RESUMO
INTRODUCTION: Periprosthetic joint infection (PJI) is a devastating complication following total joint replacement (TJR). Cutibacterium acnes (C. acnes) is a low virulent skin commensal, commonly found during TJR revision surgery for "aseptic" causes. The purpose of the present study was to report the treatment outcomes of patients with C. acnes contamination or infection in the presence of a TJR treated with a revision surgery ± implant exchange ± prolonged (≥ 8 weeks) postoperative antibiotics. METHODS: Medical records of patients with at least one positive C. acnes culture in intraoperative tissue samples or sonication fluid from a TJR revision surgery between January 2005 and December 2014 were retrospectively evaluated. The primary endpoint was infection eradication according to Delphi criteria. The diagnostic accuracy of preoperative TJR aspiration regarding the diagnosis of C. acnes PJI was also investigated. RESULTS: A total of 52 TJR (28 shoulders, 17 hips, 7 knees) in 52 patients (35 males, 17 females) with an average age of 63 ± 11 (33-86) years were included. At an average follow-up of 67 ± 33 (24-127) months, the infection eradication of C. acnes PJI was 97% regardless of the surgical treatment or administration of prolonged postoperative antibiotics. The incidence of unsuspected C. acnes PJI was 28.8%. The sensitivity and specificity of preoperative joint aspiration in detecting C. acnes PJI were 59% and 88%, whereas the PPV and NNV were 83% and 67%, respectively. CONCLUSION: Infection eradication of C. acnes PJI was very high at a minimum follow-up of 24 months, suggesting that C. acnes PJI could be adequately treated with a combination of revision surgery and prolonged postoperative antibiotics. The preoperative diagnosis of C. acnes PJI might be challenging with more than one-quarter of patients presenting without suspicion of C. acnes PJI. The appropriate treatment of patients with a single positive culture remains still unclear. A negative TJR aspiration should not rule out a C. acnes PJI, especially in the presence of clinical correlates of infection. LEVEL OF EVIDENCE: Retrospective case-control study, Level III. IRB APPROVAL: Kantonale Ethikkommission Zürich, BASEC Nr.:2017-00567.
Assuntos
Artrite Infecciosa , Artroplastia de Quadril , Infecções Relacionadas à Prótese , Masculino , Feminino , Humanos , Pessoa de Meia-Idade , Idoso , Estudos Retrospectivos , Reoperação/efeitos adversos , Seguimentos , Estudos de Casos e Controles , Artroplastia de Quadril/efeitos adversos , Resultado do Tratamento , Antibacterianos/uso terapêutico , Artrite Infecciosa/cirurgia , Infecções Relacionadas à Prótese/cirurgia , Infecções Relacionadas à Prótese/microbiologiaRESUMO
PURPOSE: The effect of a distal femur varization osteotomy on patellofemoral biomechanics in genu valgum is unknown. The purpose of this study was to quantify the influence of frontal leg axis correction on the Q-angle with a novel three-dimensional (3-D) measurement method. METHODS: 3-D surface models of ten lower extremities were generated using patient computed tomography (CT) data. The preoperative 3-D Q-angle was measured using a novel defined and validated 3-D measurement method. Biplanar supracondylar osteotomies were simulated with different degrees of varus correction (from 1° to 15°) in one-degree steps beginning from the preoperative valgus deformity, resulting in a total of 150 simulations. Additionally, mechanical leg axis and 3-D Q-angle measurements were performed on 3-D surface models of the postoperative CT scans of the same individuals. Further, pre- and postoperative TT-TG distance was measured. RESULTS: Mean preoperative Q-angle was 15.8 ± 3.9° (range 10°-21.4°) with a mean preoperative mechanical leg axis of 6.5° ± 2.4 valgus (range 3.8°-11.6° valgus). The Q-angle changed linearly 0.9 ± 0° per 1° of varization. No difference was detected between simulated 3-D Q-angles and effectively corrected postoperative values (n.s.). TT-TG distance changed irregularly and minimally, and with no correlation to the degree of varization. CONCLUSION: Distal femur varization osteotomy has a linear effect on the Q-angle with a change of 1° per 1° of varization. The difference in TT-TG distance was mainly due to an unintentional rotational component implemented during surgery.
Assuntos
Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Geno Valgo/cirurgia , Osteotomia/métodos , Adulto , Fenômenos Biomecânicos , Simulação por Computador , Fêmur/fisiopatologia , Geno Valgo/diagnóstico por imagem , Geno Valgo/fisiopatologia , História do Século XVI , Humanos , Imageamento Tridimensional , Extremidade Inferior/fisiopatologia , Extremidade Inferior/cirurgia , Pessoa de Meia-Idade , Período Pós-Operatório , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: The role of increased femoral antetorsion (femAT) as a contributor to patellofemoral (PF) osteoarthritis (OA) is unknown. The purpose of this study was to investigate whether increased femAT was associated with advanced cartilage degeneration in the lateral PF joint. METHODS: Patients who underwent complete radiographic workup for surgical intervention due to OA in any knee joint compartment were included. Cartilage morphology according to the International Cartilage Repair Society (ICRS) cartilage lesion classification system in the PF joint, femoral and tibial torsion, frontal leg axis, and tibial tuberosity-trochlear groove (TT-TG) distance were assessed. Increased femAT was defined as > 20° according to previous reports. RESULTS: A total of 144 patients were included. Ninety-seven patients had a femAT of < 20° and 45 of > 20°. A significant odds ratio (OR) was found for lateral retropatellar (OR 3.5; p = 0.02) ICRS grade 3 and 4 cartilage degeneration and increased femAT ≥ 20°. In the medial PF compartment, increased femAT had an inverse effect (OR 0.16; p = 0.01). No significant ORs were found for TT-TG distance, tibial torsion, or leg axis. The lateral retropatellar ICRS grade showed a linear correlation to increased femAT values. In valgus knees, isolated lateral PF OA had an even more pronounced correlation to increased femAT (p = 0.004). CONCLUSION: Increased femAT showed higher grades of lateral retropatellar cartilage degeneration, which was even more pronounced in valgus knees. LEVEL OF EVIDENCE: Cohort study: Level III.
Assuntos
Doenças das Cartilagens/epidemiologia , Fêmur/patologia , Geno Valgo/epidemiologia , Osteoartrite do Joelho/epidemiologia , Articulação Patelofemoral/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cartilagem/patologia , Estudos de Coortes , Feminino , Humanos , Articulação do Joelho/patologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Tíbia/patologiaRESUMO
INTRODUCTION: More than half of all traumatic deaths happen in prehospital settings. Until now, there have been no long-term studies examining the actual additive treatment during trauma-associated cardiopulmonary resuscitation (tCPR), including pleural decompression, pericardiocentesis, tourniquets and external stabilization of the pelvis. The present cohort study evaluated forensic autopsy reports of trauma deaths occurring at the scene with respect to additive actions in preclinical tCPR as well as the potentially preventable nature of the individual death cases. MATERIAL AND METHODS: All autopsy protocols from the Institutes of Legal Medicine in Leipzig and Chemnitz, Germany within the years 2011-2017 were retrospectively examined and all trauma deaths with professional prehospital tCPR at the scene, during transport or shortly after arriving at the emergency room were analyzed. In addition to epidemiological parameters all forms of medical procedure performed by emergency physicians and the injury patterns were recorded. Thus, the questions whether any of the trauma deaths were preventable and if failures in work-flow management were evident could be retrospectively answered through a structured Delphi method. RESULTS: Overall, 3795 autopsy protocols were listed containing 154 trauma cases (4.1%) with various preclinical tCPR attempts (male patients 70.1%; mean age 48 ± 21 years). Most of them died at the accident site (84.4%), some during transport (2.6%) or directly after admission to a hospital (13.0%). Only 23 patients (14.9%) received 25 additional interventions exceeding the normal scope (pleural decompression 80.0%, pericardiocentesis 8.0% and external stabilization of the pelvis 12.0%). A relevant number of potentially reversible causes for trauma-associated cardiac arrest was determined. There were deficits in the performance of pleural decompression in cases of tension pneumothorax. Even if isolated traumatic hemopericardium was a rare occurrence in the examined cases, the rate of pericardiocentesis was still too low. Also, more focus needs to be placed on provisional external pelvic stabilization of trauma patients which was performed too rarely even though an instable pelvic ring was apparent during the postmortem external examination. None of the cases received a rescue thoracotomy even if a few patients might have derived benefit from this and none of the cases showed injury patterns with tourniquet indications. Furthermore, no single case of death due to incorrect or missing airway management was determined. Errors in work-flow management were found in 37.0% and potentially preventable deaths occurred cumulatively in 12.3% of the cases. The potentially preventable deaths were particularly related to penetrating chest injuries caused by a sharp force. DISCUSSION: The percentage of patients who might benefit from additive treatment implemented in tCPR efforts was shown to be equal between the local situations in Leipzig and Chemnitz compared to previous reports in Berlin. A need for optimizing the professional resuscitation process still remains as not all reversible causes were appropriately addressed. Further training and education should intensively address the mentioned deficits and continuous awareness of necessary additional medical procedures in the preclinical setting in cases of traumatic cardiac arrest is inevitable. Cooperation with forensic institutes can help to impart particular issues and treatment options of emergency medicine in cases of potentially reversible causes of traumatic cardiac arrest.
Assuntos
Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Ferimentos e Lesões/complicações , Ferimentos e Lesões/terapia , Adulto , Idoso , Manuseio das Vias Aéreas , Autopsia , Reanimação Cardiopulmonar , Causas de Morte , Estudos de Coortes , Serviços Médicos de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumotórax/etiologia , Pneumotórax/terapia , Estudos Retrospectivos , Traumatismos Torácicos/complicações , Traumatismos Torácicos/terapiaRESUMO
The steady increase in antimicrobial resistance is of growing concern in healthcare. Antibiotic Stewardship [ABS] Strategies are important tools to control antibiotic use and -prevent antimicrobial resistance. An increasing number of institutions are developing ABS initiatives also in pediatrics. However, few data are available assessing the implementation and efficiency of these pediatric ABS programs.At the Dr. von Hauner Children's Hospital, Ludwig-Maximilian University, a tertiary care pediatric reference center, a pediatric ABS Team has been implemented. Key structural elements were the same as for adult patients, but antimicrobials agents selected for monitoring and appropriate clinical endpoints are different in pediatrics.Key features were: 1. prospective-audit with feedback and formulary restriction and 2. pre-authorization (also referred to as prior approval). The ABS team consisted of one pediatric infectious disease specialist, one clinical fellow in pediatric infectious diseases, and one clinical pharmacist with training in infectious diseases.With the implementation of a pediatric ABS strategy we could significantly influence antimicrobial consumption in our hospital. Cost-savings are estimated to be above 330 000 per year, and concomitantly the use of broad-spectrum antibiotics and antifungal compounds was significantly reduced.Antibiotic Stewardship [ABS] Strategies may be an effective tool to control antibiotic use in the setting of a large tertiary pediatric teaching hospital. A national guideline for ABS initiatives may help to further improve rational use of antibiotics in the hospital setting.
Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Farmacorresistência Bacteriana , Infecções Bacterianas/diagnóstico , Criança , Pré-Escolar , Comportamento Cooperativo , Grupos Diagnósticos Relacionados , Uso de Medicamentos/tendências , Previsões , Alemanha , Hospitais Pediátricos , Hospitais Universitários , Humanos , Lactente , Recém-Nascido , Comunicação Interdisciplinar , Tempo de Internação , Equipe de Assistência ao Paciente , Projetos Piloto , Encaminhamento e Consulta , Fatores de Risco , Visitas de PreceptoriaRESUMO
BACKGROUND: The aim of this study was to investigate the influence of the surgical timing in patients with pelvic fractures and severe chest trauma on the clinical course, especially on postoperative lung function. METHODS: A total of 47 patients were included in a prospective dual observational study. The study investigated the clinical course depending on the time of operation based on the functional lung parameters, SAPS II, SOFA and total hospital stay. RESULTS: The average ISS was 32±6, PTS was 34±11 and TTSS was 9±3 points. The pelvic fractures were stabilized definitively after an average of 7±2 days. The early stabilization correlated significantly with a lower TTSS and SAPS II on admission (p<0.05), shorter time of ventilation (p<0.05) and stay in the intensive care unit (p<0.01) as well as the decreased need for packed red blood cells (p<0.01). CONCLUSIONS: In this study patients with pelvic fractures and thoracic trauma benefited positively from an earlier definitive pelvic fracture stabilization with respect to a shorter time of ventilation and stay in the intensive care unit due to a lower need for red cell concentrates.
Assuntos
Fraturas Ósseas/epidemiologia , Fraturas Ósseas/terapia , Traumatismo Múltiplo/epidemiologia , Traumatismo Múltiplo/terapia , Ossos Pélvicos/lesões , Traumatismos Torácicos/epidemiologia , Traumatismos Torácicos/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Transfusão de Eritrócitos/estatística & dados numéricos , Fixação Interna de Fraturas/estatística & dados numéricos , Alemanha/epidemiologia , Humanos , Tempo de Internação/estatística & dados numéricos , Pessoa de Meia-Idade , Ossos Pélvicos/cirurgia , Prevalência , Prognóstico , Estudos Prospectivos , Respiração Artificial/estatística & dados numéricos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
Oropouche virus (arbovirus family Bunyaviridae, Simbu serological group) was experimentally transmitted from man to hamster by the bite of the midge Culicoides paraensis. Infection rates and transmission rates were determined after the midge had engorged on patients with viremia. The threshold titer necessary to enable infection or transmission by the midges was approximately 5.3 log10 of the median lethal dose of the virus in suckling mice per milliliter of blood. Transmission was achieved 6 to 12 days after C. paraensis had taken the infective blood meal. This represents conclusive evidence of transmission of an arbovirus of public health importance to man by a member of the Ceratopogonidae family.
Assuntos
Infecções por Bunyaviridae/transmissão , Bunyaviridae/fisiologia , Ceratopogonidae/microbiologia , Insetos Vetores/microbiologia , Vírus Simbu/fisiologia , Animais , Cricetinae , Modelos Animais de Doenças , HumanosRESUMO
PURPOSE: According to Young and Burgess, type B 2-1 pelvic fractures are a type of lateral compression fracture (LC-1) and are the most common pelvic injury at all ages. Although they are considered unstable in rotation and despite biomechanical recommendations for anterior stabilization, most authors recommend non-operative treatment. However, studies comparing outcomes and complications regarding operative versus non-operative treatment are still scarce. METHODS: Seventy-one patients aged under 65 years with a type B 2-1 pelvic fracture were treated between 2006 and 2011. Patients in Group I (n = 35) were treated non-operatively and patients in Group II (n = 36) were treated operatively. Postoperative complications, clinical course, and follow-up (VAS for Pain, SF 36, EQ-5D) of at least 1 year postoperatively were evaluated. RESULTS: Our data show that operatively treated patients had a significantly higher complication rate. Preoperatively, the only significant difference between the non-operative and operative groups was the amount of anterior fracture dislocation and the presence of an isolated pelvic ring fracture. In the postoperative follow-up, no significant differences were found regarding pain or quality of life. CONCLUSION: Type B 2-1 pelvic ring fractures in young patients should be treated non-operatively.
Assuntos
Fraturas Ósseas/terapia , Fraturas por Compressão/terapia , Ossos Pélvicos/lesões , Adulto , Fatores Etários , Estudos de Coortes , Tratamento Conservador , Feminino , Fraturas Ósseas/cirurgia , Fraturas por Compressão/cirurgia , Humanos , Masculino , Complicações Pós-Operatórias , Resultado do TratamentoRESUMO
Experimental studies were conducted to determine if hematophagous Diptera were capable of mechanical transmission of Rift Valley fever (RVF) virus to laboratory animals. All species tested (Glossina morsitans, Aedes aegypti, Aedes taeniorhynchus, Culex pipiens, Stomoxys calcitrans, Lutzomyia longipalpis, and Culicoides variipennis) mechanically transmitted the virus to hamsters. Mechanical transmission rates for G. morsitans ranged from 0-100%, with the probability of mechanical transmission positively correlated with initial viremia titer and negatively correlated with the time after virus exposure. Mechanical transmission of RVF virus to lambs was demonstrated with both G. morsitans and Cx. pipiens. These findings demonstrated that mechanical transmission of RVF virus by hematophagous flies may contribute to the natural transmission and dissemination of this virus.
Assuntos
Bunyaviridae/fisiologia , Dípteros/microbiologia , Vírus da Febre do Vale do Rift/fisiologia , Aedes/microbiologia , Animais , Bovinos , Ceratopogonidae/microbiologia , Cricetinae , Culex/microbiologia , Humanos , Insetos Vetores/microbiologia , Mesocricetus , Psychodidae/microbiologia , Febre do Vale de Rift/transmissão , Ovinos , Moscas Tsé-Tsé/microbiologiaRESUMO
An initial evaluation of insecticide barrier spraying directed against sand fly vectors of cutaneous leishmaniasis was done in a nonclimax forested area with heavy undergrowth in Peten, Guatemala. A 100 m-wide swath of vegetation was sprayed once with a 1:3 mixture of cyfluthrin insecticide and a palm oil carrier using back-pack sprayers to simulate a central cantonment area in one site while another site remained as an untreated control. Prior to spraying and throughout 87 days post-treatment, sand fly populations were monitored at both sites with light traps set at ground and canopy levels at 50-m intervals radiating out from the centers of the cantonments, 150-m in the four cardinal directions. A total of 2,876 female sand flies were captured, representing 16 species. Three species, Brumptomyia galindoi, Lutzomyia panamensis, and Lu, ovallesi, comprised 70% of the total collection. The single insecticide barrier significantly reduced sand flies from reaching the cantonment area for more than 80 days, while sand fly populations outside the treated cantonment and in the untreated (control) cantonment remained high (52 sand flies in the treated cantonment versus 235 sand flies in the untreated cantonment).
Assuntos
Controle de Insetos/métodos , Insetos Vetores , Leishmaniose Cutânea/prevenção & controle , Psychodidae , Animais , Feminino , Guatemala , Inseticidas , Nitrilas , Piretrinas , Saúde da População RuralRESUMO
Rift Valley fever virus was shown to replicate in Lutzomyia longipalpis after intrathoracic inoculation. Viral titers peaked at approximately 4 days postinoculation [mean titer = 10(4.0) plaque forming units (PFU)] and remained relatively constant through day 7. A minimum of 6 of 326 sand flies transmitted virus by bite to susceptible hamsters after 5-9 days of extrinsic incubation. Viral titers of sand flies exposed per os declined steadily through day 9. None of 378 flies that had ingested approximately 10(4.0) PFU of virus transmitted virus when refed on susceptible hamsters.
Assuntos
Bunyaviridae/fisiologia , Insetos Vetores/microbiologia , Psychodidae/microbiologia , Febre do Vale de Rift/transmissão , Vírus da Febre do Vale do Rift/fisiologia , Replicação Viral , Animais , Cricetinae , Feminino , Ensaio de Placa ViralRESUMO
Biological transmission of Oropouche (ORO) virus by Culicoides paraensis (Goeldi) has been successfully demonstrated in the laboratory. Adult Culicoides, collected in an area where ORO virus was absent, were infected by feeding on viremic hamsters and then periodically exposed to susceptible hamsters at specific intervals post-infectious blood meal. These C. paraensis were capable of biological transmission of the virus 4-9 days post-feeding on viremic hamsters circulating 6.7-9.9 log10SMLD50/ml virus. Infection rates of 54% and 80% were found for C. paraensis assayed 7 days post-feeding. Virus transmission rates for these experiments were 83% and 25%, respectively. No evidence of mechanical transmission of ORO virus by C. paraensis was observed when interrupted feeding of Culicoides on viremic hamsters was followed by feeding on susceptible hamsters.
Assuntos
Infecções por Arbovirus/transmissão , Ceratopogonidae/microbiologia , Insetos Vetores , Animais , Arbovírus/isolamento & purificação , CricetinaeRESUMO
Urban epidemics of Oropouche (ORO) fever in three municipalities in Pará, Brazil were studied in 1975. Culicoides paraensis (Goeldi) were collected during each of the epidemics and there was a positive correlation, by study areas within the city of Santarém, between human seropositivity to ORO virus and population densities of C. paraensis and Culex quinquefasciatus Say. The best numerical correlation was with populations of C. paraensis. The relative absence of other species in the areas of high disease attack rates was further evidence C. paraensis were the probable vectors of ORO virus. These biting midges were found to bite readily inside of houses, with an indoor/outdoor ratio of 29%, and were most active around 1700-1800 hours. Other biological observations on C. paraensis are presented.
Assuntos
Infecções por Arbovirus/epidemiologia , Ceratopogonidae/microbiologia , Culex/microbiologia , Insetos Vetores , Animais , Infecções por Arbovirus/transmissão , Brasil , Surtos de Doenças/epidemiologia , Humanos , Fatores de TempoRESUMO
Results in entomological and vertebrate host investigations made during dual outbreaks of Mayaro (MAY) and yellow fever (YF) viruses in Belterra, Pará, Brazil in 1978 are reported. Over 9,000 insects representing 26 species were assayed in 396 pools for the presence of arboviruses. Pools of Haemagogus janthinomys Dyar yielded the only isolates of either MAY or YF virus. The minimum field infection rate for nine isolates of MAY virus from Hg. janthinomys was 1:82, and for two isolates of YF virus was 1:368. Analysis of collection data showed Hg. janthinomys to be attracted to man as a blood source and present in all habitats sampled, although most abundant in the forest canopy. Twelve hundred bird sera and 584 mammal sera were tested by hemagglutination-inhibition (HI) tests for antibody to MAY virus. Highest MAY antibody prevalence rates were found among marmosets (Calithrix argentata, 32 positive of 119 tested, 27%). Mayaro virus was also isolated from the blood of a sylvan marmoset captured at the peak of the MAY virus outbreak. Experimental infection of marmosets with MAY virus confirmed that a substantial viremia follows infection with this virus. Marmosets were also found with HI antibody to YF virus (5/119, 4%). The results presented indicate that Hg. janthinomys was the principal vector of both MAY and YF viruses and that marmosets were the main amplifying hosts for MAY virus, and perhaps for YF virus as well.
Assuntos
Surtos de Doenças , Infecções por Togaviridae/epidemiologia , Alphavirus , Animais , Brasil , Callitrichinae/microbiologia , Vetores de Doenças , Humanos , Insetos Vetores , Infecções por Togaviridae/transmissãoRESUMO
The ecology of Culicoides paraensis was studied with human bait collections at an agricultural research station near Belém and within 2 neighborhoods of Belém, Brazil, from 1977 to 1978. From collections conducted along transects that were centered on a house, we found most dense populations of host-seeking midges within and near the house. Host-seeking activity was least in areas fully exposed to sunlight compared to the levels of activity indoors and in shaded areas outside. Numbers of flies biting under shade trees and within the house increased during intervals of rain; concomitantly the levels of activity decreased in open areas. Seasonal population densities correlated with the pattern of rainfall, with a 2-month lag due to the long maturation time of immature C. paraensis. The effects of temperature and humidity on host-seeking activity are discussed.
Assuntos
Ceratopogonidae/fisiologia , Mordeduras e Picadas de Insetos/epidemiologia , Insetos Vetores/fisiologia , Animais , Brasil/epidemiologia , Ritmo Circadiano , Ecologia , Comportamento Alimentar/fisiologia , Humanos , Incidência , Estações do AnoRESUMO
A combined formulation of the U.S. Army's camouflage face paints and the new extended duration topical insect/arthropod repellent was tested on human volunteers to determine repellency and duration of protection (2-12 h) against Aedes aegypti and Anopheles stephensi. Under laboratory conditions (27 degrees C and 80% RH), the face paint/repellent formulation provided > or = 95% repellency or better for up to 6 h for Ae. aegypti and 8 h for An. stephensi. An analysis of variance showed no significant differences in the repellent efficacy of the 4 camouflage colors: white, green, loam, and sand.
Assuntos
Culicidae , DEET , Repelentes de Insetos , Animais , Estudos de Avaliação como Assunto , Face , Humanos , Mordeduras e Picadas de Insetos/prevenção & controle , Ciência Militar , Pintura , Estados UnidosRESUMO
Following gas generation in a Geological Disposal Facility (GDF), (14)C-containing gases could migrate through the geosphere, eventually diffusing into soils at the Earth's surface. This paper reports summary results from laboratory and field experiments to obtain information on the probable rates of a) diffusive transport and b) oxidation of (12/13)CH(4) (as a surrogate for (14)CH4) in a typical agricultural soil in the UK. Rates of CH(4) oxidation were generally low in the field and undisturbed soil columns, though a re-packed column of homogenised topsoil oxidised ambient atmospheric CH(4) 20× faster than an undisturbed soil column. In contrast to low observed rates of CH(4) oxidation, the effective diffusion of CH(4) through the soil was rapid. Isotopically labelled CH(4) injected at a depth of 45 cm in the field diffused to the surface and exited the soil over a time period ranging from 8 to 24 h. The rate of CH(4) diffusion through the soil was increased by the presence of ryegrass roots which increased soil porosity and decreased water content. δ(13)C values for laboratory column soils after labelled CH(4) injection experiments showed no sign of residual (13)C, despite the extremely high δ(13)C values of the injected (12/13)CH(4). If laboratory observations are confirmed by measurements in field samples it can be concluded that the majority of (14)CH(4) from a GDF which enters a soil with low methanotrophic activity will be lost to the free atmosphere after diffusing rapidly through the soil column.
Assuntos
Agricultura , Metano/análise , Eliminação de Resíduos , Solo/química , Radioisótopos de Carbono/análise , Microbiologia do SoloRESUMO
The incidence of osteoporotic pelvic fractures is rapidly increasing. Following low energy trauma fractures are frequently classified as pelvic girdle fractures. Based on the pelvic expert group database of the German Trauma Society the estimated rate of osteoporotic pelvic ring fractures is about 51%. In cases of fractured pubic rami standard X-ray in anterior-posterior, inlet and outlet views should be carried out by computed tomography (CT) scanning to identify fractures of the sacrum. Only if pain persists and no fracture is evident with CT is magnetic resonance imaging (MRI) indicated. Therapy should be carried out under biomechanical instability aspects. Pubic rami fractures are stable and treated conservatively with sufficient pain medication, thromboembolic prophylaxis and physiotherapy. In cases of persisting pain or biomechanical instability operative treatment is indicated and stabilization methods should be chosen under biomechanical aspects. Therefore external fixator for pubic rami fractures and iliosacral screws, optionally with cement augmentation for posterior pelvic girdle fractures are the preferred techniques. Sacral fractures with severe osteolysis should be stabilized by lumbopelvic fixation techniques.
Assuntos
Fraturas por Osteoporose/cirurgia , Ossos Pélvicos/lesões , Ossos Pélvicos/cirurgia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Artroplastia de Quadril , Fenômenos Biomecânicos , Placas Ósseas , Parafusos Ósseos , Terapia Combinada , Estudos Transversais , Feminino , Fixação Interna de Fraturas/métodos , Consolidação da Fratura/fisiologia , Fraturas do Quadril/diagnóstico , Fraturas do Quadril/cirurgia , Humanos , Incidência , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/classificação , Fraturas por Osteoporose/diagnóstico , Fraturas por Osteoporose/epidemiologia , Modalidades de Fisioterapia , Prognóstico , Osso Púbico/lesões , Osso Púbico/cirurgia , Sacro/lesões , Sacro/cirurgia , Fatores Sexuais , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: The incidence of pelvic ring fractures in elderly patients increases continuously. Several studies showed that the complexity of injury is often underestimated and a fracture of the posterior pelvic ring not visible with conventional X-rays. The aim of this study was to determine the influence of routine CT on incidence, classification of and therapy for pelvic ring fractures in patients aged over 65 years. PATIENTS AND METHODS: Between 2004 and 2010, 310 elderly patients with a pelvic ring fracture were admitted to a German university level 1 trauma centre. Patients of group 1 (2004-2006) were examined with CT only if a pelvic ring fracture was diagnosed by X-ray and pain in the posterior pelvic ring persisted so that mobilisation was impossible. In group 2 (2007-2010) CT was used for routine examination. Demographic data, injury mechanism and severity (ISS) were documented as well as time and type of diagnostic procedure. Also fracture classification (AO), time and type of treatment were investigated in correlation with total hospital stay. RESULTS: 252 (82â%) patients were female, the median age was 81 years (65-100 years). 228 (74â%) had a low energy trauma, 41 (13â%) a traffic accident and 12 (4â%) had fallen from heights over 3 m. Only in 29 (9â%) cases was no trauma evident. 35 (11â%) patients were injured with an ISS over 16 and classified as polytrauma. The mean ISS was 26.8 ± 11.7. In group 2 the incidence of type A fractures decreased from 64â% to 36â%, whereas the incidence of type B fractures increased from 25â% to 49â% as did isolated sacrum fractures from 1â% to 6â%. Also the indication for operative stabilisation changed in type B fractures from 33â% to 40â% and in isolated sacrum fractures to 71â%. Total hospital stay was between eight and ten days in non-operative and between 20 and 22 days in operative treatment. CONCLUSION: A low energy trauma is the major cause of injury for patients of an age over 65 years with a pelvic ring fracture. With the routine CT examination type B fractures and isolated sacrum fractures are seen more often than expected and resulting in a change of treatment procedures.