RESUMO
STUDY OBJECTIVE: To assess the late complications of percutaneous dilatational tracheotomy, particularly the incidence of tracheal stenosis and voice changes. DESIGN: Prospective descriptive clinical study. SETTING: Teaching hospital, the Netherlands. PATIENTS: Eighty consecutive patients who were successfully decannulated after percutaneous tracheotomy. MEASUREMENTS AND RESULTS: Fourteen patients died after decannulation, of tracheotomy-unrelated causes. Sixty-six patients were followed up 3 to 39 months after decannulation (mean, 16 months). Fifty-four patients underwent tomography of the trachea. In 14 patients (26%), there was tracheal narrowing of more than 10%. Data analysis showed that these stenoses were operator dependent (p = 0.03). Voice changes, found in 13 (21%) of 61 patients, were major in 1 and minor in 12. Scars were generally cosmetically acceptable. Retraction of the scar, seen in 13 (19%) of 66 patients, was related to the duration of cannulation (p = 0.002). A persistent tracheocutaneous fistula was present in two patients. CONCLUSIONS: The incidence of tracheal stenosis after percutaneous dilatational tracheotomy is low compared with conventional tracheotomy. Experience with the technique is important to avoid late complications.
Assuntos
Traqueotomia/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cicatriz/etiologia , Dilatação/efeitos adversos , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Punções , Fatores de Risco , Estenose Traqueal/etiologia , Qualidade da VozRESUMO
PURPOSE: To correlate clinical results to magnetic resonance imaging (MRI) and arthroscopy after cryopreserved nontissue-antigen-matched meniscal transplantations. TYPE OF STUDY: Blinded; the observers were blinded for each others' assessment. MATERIALS AND METHODS: Sixteen consecutive patients were included in the protocol. First, clinical evaluation and MRI were performed. Second, within 24 hours, arthroscopy was performed. RESULTS: The clinical results showed better correlation between clinical results and arthroscopy than between clinical results and MRI. In the present study, MRI was not beneficial in evaluating meniscal transplants. CONCLUSIONS: Using more sophisticated MRI techniques, the correlation between clinical results, arthroscopy, and MRI could probably be improved.
Assuntos
Artroscopia , Articulação do Joelho/patologia , Imageamento por Ressonância Magnética , Meniscos Tibiais/transplante , Osteoartrite do Joelho/cirurgia , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Meniscos Tibiais/patologia , Pessoa de Meia-Idade , Variações Dependentes do Observador , Osteoartrite do Joelho/diagnóstico , Estudos Retrospectivos , Sensibilidade e Especificidade , Transplante Homólogo , Gravação em VídeoRESUMO
The case reports of three patients with carpometacarpal dislocations are described. The diagnosis of this condition may be difficult and is often missed. Swelling, dislocation and a palpable lump are the main clinical findings. X-ray findings, the key to the diagnosis, are loss of parallelism, interruption of the so-called M-line and overlapping of articular surfaces. Additional X-rays in different planes are to be recommended if carpometacarpal dislocation is suspected.