnervação intrínseca do jejuno após enterectomia extensa na síndrome do intestino curto em ratos / Effects of intrinsic denervation of the jejunum after extensive enterectomy in the rat bowel syndrome

OBJETIVO: Investigar em ratos Wistar as respostas adaptativas da mucosa em conseqüência da desnervação intrínseca do jejuno após ressecção intestinal extensa. MÉTODOS: Utilizaram-se 30 ratos distribuídos em três grupos segundo o procedimento realizado: C (controle), R (ressecção intestinal) e D (ressecção intestinal e desnervação intrínseca do jejuno). Posteriormente foi avaliado o ganho de peso e realizado estudos morfométrico da mucosa intestinal. RESULTADOS: Os animais do grupo D apresentaram ganho ponderal consideravelmente maior do que os do grupo R (D=312,2±21g e R=196,7±36,2g). A contagem neuronal mostrou diminuição na população de neurônios mientéricos no grupo D (344,8±34,8 neurônios/mm de jejuno) em relação aos outros grupos (R=909,0±55,5 e C=898,5±73,3). A área do epitélio da mucosa jejunal foi maior no grupo D (10,8±4,3mm²) em comparação aos grupos R (7,3±3,9mm²) e C (5,8±3,0mm²). O índice de proliferação celular epitelial da mucosa foi maior no grupo D (48,7 por cento), em relação aos grupos R (31,9 por cento) e C (23,6 por cento). CONCLUSÕES: O modelo experimental mostrou-se eficaz em melhorar o ganho ponderal dos animais submetidos à ressecção intestinal extensa, provocando intensificação da resposta hiperplásica da mucosa, a qual provavelmente levou a aumento da superfície de absorção de nutrientes. Abrem-se boas perspectivas para novas abordagens cirúrgicas para a síndrome do intestino curto.

O que eles fazem depois da aula? As atividades extracurriculares dos alunos de Ciências Médicas da FMRP-USP / What do they do after class? Extra curriculum activities of medical students of Ribeirão Preto-University of São Paulo

Em 1999, O Programa Especial de Treinamento da Faculdade de Medicina de Ribeirão Preto, da Universidade de São Paulo realizou um estudo com 326 alunos, do primeiro ao quarto ano, com o objetivo de identificar e descrever as atividades extracurriculares desses alunos. Em 2002, o estudo foi repetido, utilizando-se o mesmo instrumento, aplicado em 360 alunos. Trata-se, portanto, de estudo transversal, cujas variáveis estudadas são: idade, sexo, ano do curso, atividades extracurriculares ligadas à FMRP-USP, motivo da pratica de tais atividades, horas despendidas com elas, grau de satisfação e motivo de satisfação e insatisfação. Do total de entrevistados, 64 por cento são homens e 36 por cento são mulheres. A média da idade é 20,7 anos e apenas 8por cento (29) não estavam engajados em nenhuma atividade extracurricular na época da entrevista. Das atividades mais freqüentadas estão as ligas (73 por cento), os treinos esportivos (53 por cento), os estágios em laboratório de iniciação cientifica (31,5 por cento) e os plantões voluntários (31 por cento). Das atividades não relacionadas à Faculdade, 36 por cento referiram-se ao estudo de uma língua estrangeira e 24,5 por cento, à música ou ao teatro. A maioria gasta, pelo menos, cinco horas semanais com essas atividades. Maior número de atividades foi encontrado, associado ao maior o tempo de permanência do aluno no curso médico (p=0,002), embora a carga horária da grade curricular também aumente com o passar do tempo. Embora não tenham sido encontradas grandes diferenças, ao compararmos os alunos entrevistados em 1999 e 2002, houve aumento significativo de participação em ligas, já que novas foram criadas no período