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1.
Clin Exp Rheumatol ; 31(2): 195-200, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23190565

RESUMO

OBJECTIVES: This paper aims to study the prevalence of total knee and hip replacements in Greek patients with rheumatoid arthritis (RA) and to identify possible predictive factors for future total hip or knee replacement. METHODS: A retrospective medical record review was performed in 750 RA patients who were recruited during 1994 to 2008 in a single Greek medical centre. Of the reviewed patients, 489 with a minimum follow-up duration of 1 year were enrolled in the study. The occurrence of total hip or knee replacement was used as the primary outcome variable in the predictive analysis. RESULTS: Total hip or knee replacement associated with RA was performed in 21 patients (4.3%). Total disease duration was the most significant factor associated with increased likelihood of total joint replacement. Erythrocyte sedimentation rate (ESR) at baseline examination was positively associated with subsequent knee or hip joint replacement (OR=1.023, 95%CI 1.005-1.04). Inadequate response to treatment was associated with a 3.12-times higher likelihood of joint replacement (95%CI, 1.28-7.58). The patients who underwent total hip or knee replacement had significantly higher ESRs and DAS 28 levels (p<0.046 and p<0.002, respectively) after the first year of follow-up. CONCLUSIONS: The identification of factors associated with total joint hip or knee replacement can improve pharmacological treatment to maintain function and prevent destruction of the affected joints. Longer disease duration and inadequate response to treatment after the first year of follow-up increases the likelihood ratio for total joint replacement during the course of disease in Greek RA patients.


Assuntos
Artrite Reumatoide/cirurgia , Artroplastia de Quadril , Artroplastia do Joelho , Articulação do Quadril/cirurgia , Articulação do Joelho/cirurgia , Adulto , Antirreumáticos/uso terapêutico , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/fisiopatologia , Sedimentação Sanguínea , Distribuição de Qui-Quadrado , Avaliação da Deficiência , Progressão da Doença , Feminino , Grécia , Articulação do Quadril/patologia , Articulação do Quadril/fisiopatologia , Humanos , Articulação do Joelho/patologia , Articulação do Joelho/fisiopatologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Seleção de Pacientes , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Falha de Tratamento
2.
J Appl Biomech ; 28(5): 568-78, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22661047

RESUMO

The objective of the current study was to compare quantitative data on the biomechanical analysis of different techniques for fixation of intercalary bone defects of the humerus, by means of consistently applied methodology on composite models. A total of 25 humeral specimens of composite models were used. An intercalary defect was created and reconstructed using plates, intramedullary nails, external fixators and segmental prosthetic implants. The specimens were loaded under axial compression, four-point bending and torsion within the linear elastic region. Modular segmental implants and intramedullary nails were able to compensate significantly greater amounts of compressive loads compared to locking plates and external fixators. However, in flexion and torsion, the modular segmental implants and the external fixators were significantly better load-bearing devices compared to the intramedullary nails and plates. Early mobilization of the upper limb in patients with diaphyseal bone defects of the humerus could probably be more safe and tolerable when reconstructed with modular segmental implants.


Assuntos
Neoplasias Ósseas/cirurgia , Úmero/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Fenômenos Biomecânicos , Pinos Ortopédicos , Placas Ósseas , Diáfises , Fixadores Externos , Humanos , Próteses e Implantes
3.
Med Sci Monit ; 17(2): MT7-12, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21278699

RESUMO

BACKGROUND: The aim of this study was to analyze the long-term results of a modified Matti-Russe technique for the treatment of scaphoid non-union and pseudarthrosis. The modification was based on the use of bone graft taken from the ipsilateral distal radius, rather than from the iliac crest, as originally described. MATERIAL/METHODS: Between 1987 and 2000, 23 consequent male patients with scaphoid waist non-union or pseudarthrosis underwent surgery by a modified Matti-Russe technique. During the 5-year follow-up, patient evaluation was based on radiological findings and the Green and O'Brien scoring system. RESULTS: Anatomy was restored and healing of the non-union was achieved in 21 (91.3%) patients. The other 2 patients failed to achieve union and underwent the same operation a second time, which was successful. According to the Green and O'Brien scoring system, 82.6% (19/23) of patients showed excellent results and 17.4% (4/23) showed good results at 2-year follow-up. At 5-year follow-up, 73.9% of patients (19/23) had excellent results and 26.0% (4/23) had good results. No early post-operative complications developed. Two patients demonstrated mild radiological radio-scaphoid arthritis at 2.5 years postoperatively. All patients returned to previous levels of activity. CONCLUSIONS: The standard Matti-Russe technique is an old but reliable and inexpensive method for the treatment of long-standing or neglected scaphoid non-unions or pseudarthroses. The modification of this established method, based on use of the distal radius as a donor site, reduces operative time, can be performed through a single approach, does not show donor site morbidity, and allows the use of regional anaesthesia.


Assuntos
Transplante Ósseo/métodos , Pseudoartrose/cirurgia , Osso Escafoide/patologia , Osso Escafoide/cirurgia , Articulação do Punho/patologia , Articulação do Punho/cirurgia , Adolescente , Adulto , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pseudoartrose/diagnóstico por imagem , Pseudoartrose/fisiopatologia , Pseudoartrose/reabilitação , Radiografia , Osso Escafoide/diagnóstico por imagem , Resultado do Tratamento , Adulto Jovem
4.
Ann Plast Surg ; 66(2): 137-42, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21178757

RESUMO

Congenital deficiency of the thumb greatly compromises hand function, because the normal thumb contributes at least 40% of its usefulness. The method of choice in the treatment of this functional liability is the pollicization of the index finger. This study presents the long term outcome of 21 index finger pollicizations in 18 patients, with a mean follow-up time of 9 years. The thumb deficiency was bilateral in 3 patients, whereas in 7 it was associated with radial club hand. The result was considered excellent in 75%, good in 19%, and poor in 6% of the 21 pollicizations, according to Percival's scoring system. The less rewarding function was obtained in the presence of associated radial club hand in combination with late reconstruction. Index finger pollicization is the method of choice in the treatment of thumb aplasia or severe hypoplasia. The younger patients adapt easier and use the new thumb in a more natural way.


Assuntos
Procedimentos de Cirurgia Plástica/métodos , Polegar/anormalidades , Polegar/cirurgia , Adolescente , Criança , Pré-Escolar , Dedos/transplante , Humanos , Lactente , Masculino
5.
J Hand Surg Am ; 36(5): 847-52, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21435802

RESUMO

PURPOSE: The purpose of this study was to classify Galeazzi type injuries and determine the association of residual instability after rigid fixation with the fracture pattern of the shaft of the radius, using a system that is based on anatomic landmarks of the radial shaft. METHODS: The clinical records of 95 patients (72 men and 23 women) with Galeazzi type injuries requiring open reduction and internal fixation of the fractures were retrospectively reviewed. The mean follow-up was 6.8 years (range, 18 mo to 11 y) after injury. Sixty-nine fractures occurred in the distal third of the radial shaft (type I), 17 fractures were in the middle third (type II), and 9 fractures were in the proximal third of the shaft of the radius (type III). Gross instability of the distal radioulnar joint (DRUJ) was determined intraoperatively by manipulation after radial fixation as compared to the uninjured side. RESULTS: Forty patients had DRUJ instability after internal fixation and were treated with temporary pinning with a K-wire placed transversely proximal to the sigmoid notch. Distal radioulnar joint instability after internal fixation was recorded in 37 type I fractures, 2 type II fractures, and 1 type III fracture. CONCLUSIONS: Distal radioulnar joint instability following radial shaft fracture fixation is significantly higher in patients with type I fractures than in patients with type II or type III fractures. The location of the radius fracture can be sufficiently used for preoperative estimation of percentage chance of potential DRUJ instability after fracture fixation.


Assuntos
Fixação Interna de Fraturas/efeitos adversos , Instabilidade Articular/diagnóstico por imagem , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/fisiopatologia , Adulto , Fios Ortopédicos , Estudos de Coortes , Feminino , Seguimentos , Fixação Interna de Fraturas/métodos , Humanos , Incidência , Escala de Gravidade do Ferimento , Instabilidade Articular/epidemiologia , Instabilidade Articular/etiologia , Masculino , Pessoa de Meia-Idade , Radiografia , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo , Adulto Jovem
6.
Microsurgery ; 31(3): 223-8, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21400578

RESUMO

Osteonecrosis of the femoral head is a disease in which bone death occurs and usually progresses to articular incongruity and subsequent osteoarthritis. To delay the process of the disease and the conversion to total hip arthroplasty, many surgical techniques have been described. Core decompression, nonvascularized autologous bone grafts, porous tantalum implant procedure, and various osteotomies have been used for the management of early precollapse stage osteonecrosis of the femoral head. However, none of these procedures is neither entirely effective nor can obtain predictable results. With the progress of microsurgery, the implantation of a free vascularized fibula graft to the necrotic femoral head has provided the most consistently successful results. Although the procedure is technically demanding, there is growing recognition that the use of free vascularized fibula graft may improve patient quality of life by functional improvement and pain alleviation. The success of the procedure is related to decompression of the femoral head, excision of the necrotic bone, and addition of cancellous bone graft with osteoinductive and osteoconductive properties, which augments revascularization and neoosteogenesis of the femoral head. Free vascularized fibula graft, especially in younger patients, is a salvaging procedure of the necrotic femoral head in early precollapse stages. In postcollapse osteonecrosis, the procedure appears to delay the need for total hip arthroplasty in the majority of patients. The purpose of this review article is to update knowledge about treatment strategies in femoral head osteonecrosis and to compare free vascularized fibula grafting to traditional and new treatment modalities.


Assuntos
Transplante Ósseo/métodos , Necrose da Cabeça do Fêmur/cirurgia , Fíbula/transplante , Retalhos de Tecido Biológico , Microcirurgia , Artroplastia de Quadril , Descompressão Cirúrgica , Prótese de Quadril , Humanos , Osteotomia , Tantálio
7.
Microsurgery ; 31(3): 205-11, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21360586

RESUMO

Massive bony defects of the lower extremity are usually the result of high-energy trauma, tumor resection, or severe sepsis. Vascularized fibular grafts are useful in the reconstruction of large skeletal defects, especially in cases of scarred and avascular recipient sites, or in patients with combined bone and soft-tissue defects. Microvascular free fibula transfer is considered the most suitable autograft for reconstruction of the middle tibia because of its long cylindrical straight shape, mechanical strength, predictable vascular pedicle, and hypertrophy potential. The ability to fold the free fibula into two segments or to combine it with massive allografts is a useful technique for reconstruction of massive bone defects of the femur or proximal tibia. It can also be transferred with skin, fascia, or muscle as a composite flap. Proximal epiphyseal fibula transfer has the potential for longitudinal growth and can be used in the hip joint remodeling procedures. Complications can be minimized by careful preoperative planning of the procedure, meticulous intraoperative microsurgical techniques, and strict postoperative rehabilitation protocols. This literature review highlights the different surgical techniques, indications, results, factors influencing the outcome, and major complications of free vascularized fibular graft for management of skeletal or composite defects of the lower limb.


Assuntos
Transplante Ósseo/métodos , Fíbula/transplante , Retalhos de Tecido Biológico , Extremidade Inferior/lesões , Extremidade Inferior/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Neoplasias Ósseas/cirurgia , Transplante Ósseo/efeitos adversos , Fêmur/lesões , Fêmur/patologia , Fêmur/cirurgia , Humanos , Extremidade Inferior/patologia , Microcirurgia/efeitos adversos , Microcirurgia/métodos , Osteomielite/cirurgia , Pseudoartrose/congênito , Pseudoartrose/cirurgia , Procedimentos de Cirurgia Plástica/efeitos adversos , Sarcoma/cirurgia , Tíbia/lesões , Tíbia/patologia , Tíbia/cirurgia , Ferimentos e Lesões/cirurgia
8.
Circulation ; 117(20): 2662-9, 2008 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-18474811

RESUMO

BACKGROUND: Interleukin-1 increases nitrooxidative stress. We investigated the effects of a human recombinant interleukin-1a receptor antagonist (anakinra) on nitrooxidative stress and vascular and left ventricular function. METHODS AND RESULTS: In an acute, double-blind trial, 23 patients with rheumatoid arthritis were randomized to receive a single injection of anakinra (150 mg s.c.) or placebo and, after 48 hours, the alternative treatment. At baseline and 3 hours after the injection, we assessed (1) coronary flow reserve, aortic distensibility, systolic and diastolic (Em) velocity of the mitral annulus, and E to Em ratio (E/Em) using echocardiography; (2) flow-mediated, endothelium-dependent dilation of the brachial artery; and (3) malondialdehyde, nitrotyrosine, interleukin-6, endothelin-1, and C-reactive protein. In a chronic, nonrandomized trial, 23 patients received anakinra and 19 received prednisolone for 30 days, after which all indices were reassessed. Compared with baseline, there was a greater reduction in malondialdehyde, nitrotyrosine, interleukin-6, and endothelin-1 and a greater increase in flow-mediated dilation, coronary flow reserve, aortic distensibility, systolic velocity of mitral annulus, and E/Em after anakinra than after placebo (malondialdehyde -25% versus 9%; nitrotyrosine -38% versus -11%; interleukin-6 -29% versus 0.9%; endothelin-1 -36% versus -11%; flow-mediated dilation 45% versus -9%; coronary flow reserve 29% versus 4%; and aortic distensibility 45% versus 2%; P<0.05 for all comparisons). After 30 days of treatment, the improvement in biomarkers and in vascular and left ventricular function was greater in the anakinra group than in the prednisolone group (P<0.05). CONCLUSIONS: Interleukin-1 inhibition improves vascular and left ventricular function and is associated with reduction of nitrooxidative stress and endothelin.


Assuntos
Artrite Reumatoide/tratamento farmacológico , Vasos Sanguíneos/efeitos dos fármacos , Proteína Antagonista do Receptor de Interleucina 1/administração & dosagem , Função Ventricular Esquerda/efeitos dos fármacos , Adulto , Idoso , Estudos Cross-Over , Método Duplo-Cego , Endotelinas , Feminino , Humanos , Proteína Antagonista do Receptor de Interleucina 1/farmacologia , Interleucina-1/antagonistas & inibidores , Masculino , Pessoa de Meia-Idade , Óxido Nítrico , Estresse Oxidativo/efeitos dos fármacos , Proteínas Recombinantes
9.
Microsurgery ; 29(5): 346-52, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19378329

RESUMO

Congenital pseudarthrosis of the tibia (CPT) remains one of the most challenging problems confronting the orthopaedic surgeon. The operative results are frequently less than successful; many cases require several surgical procedures, and a significant number of them ending in amputation. The purpose of this study was to access the surgical results, complications, secondary procedures, and long-term results of free vascularized fibular graft (FVFG) in the treatment of congenital pseudarthrosis of the tibia. Between 1992 and 2007, nine patients with CPT were treated consecutively at our clinic with free fibula transfer. There were six females and three males. The mean age at the time of operation was 6.5 years (range, 1-12 years). Stability, after reconstruction with FVFG, was maintained with internal fixation in five patients, unilateral frame external fixation in three patients, and intramedullary pin in one patient. Average postoperative follow-up time was 9 years (range, 2-15 years). In seven patients, both ends of the graft healed primarily within 3.7 months (range, 1.5-6 months). In one patient, the distal end of the graft did not unit. This patient required three subsequent operations to achieve union. Stress fracture occurred in the middle of the grafted fibula in one patient, who underwent four additional operations before union, was achieved. Despite the relatively high-complication rate, FVFG remains a valid method for the treatment of CPT. However, even achieving union of pseudarthrosis is not enough for the resolution of the disease. This is only half of the problem; the other half is to maintain union. Long-term follow-up beyond skeletal maturity, if possible, is necessary to evaluate surgical results.


Assuntos
Transplante Ósseo , Fíbula/transplante , Pseudoartrose/congênito , Pseudoartrose/cirurgia , Tíbia/cirurgia , Criança , Pré-Escolar , Feminino , Fíbula/irrigação sanguínea , Humanos , Lactente , Masculino
10.
J Reconstr Microsurg ; 25(8): 483-95, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19697286

RESUMO

This study investigated the hypothesis that acetyl-L-carnitine (ALCAR) could have a significant effect on nerve regeneration after end-to-side neurorrhaphy. The ability of the ALCAR to enhance nerve regeneration in combination with various types of donor nerve injury distal to the coaptation site was also determined. Twenty-five Sprague-Dawley rats were randomized to five groups of five animals each, in which three different types of donor injury (crush, ligation, and transection injury) distal to the coaptation site were executed (groups C, D, and E, respectively). Animals in group A (placebo) and group B underwent a standard end-to-side neurorrhaphy. Animals from groups B to E received a daily intraperitoneal injection of 50 mg/kg/d of ALCAR, and a placebo was injected in place of ALCAR in animals in group A. Administration of acetyl-L-carnitine alone did not prove to be a significant stimulus for regeneration, as concluded after comparison among the two noninjury models of the donor nerve (groups A and B). Indeed, the combination of an injury model of the donor nerve (crush injury) with administration of acetyl-L-carnitine proved to be a significantly more potent stimulus for regeneration than the control (placebo) group, as measured by behavioral, muscle morphometric, electrophysiological, and histomorphometric studies.


Assuntos
Acetilcarnitina/farmacologia , Axônios/fisiologia , Regeneração Nervosa/efeitos dos fármacos , Traumatismos dos Nervos Periféricos , Complexo Vitamínico B/farmacologia , Animais , Axônios/efeitos dos fármacos , Modelos Animais de Doenças , Eletromiografia , Masculino , Placa Motora/fisiologia , Ratos , Ratos Sprague-Dawley
11.
Microsurgery ; 28(4): 252-61, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18381657

RESUMO

Birth brachial plexus injury usually affects the upper roots. In most cases, spontaneous reinnervation occurs in a variable degree. This aberrant reinnervation leaves characteristic deformities of the shoulder, elbow, forearm, wrist, and hand. Common sequelae are the internal rotation and adduction deformity of the shoulder, elbow flexion contractures, forearm supination deformity, and lack of wrist extension and finger flexion. Nowadays, the strategy in the management of obstetrical brachial plexus palsy focuses in close follow-up of the baby up to 3-6 months and if there are no signs of recovery, microsurgical repair is indicated. Nonetheless, palliative surgery consisting of an ensemble of secondary procedures is used to further improve the overall function of the upper extremity in patients who present late or fail to improve after primary management. These secondary procedures include transfers of free vascularized and neurotized muscles. We present and discuss our experience in treating early and/or late obstetrical palsies utilizing the above-mentioned microsurgical strategy and review the literature on the management of brachial plexus birth palsy.


Assuntos
Neuropatias do Plexo Braquial/cirurgia , Microcirurgia/métodos , Músculo Esquelético/transplante , Cuidados Paliativos/métodos , Paralisia Obstétrica/cirurgia , Adolescente , Adulto , Neuropatias do Plexo Braquial/classificação , Neuropatias do Plexo Braquial/fisiopatologia , Criança , Pré-Escolar , Articulação do Cotovelo/fisiopatologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Músculo Esquelético/fisiopatologia , Amplitude de Movimento Articular , Articulação do Ombro/fisiopatologia , Supinação , Resultado do Tratamento , Articulação do Punho/fisiopatologia
12.
Am J Orthop (Belle Mead NJ) ; 34(9): 420-4, 2005 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-16250482

RESUMO

In the pediatric population, the majority of displaced 2-bone forearm fractures can be reduced and stabilized by conservative means. In this article, we report on a retrospective study of 23 patients with unstable or open forearm fractures treated with closed reduction and percutaneous stabilization with flexible titanium nails. All fractures healed without complication, and final functional results were excellent.


Assuntos
Pinos Ortopédicos , Fixação Interna de Fraturas/instrumentação , Fraturas não Consolidadas/cirurgia , Fraturas do Rádio/cirurgia , Fraturas da Ulna/cirurgia , Adolescente , Criança , Feminino , Seguimentos , Fraturas não Consolidadas/diagnóstico por imagem , Humanos , Masculino , Radiografia , Fraturas do Rádio/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento , Fraturas da Ulna/diagnóstico por imagem
13.
Artigo em Inglês | MEDLINE | ID: mdl-26464895

RESUMO

Purpose. In this study, the early and midterm clinical and radiological results of the anterior cruciate ligament (ACL) reconstruction surgery with or without the use of platelet rich plasma (PRP) focusing on the tunnel-widening phenomenon are evaluated. Methods. This is a double blind, prospective randomized study. 51 patients have completed the assigned protocol. Recruited individuals were divided into two groups: a group with and a group without the use of PRPs. Patients were assessed on the basis of MRI scans, which were performed early postoperatively and repeated at least one-year postoperatively. The diameter was measured at the entrance, at the bottom, and at the mid distance of the femoral tunnel. Results. Our study confirmed the existence of tunnel widening as a phenomenon. The morphology of the dilated tunnels was conical in both groups. There was a statistical significant difference in the mid distance of the tunnels between the two groups. This finding may support the role of a biologic response secondary to mechanical triggers. Conclusions. The use of RPRs in ACL reconstruction surgery remains a safe option that could potentially eliminate the biologic triggers of tunnel enlargement. The role of mechanical factors, however, remains important.

14.
Injury ; 44(3): 323-6, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23352153

RESUMO

INTRODUCTION: While recommendations for early exploration and nerve repair in cases of open fractures of the humeral shaft associated with radial nerve palsy are clear, the therapeutic algorithm for the management of closed humeral shaft fractures complicated by radial nerve palsy is still uncertain. The purpose of this study was to determine whether patients with complete sensory and motor radial nerve palsy following a closed fracture of the humeral shaft should be surgically explored. PATIENTS AND METHODS: Twenty-five patients with closed humeral shaft fractures complicated by complete radial nerve palsy were retrospectively reviewed during a 12-year period. Surgical intervention was indicated if functional recovery of the radial nerve was not present after 16 weeks of expectant management. RESULTS: Surgical exploration was performed in 12 patients (48%) after a mean period of expectant management of 16.8 weeks (range: 16-18 weeks). In 2 of them (10%) total nerve transection was found. In the rest 10 patients underwent surgical exploration the radial nerve was found to be macroscopically intact. All intact nerves were fully recovered after a mean time of 21.6 weeks (range: 20-24 weeks) post-injury. In 13 patients (52%) in whom surgical exploration was not performed the mean time to full nerve recovery was 12 weeks (range: 7-14 weeks) post-injury. CONCLUSIONS: We proposed immediate exploration of the radial nerve in case of open fractures of the humeral shaft, irreducible fractures or unacceptable reduction, associated vascular injuries, radial nerve palsy after manipulation or intractable neurogenic pain. Due to high rate of spontaneous recovery of the radial nerve after closed humeral shaft fractures we recommend 16-18 weeks of expectant management followed by surgical intervention.


Assuntos
Consolidação da Fratura , Fraturas do Úmero/complicações , Microcirurgia , Nervo Radial/lesões , Neuropatia Radial/diagnóstico , Transferência Tendinosa/métodos , Feminino , Humanos , Fraturas do Úmero/fisiopatologia , Fraturas do Úmero/cirurgia , Masculino , Guias de Prática Clínica como Assunto , Prognóstico , Nervo Radial/cirurgia , Neuropatia Radial/etiologia , Neuropatia Radial/cirurgia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Conduta Expectante
15.
Tech Hand Up Extrem Surg ; 14(1): 14-20, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20216047

RESUMO

Inadequate elbow extension is a recognized sequela after obstetric brachial plexus injury because of muscle imbalance and adversely affects the ability to perform sufficiently most daily living activities. The various methods that have been used to correct this deformity do not offer a satisfactory outcome in the long term and show a tendency for gradual recurrence. We present a new technique of a closed gradual arthrodiatasis using a unilateral hinged elbow external fixator. The technique was applied in 10 patients with elbow flexion contracture as a sequela of brachial plexus birth palsy. Loss of elbow extension measured 55 degrees at average. With a mean device application of 8.8 weeks all patients gained full elbow extension. No major complications were noted. All patients were satisfied with the outcome. This novel technique (closed gradual arthrodiatasis of the elbow joint) has a definite role in the treatment of elbow flexion contracture in late cases of obstetric palsy, given the otherwise limited surgical options.


Assuntos
Artroplastia/métodos , Plexo Braquial/lesões , Contratura/cirurgia , Articulação do Cotovelo/cirurgia , Paralisia Obstétrica/complicações , Adolescente , Adulto , Artroplastia/instrumentação , Contratura/etiologia , Feminino , Humanos , Masculino , Cuidados Pós-Operatórios , Resultado do Tratamento
16.
Tech Hand Up Extrem Surg ; 14(1): 2-7, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20216045

RESUMO

Congenital syndactyly is one of the most common congenital hand differences and various methods of surgical treatment have been described since the 19th century. Nevertheless, unsatisfactory results including web creep, flexion contractures, and rotational deformities of the fingers are still reported. This study presents the outcome of syndactyly release in 131 webs in 78 patients. The sex ratio was 40 males/38 females. The age ranged from 4 months to 22 years (average: 4 y). In the majority of the webs the result was good or excellent. The type of flaps used for the reconstruction of the web was important as the combination of a dorsal rectangular and 2 volar triangular flaps gave superior results than the use of 2 triangular flaps. The less rewarding overall outcome was obtained in the presence of associated differences of the involved fingers, that is, complex complicated syndactyly and in the cases of delayed correction. Use of a dorsal rectangular flap in combination with 2 volar triangular flaps and use of full thickness skin grafts, ensure a satisfactory outcome and minimize the number of operations per web.


Assuntos
Sindactilia/cirurgia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Procedimentos Ortopédicos/métodos , Retalhos Cirúrgicos , Resultado do Tratamento , Adulto Jovem
17.
J Reconstr Microsurg ; 25(5): 295-306, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19288407

RESUMO

In end-to-side neurorrhaphy, "noninjury" models of the donor nerve do not seem to offer worthwhile functional outcomes. The role of donor nerve injury distal to the coaptation site remains unclear. End-to-side neurorrhaphy was studied in a rat model in which the proximal stump of the transected musculocutaneous nerve was sutured to the median nerve by end-to-side coaptation. Twenty Sprague-Dawley rats were randomized to four groups of five animals each, in which three different types of donor injury (crush, ligation, or transection injury) distal to the coaptation site were executed; findings were compared with a similar end-to-side model without donor nerve injury (control). Behavioral analysis, electrophysiological studies, muscle morphometric studies, and nerve fibers counts showed no significant differences among groups. However, there was a significant difference regarding mean myelin area (P = 0.0362) and mean fiber diameter (P = 0.0159) for the crush injury group as compared with the control group. No significant differences were found among the other groups. These data suggest that donor crush injury distal to the coaptation site may increase the rate of myelin formation in regenerating axons across an end-to-side model; however, at 4 weeks of follow-up, there was no significant behavioral or functional significance in this treatment group.


Assuntos
Anastomose Cirúrgica/métodos , Regeneração Nervosa/fisiologia , Traumatismos dos Nervos Periféricos , Nervos Periféricos/cirurgia , Animais , Axônios/fisiologia , Eletromiografia , Membro Anterior/inervação , Masculino , Modelos Anatômicos , Fibras Nervosas/patologia , Ratos , Ratos Sprague-Dawley
18.
J Orthop Surg Res ; 4: 4, 2009 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-19216787

RESUMO

BACKGROUND: The decision, whether to amputate or reconstruct a mangled extremity remains the subject of extensive debate since multiple factors influence the decision. METHODS: Sixty three patients with high energy extremity trauma and attempts at limb salvage were retrospectively reviewed. We analyzed 10 cases of massive extremity trauma where there was made an attempt to salvage limbs, although there was a controversy between salvage and amputation. RESULTS: All of the patients except one had major vascular injury and ischemia requiring repair. Three patients died. All of the remaining patients were amputated within 15 days after the salvage procedure, mainly because of extremity sepsis. Seven patients required treatment at the intensive care unit. All patients had at least 2 reconstruction procedures and multiple surgical debridements. CONCLUSION: The functional outcome should be considered realistically before a salvage decision making for extremities with indeterminate prognosis.

19.
J Surg Oncol ; 97(3): 259-66, 2008 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-18161867

RESUMO

BACKGROUND AND OBJECTIVES: To investigate the immunohistochemical expression of three apoptosis-related genes (bax, bcl-2, and p53) and apoptosis (TUNEL) in patients with primary osteosarcoma, and examine potential correlations between gene expression and clinicopathological characteristics in these patients. MATERIALS AND METHODS: Thirty-five primary osteosarcoma specimens and 18 tissue specimens deriving from non-malignant osseous lesions were immunohistochemically stained for bax, bcl-2, and p53 proteins, while apoptosis was investigated by the TUNEL method. The results were statistically analyzed. RESULTS: P53, bax, and bcl-2 protein expression was observed in 22 (62.9%), 29 (82.9%), and 18 (51.4%) osteosarcoma patients, respectively. Non-specific positive TUNEL staining (+/-) was observed in two primary osteosarcoma cases (5.7%). None of the benign controls expressed any of the genes studied. None of the apoptosis-related genes studied was able to predict overall or disease-free survival in our group of patients. Nevertheless, increased bax/bcl-2 protein expression ratio was associated with a decreased 4-year survival and disease free survival (P = 0.0229 and P = 0.0370, respectively). Furthermore, all the patients who were bax(+)/bcl-2(-)/p53(+) relapsed within the 4-year follow-up period (P = 0.0385). CONCLUSIONS: The increased apoptotic rate as determined by an elevated bax/bcl-2 protein expression ratio or by the bax(+)/bcl-2(-)/p53(+) protein expression pattern, appears to identify groups of osteosarcoma patients with unfavorable prognosis.


Assuntos
Neoplasias Ósseas/metabolismo , Osteossarcoma/metabolismo , Proteínas Proto-Oncogênicas c-bcl-2/metabolismo , Proteína Supressora de Tumor p53/metabolismo , Proteína X Associada a bcl-2/metabolismo , Adolescente , Adulto , Idoso , Apoptose/fisiologia , Neoplasias Ósseas/patologia , Neoplasias Ósseas/terapia , Feminino , Seguimentos , Humanos , Marcação In Situ das Extremidades Cortadas , Masculino , Pessoa de Meia-Idade , Osteossarcoma/patologia , Osteossarcoma/terapia , Valor Preditivo dos Testes , Estudos Retrospectivos , Resultado do Tratamento
20.
Microsurgery ; 27(2): 88-90, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17295258

RESUMO

The evolution of microsurgery popularized the free functioning muscle transfers as secondary procedures to reanimate paralyzed extremities after severance of the brachial plexus, especially when the surgeon deals with late cases. Studies considering transplantation, describe thrombophilic factors as a cause of severe complications after transplantation, such as acute or early rejection episodes, delayed graft function, or chronic graft dysfunction. It is the first time that thrombophilia associated with free muscle-graft rejection is reported. A young man who had two free functional muscle transfers for brachial plexus reconstruction in the same forearm within an interval of 6 months. The free functional muscle transfer was failed in both cases because of vein thrombosis and subsequent arterial clot. The possibility of thrombophilia was investigated and during the genetic investigation it was discovered that he was heterozygous for the mutations of factor V, G1691A-Leiden, A4070G and homozygous for the MTHFR C677T mutation.


Assuntos
Plexo Braquial/lesões , Músculo Esquelético/transplante , Mutação/genética , Retalhos Cirúrgicos/irrigação sanguínea , Trombofilia/genética , Adolescente , Fator V/genética , Traumatismos do Antebraço/cirurgia , Marcadores Genéticos/genética , Sobrevivência de Enxerto , Humanos , Masculino , Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , Complicações Pós-Operatórias , Tromboembolia/genética , Trombofilia/complicações
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