Hallux valgus in males--part 2: radiographic assessment of surgical treatment.

BACKGROUND: In an early report on this patient cohort, we concluded that a hallux valgus deformity in males is frequently hereditary in nature. An increase in the distal metatarsal articular angle (DMAA) was observed to be the major defining characteristic of hallux valgus in males. In this follow-up study, our goal was to evaluate the effectiveness of surgical treatment for this cohort of male patients. METHODS: Data from 50 feet of male patients with hallux valgus who were surgically treated by the same surgeon between 1985 and 2005 were retrospectively analyzed. The technique was algorithmically chosen according to the severity and complexity of the deformity. Thus, 10 chevron osteotomies, 9 biplanar chevron osteotomies, 12 Mitchell osteotomies, 9 scarf osteotomies, and 10 basilar first metatarsal osteotomies were performed. The average follow-up was 10 years (range, 2-20). RESULTS: After analyzing the angular radiological parameters, sesamoid subluxation, and the articular congruency, most procedures proved to have achieved adequate correction of the angular deformities. When examining each of the procedures separately, 4 of the 5 procedures had similar corrective capacities; the scarf osteotomy however had decidedly inferior results. The improvement in the postoperative American Orthopaedic Foot and Ankle Society (AOFAS) score demonstrated the clinical and functional improvement. CONCLUSIONS: The algorithm was based mainly upon the presence of increased DMAA and increased severity of angular deformities. We conclude that hallux valgus deformities in males were adequately corrected with the selected techniques. Greater difficulty or resistance to surgical treatment could not be detected when we contrasted our results to females. The scarf osteotomy proved to have an inferior corrective capacity compared to the other techniques used in this series. LEVEL OF EVIDENCE: Level III, retrospective comparative series.

Hallux valgus in males--part 1: demographics, etiology, and comparative radiology.

BACKGROUND: The high frequency of hallux valgus deformities in females is well known and has been widely reported in the literature. This finding tends to obscure the importance and the characteristic details of hallux valgus deformities in males. The severity of the deformity, its onset at an earlier age, and its inheritability seem to be more frequent in males, but there are no reports in the literature to substantiate these concepts. The purpose of this study was to analyze these questions in regard to males with hallux valgus. METHODS: The records and plain radiographs of 31 males (53 feet) with a diagnosis of hallux valgus that were treated over a 20-year period (1985-2005) were analyzed. During that same period, the senior author (CN) performed 812 procedures for the correction of hallux valgus deformities in women. In order to compare gender-related differences associated with this deformity, 31 women's charts-paired by age and affected side-were randomly selected and both clinical and radiological data were statistically compared. RESULTS: The onset of the complaints of first ray pain in males was equally distributed by decades, indicating that the deformity begins earlier in this group. Among males, we found 68% of the subjects had a familial history of bunion deformities-58% were maternal and 10% were fraternal. In the control group of females, only 35% of the women reported inheritance of the deformity. No correlation with footwear was found among males. The radiographic measurements were significantly higher in the male group, which included the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), and the tarsal metatarsal angle (TMA). The main gender difference was found to be the DMAA with first metatarsophalangeal (MTP) joint congruence being much more common in males (males = 57%, females = 30%). No correlations were found for metatarsus primus varus or pes planus. CONCLUSION: Based on our observations, we conclude that hallux valgus in males is commonly hereditary in nature and is mainly transmitted by the mother, with early onset and higher severity when compared to women. We report a female/male ratio of 15:1. The main intrinsic factor associated with a hallux valgus deformity in males is a high DMAA. LEVEL OF EVIDENCE: Level III, retrospective comparative series.

Prevention of bone infection after open fracture using a chitosan with ciprofloxacin implant in animal model.

PURPOSE: To evaluate different concentrations of ciprofloxacin to prevent infection after open fracture contaminated with S. aureus in rats using absorbable local delivery system. METHODS: Fifty-two Wistar rats were assigned to six groups. After 4 weeks, all animals underwent 99mTc-ceftizoxima scintigraphy evaluation, callus formation measurement and histological analysis. ANOVA, t-Student and Kruskal Wallis were used for quantitative variables statistical analysis, whereas qui square and exact Fisher were used for qualitative variables. RESULTS: Treatment using 25% and 50% of ciprofloxacin incorporated at the fracture fixation device were effective in preventing bone infection compared to control group (p<0.05). Chitosan were not effective in preventing bone infection when used alone compared to control group (p>0.05). Histological findings demonstrated bone-healing delay with 50% of ciprofloxacin. No difference in callus formation were observed (p>0.05). CONCLUSION: Local delivery treatment for contaminated open fracture using chitosan with ciprofloxacin is effective above 25%.

Reproducibility of the Lauge-Hansen, Danis-Weber, and AO classifications for ankle fractures.

OBJECTIVE: This study evaluated the reproducibility of the three main classifications of ankle fractures most commonly used in emergency clinical practice: Lauge-Hansen, Danis-Weber, and AO-OTA. The secondary objective was to assess whether the level of professional experience influenced the interobserver agreement for the classification of this pathology. METHODS: The study included 83 digitized preoperative radiographic images of ankle fractures, in anteroposterior and lateral views, of different adults that had occurred between January and December 2013. For sample calculation, the estimated accuracy was approximately 15%, with a sampling error of 5% and a sampling power of 80%. The images were analyzed and classified by six different observers: two foot and ankle surgeons, two general orthopedic surgeons, and two-second-year residents in orthopedics and traumatology. The Kappa statistical method of multiple variances was used to assess the variations. RESULTS: The Danis-Weber classification indicated that 40% of the agreements among all observers were good or excellent, whereas only 20% of good and excellent agreements were obtained using the AO and Lauge Hansen classifications. The Kappa index was 0.49 for the Danis-Weber classification, 0.32 for Lauge Hansen, and 0.38 for AO. CONCLUSION: The Hansen-Lauge classification presented the poorest interobserver agreement among the three systems. The AO classification demonstrated a moderate agreement and the Danis-Weber classification presented an excellent interobserver agreement index, regardless of professional experience.

OBJETIVO: Avaliar a reprodutibilidade e comparatividade das três principais classificações usadas para fraturas do tornozelo mais comumente empregadas nos servicos de emergência: Lauge-Hansen, Danis-Weber e AO-OTA. Observar secundariamente se existe influência da experiência profissional sobre a concordância entre observadores para a classificação dessa patologia. MÉTODOS: Foram usadas 83 imagens digitalizadas de radiografias pré-operatórias, em incidências anteroposterior e perfil, de fraturas do tornozelo de adultos diferentes, ocorridas entre janeiro e dezembro de 2013. No cálculo amostral assumiu-se precisão da estimativa de 15%, com erro amostral de 5% e com poder de amostragem de 80%. A leitura e a classificação das fraturas foram feitas por seis observadores, dois cirurgiões de pé e tornozelo, dois ortopedistas generalistas e dois residentes do segundo ano de ortopedia e traumatologia. A análise das variações foi feita pelo método estatístico de Kappa de múltiplas variâncias. RESULTADOS: Com o uso da classificação de Danis-Weber, 40% das concordâncias foram consideradas boas ou excelentes entre todos os observadores, enquanto nas classificações de Lauge Hansen e AO apenas 20% se apresentaram boas ou excelentes. O índice Kappa acumulado para cada classificação foi de 0,49 para a classificação de Danis-Weber, 0,32 para Lauge Hansen e 0,38 para a classificação AO. CONCLUSÃO: A classificação de Lauge Hansen apresenta a pior concordância interobservador dentre as três classificações. A classificação da AO demonstrou concordância intermediária e a de Danis-Weber apresentou o maior índice de concordância interobservador, independentemente da experiência do profissional.

Modulation of the exocellular serine-thiol proteinase activity of Paracoccidioides brasiliensis by neutral polysaccharides.

Our group characterized an exocellular serine-thiol proteinase activity in the yeast phase of Paracoccidioides brasiliensis (PbST), a dimorphic human pathogen. The fungal proteinase is able to cleave in vitro, at pH 7.4, proteins associated with the basal membrane, such as human laminin and fibronectin, type IV collagen and proteoglycans. In the present study, we investigated the influence of glycosaminoglycans (GAGs) and neutral polysaccharides upon the serine-thiol proteinase activity by means of kinetic analysis monitored with fluorescence resonance energy transfer (FRET) peptides using the substrate Abz-MKALTLQ-EDDnp (Abz=ortho-aminobenzoic acid; EDDnp=ethylenediaminedinitrophenyl). Only neutral polysaccharides exhibited patterns of interaction with the proteinase, while sulfated GAGs had no effect. Incubation with neutral polysaccharides resulted in a powerful modulation of the enzyme activity, intensely changing the enzyme kinetic parameters of catalysis and affinity for the substrate. Commercial dextran at the highest concentration of 20 microM increased 6.8-fold the enzyme affinity for the substrate. In the presence of 8 microM of purified baker's yeast mannan, the apparent KM of the enzyme increased about 5.5-fold, reflecting a significant inhibition in binding to the peptide substrate. When an exocellular galactomannan (GalMan) complex isolated from P. brasiliensis was added to the reaction mixture at 400 nM, the apparent KM and VMAX decreased about threefold. Moreover, GalMan was able to protect the enzymatic activity at high temperatures, but it caused no effect on the optimum cleavage pH. Our results show a novel modulation mechanism in P. brasiliensis, where a fungal polysaccharide-rich component can stabilize a serine-thiol proteolytic activity, which is possibly involved in fungal dissemination.

Reproducibility of the Lauge-Hansen, Danis-Weber, and AO classifications for ankle fractures / Análise da reprodutibilidade das classificações de Lauge-Hansen, Danis-Weber e AO para as fraturas de tornozelo

ABSTRACT Objective: This study evaluated the reproducibility of the three main classifications of ankle fractures most commonly used in emergency clinical practice: Lauge-Hansen, Danis-Weber, and AO-OTA. The secondary objective was to assess whether the level of professional experience influenced the interobserver agreement for the classification of this pathology. Methods: The study included 83 digitized preoperative radiographic images of ankle fractures, in anteroposterior and lateral views, of different adults that had occurred between January and December 2013. For sample calculation, the estimated accuracy was approximately 15%, with a sampling error of 5% and a sampling power of 80%. The images were analyzed and classified by six different observers: two foot and ankle surgeons, two general orthopedic surgeons, and two-second-year residents in orthopedics and traumatology. The Kappa statistical method of multiple variances was used to assess the variations. Results: The Danis-Weber classification indicated that 40% of the agreements among all observers were good or excellent, whereas only 20% of good and excellent agreements were obtained using the AO and Lauge Hansen classifications. The Kappa index was 0.49 for the Danis-Weber classification, 0.32 for Lauge Hansen, and 0.38 for AO. Conclusion: The Hansen-Lauge classification presented the poorest interobserver agreement among the three systems. The AO classification demonstrated a moderate agreement and the Danis-Weber classification presented an excellent interobserver agreement index, regardless of professional experience.

RESUMO Objetivo: Avaliar a reprodutibilidade e comparatividade das três principais classificações usadas para fraturas do tornozelo mais comumente empregadas nos servicos de emergência: Lauge-Hansen, Danis-Weber e AO-OTA. Observar secundariamente se existe influência da experiência profissional sobre a concordância entre observadores para a classificação dessa patologia. Métodos: Foram usadas 83 imagens digitalizadas de radiografias pré-operatórias, em incidências anteroposterior e perfil, de fraturas do tornozelo de adultos diferentes, ocorridas entre janeiro e dezembro de 2013. No cálculo amostral assumiu-se precisão da estimativa de 15%, com erro amostral de 5% e com poder de amostragem de 80%. A leitura e a classificação das fraturas foram feitas por seis observadores, dois cirurgiões de pé e tornozelo, dois ortopedistas generalistas e dois residentes do segundo ano de ortopedia e traumatologia. A análise das variações foi feita pelo método estatístico de Kappa de múltiplas variâncias. Resultados: Com o uso da classificação de Dannis-Weber, 40% das concordâncias foram consideradas boas ou excelentes entre todos os observadores, enquanto nas classificações de Lauge Hansen e AO apenas 20% se apresentaram boas ou excelentes. O índice Kappa acumulado para cada classificação foi de 0,49 para a classificação de Dannis-Weber, 0,32 para Lauge Hansen e 0,38 para a classificação AO. Conclusão: A classificação de Lauge Hansen apresenta a pior concordância interobservador dentre as três classificações. A classificação da AO demonstrou concordância intermediária e a de Dannis-Weber apresentou o maior índice de concordância interobservador, independentemente da experiência do profissional.

Endometriose de parede abdominal: relato de oito casos / Scar endometriosis: eight cases report

Constitui a endometriose de parede abdominal entidade rara que ocorre, em geral, após cirurgias ginecológicas ou obstétricas. Relatam-se, neste trabalho, oito casos, estudados em um período de cinco anos, na Disciplina de Ginecologia da Escola Paulista de Medicina. Em seis casos, os sintomas apareceram entre dois e 56 meses após a realizaçåo de cesárea; em um cerca de um mês após histerectomia abdominal e, finalmente, no caso restante, nåo havia antecedente cirúrgico que justificasse o achado, sendo a paciente, no entanto, grande multípara

Distúrbios urinários em mulheres segundo o grau de cistocele e a paridade / Urinary disorders in women according to the grade of cystocele and parity

Os autores avaliam a influência do grau de cistocele e da paridade nas diversas afecçoes uroginecológicas, em mulheres na menacme e na pós-menopausa. Sao analisadas 101 mulheres, sendo 29 na menacme e 72 na pós-menopausa. Concluem que o número de partos vaginais tem associaçao positiva com o diagnóstico de incontinência urinária verdadeira, mas nao com a incontinência urinária nao verdadeira. Quanto à cistocele, observou-se que a distopia nao auxilia no diagnóstico diferencial.

Dopplervelocimetria dos vasos peri-uretrais de mulheres na pós-menopausa com incontinência urinária de esforço, antes e durante o uso de estrogenioterapia intravaginal / Doppler velocimetry of periuethral vassels of postmenopausal women with stress urinary incontinence, before and during intravaginal estrogen therapy

A incontinência urinária de esforço, embora seja uma afecçao bastante freqüente, apresenta etiologia multifatorial e ainda nao totalmente esclarecida. Sua fisiopatologia envolve alteraçoes nos tecidos de suporte que estabilizam a uretra na posiçao anatômica correta e/ou disfunçoes que resultam em deficiência uretral intrínseca. Na pós-menopausa, os distúrbios urogenitais decorrem, provavelmente, da combinaçao do envelhecimento fisiológico dos tecidos com o hipoestrogenismo crônico. 0 hipoestrogenismo que ocorre após a menopausa tem sido sugerido como um dos fatores responsáveis pelo desenvolvimento da incontinência urinária de esforço, ao reduzirem o número de vasos peri-uretrais localizados na camada submucosa e os receptores alfa-adrenérgicos da musculatura lisa uretral, e em decorrência da atrofia da mucosa uretral e dos músculos do assoalho pélvico, além das alteraçoes no colágeno da regiao peri-uretral. Os estrogênios podem beneficiar todas essas estruturas, levando à melhora expressiva dos sintomas. Interessou-nos, neste trabalho, estudar pela dopplervelocimetria dos vasos peri-uretrais, os efeitos de três tipos de estrogênio por via intravaginal habitualmente prescritos para o tratamento dos sintomas urogenitais. Selecionamos, para o estudo, 51 mulheres na pós-menopausa com incontinência urinária de esforço. Essas pacientes foram divididas em três grupos, conforme o tipo de estrogênio recebido: grupo I, composto por 17 pacientes que usaram estrogênios conjugados eqüinos; grupo li, constituído por 16 pacientes que usaram estriol e grupo III, formado por 18 pacientes que usaram promestrieno...(au)