Anterior cruciate ligament ganglion: case report.

CONTEXT: A ganglion is a cystic formation close to joints or tendinous sheaths, frequently found in the wrist, foot or knee. Intra-articular ganglia of the knee are rare, and most of them are located in the anterior cruciate ligament. The clinical picture for these ganglia comprises pain and movement restrictions in the knee, causing significant impairment to the patient. Symptoms are non-specific, and anterior cruciate ligament ganglia are usually diagnosed through magnetic resonance imaging or arthroscopy. Not all ganglia diagnosed through magnetic resonance imaging need to undergo surgical treatment: only those that cause clinical signs and symptoms do. Surgical results are considered good or excellent in the vast majority of cases. CASE REPORT: A 29-year-old male presented with pain in the left knee during a marathon race. Physical examination revealed limitation in the maximum range of knee extension and pain in the posterior aspect of the left knee. Radiographs of the left knee were normal, but magnetic resonance imaging revealed a multi-lobed cystic structure adjacent to the anterior cruciate ligament, which resembled a ganglion cyst. The mass was removed through arthroscopy, and pathological examination revealed a synovial cyst. Patient recovery was excellent, and he resumed his usual training routine five months later.

Atividade preemptiva da infiltração da incisão com ropivacaína a 0,75%, em pacientes submetidos à herniorrafia inguinal / Preemptive activity of incision infiltration with 0.75% ropivacaine in patients submitted to inguinal hernia repair

JUSTIFICATIVA E OBJETIVOS: A eficiência da analgesia preemptiva em relação ao regime convencional no controle da dor pós-operatória continua a ser controversa. O objetivo deste estudo foi avaliar a eficácia da infiltração local com ropivacaína a 0,75% antes e depois da incisão em operações de herniorrafia inguinal na intensidade da dor pós-operatória, no consumo de analgésicos e no tempo para solicitação da primeira dose de analgésico.MÉTODO: Após a aprovação pelo Comitê de Ética em Pesquisa Institucional, 60 pacientes, estado físico P1 ou P2, com idade entre 15 e 65 anos, submetidos à herniorrafia inguinal sob anestesia geral com isoflurano e fentanil foram distribuídos aleatoriamente em três grupos: A - infiltração da pele, subcutâneo e tecido muscular antes da incisão com 2 mg/kg de ropivacaína a 0,75%; D - infiltração da pele, subcutâneo e tecido muscular após incisão com 2 mg/kg de ropivacaína a 0,75%; e o C - grupo controle - sem infiltração. Todos os pacientes receberam dipirona (2 g), 30 minutos antes do final da anestesia. Uma bomba de analgesia controlada pelo paciente com morfina foi usada depois da recuperação da anestesia. Foram avaliados durante 24 horas a intensidade da dor com a escala analógica visual, o consumo total de morfina e o tempo para a solicitação da primeira dose de morfina. RESULTADOS: O consumo de morfina foi significativamente menor no grupo A (1,5 mg) quando comparado ao grupo D de (5,5 mg) ou controle (17 mg). O tempo para a solicitação da primeira dose de morfina foi significativamente maior para o grupo A assim como a intensidade da dor em todos os momentos quando comparado ao grupo C e nas últimas 18 h comparado ao grupo.CONCLUSÃO: A infiltração pré-operatória da incisão com ropivacaína reduz significativamente a intensidade da dor e o consumo de morfina pós-operatória e retarda o tempo para a solicitação da primeira dose de morfina.

BACKGROUND AND OBJECTIVES: The effectiveness of preemptive analgesia as compared to the conventional regimen for postoperative pain control is still controversial. This study aimed at evaluating the effectiveness of local infiltration with 0.75% ropivacaine before and after the incision of inguinal hernia repair surgeries in postoperative pain intensity, analgesics consumption and time elapsed for first analgesic dose request. METHOD: After the Institutional Research Ethics Committee approval, 60 patients, physical status P1 or P2, aged between 15 and 65 years, submitted to inguinal hernia repair under general anesthesia with isoflurane and fentanyl were randomly distributed in three groups: A - skin, subcutaneous and muscle infiltration before incision with 2 mg/kg of 0.75% ropivacaine; D - skin, subcutaneous and muscle infiltration after incision with 2 mg/kg of 0.75% ropivacaine; and C - control group, without infiltration. All patients received dipirone (2 g), 30 minutes before the end of anesthesia.A patient-controlled analgesia pump with morphine was used after anesthetic recovery. Pain intensity with visual analog scale, total morphine consumption and time for the first morphine dose request were evaluated during 24 hours.RESULTS: Morphine consumption was significantly lower in the A group (1.5 mg) as compared to the D group (5.5 mg) or to the control group (17 mg). Time for first morphine dose request was significantly longer for the A group and pain intensity was lower in all moments as compared to C group and in the last 18 h as compared to the group.CONCLUSION: Preoperative incision infiltration with ropivacaine significantly decreases postoperative pain intensity and morphine consumption and delays the time for first morphine dose request.

[Comparison between pressure controlled and controlled mandatory ventilation in the treatment of postoperative hypoxemia after myocardial revascularization]. / Comparação entre ventilação controlada a volume e a pressão no tratamento da hipoxemia no período pós-operatório de cirurgia de revascularização do miocárdio.

BACKGROUND AND OBJECTIVES: Pressure controlled ventilation (PCV) has been used as the ventilation mode of choice in coronary artery bypass graft surgery patients who develop severe hypoxemia in the immediate postoperative period. However, there are no evidences showing that pressure controlled ventilation is more effective in reversing postoperative hypoxemia than controlled mandatory ventilation (CMV). This study aimed at comparing the effects of both ventilation modes on systemic oxygenation in cardiac surgery patients who develop hypoxemia characterized by PaO2/FiO2 ratio lower than 200 in the immediate postoperative period. METHODS: Participated in this study 61 consecutive patients with PaO2/FiO2 ratio lower than 200 who were randomly allocated in two groups according to the ventilatory mode (CMV and PCV). Tidal volume, respiratory rate, inspiration/expiration ratio and positive end-expiratory pressure were kept constant throughout the study in both groups. PaO2/FiO2 ratio and pulmonary shunt were obtained 1 or 2 hours after ICU admission. RESULTS: A significant increase in PaO2/FiO2 ratio and a decrease in pulmonary shunt were observed in both groups one or two hours after mechanical ventilation. However, no differences were observed between both ventilatory modes. CONCLUSIONS: Both ventilatory modes were equally effective in reversing hypoxemia observed in the immediate cardiac surgery postoperative period. Results show that inspiratory flow patterns are not relevant in the treatment of post cardiac surgery hypoxemia.

Anterior cruciate ligament ganglion: case report

CONTEXT: A ganglion is a cystic formation close to joints or tendinous sheaths, frequently found in the wrist, foot or knee. Intra-articular ganglia of the knee are rare, and most of them are located in the anterior cruciate ligament. The clinical picture for these ganglia comprises pain and movement restrictions in the knee, causing significant impairment to the patient. Symptoms are non-specific, and anterior cruciate ligament ganglia are usually diagnosed through magnetic resonance imaging or arthroscopy. Not all ganglia diagnosed through magnetic resonance imaging need to undergo surgical treatment: only those that cause clinical signs and symptoms do. Surgical results are considered good or excellent in the vast majority of cases. CASE REPORT: A 29-year-old male presented with pain in the left knee during a marathon race. Physical examination revealed limitation in the maximum range of knee extension and pain in the posterior aspect of the left knee. Radiographs of the left knee were normal, but magnetic resonance imaging revealed a multi-lobed cystic structure adjacent to the anterior cruciate ligament, which resembled a ganglion cyst. The mass was removed through arthroscopy, and pathological examination revealed a synovial cyst. Patient recovery was excellent, and he resumed his usual training routine five months later

Comparação entre ventilação controlada a volume e a pressão no tratamento da hipoxemia no período pós-operatório de cirurgia de revascularização do miocárdio / Comparison between pressure controlled and controlled mandatory ventilation in the treatment of postoperative hypoxemia after myocardial revascularization

JUSTIFICATIVA E OBJETIVOS: Ventilaçäo controlada à pressäo tem sido utilizada como modalidade ventilatória de eleiçäo em pacientes que desenvolvem hipoxemia importante no período pós-operatório de cirurgia de revascularizaçäo do miocárdio. Contudo näo existem estudos mostrando que a ventilaçäo controlada à pressäo é mais efetiva na reversäo da hipoxemia pós-operatória que ventilaçäo controlada a volume. O objetivo deste estudo foi comparar os efeitos de ventilaçäo controlada à pressäo e ventilaçäo controlada a volume sobre a oxigenaçäo sistêmica em pacientes que desenvolvem hipoxemia caracterizada por uma relaçäo PaO2/FiO2 menor que 200 no período pós-operatório imediato de cirurgia cardíaca. MÉTODO: Sessenta e um pacientes com relaçäo PaO2/FiO2 menor que 200 foram alocados em um grupo submetido à ventilaçäo controlada a pressäo e outro a volume. O volume corrente, a freqüência respiratória, a relaçäo inspiraçäo/ expiraçäo e a pressäo positiva ao final da expiraçäo foram as mesmas no dois grupos. Após a admissäo na UTI e após períodos de 1 ou 2 horas de ventilaçäo mecânica, a relaçäo PaO2/FiO2 e o shunt pulmonar foram quantificados. RESULTADOS: Houve um aumento significativo na relaçäo PaO2/FiO2 e uma diminuiçäo significativa no shunt pulmonar após 1 ou 2 horas de ventilaçäo mecânica; contudo näo foram observadas diferenças entre as modalidades ventilatórias. CONCLUSÕES: As modalidades ventilatórias controladas a volume e pressäo foram igualmente eficientes no tratamento da hipoxemia observada em pacientes no pós-operatório imediato de cirurgia de revascularizaçäo do miocárdio, mostrando que o padräo de administraçäo do fluxo inspiratório é pouco relevante para o tratamento da hipoxemia pós-operatória