RESUMO
OBJECTIVE: To investigate whether tendon degeneration in posterior tibial tendon dysfunction syndrome is associated with changes in extracellular matrix collagen composition. METHODS: Specimens from grossly abnormal tendon regions from 9 patients with posterior tibial tendon dysfunction syndrome were prepared for routine histology. Collagens I, III and V were typed by immunoblotting and quantified by densitometry after SDS-PAGE. Proline and hydroxyproline residues were determined by liquid chromatography. Four other samples from grossly normal homologous tendon regions and one surgical specimen from a healthy patient undergoing arthrodesis of the ankle after an accident were included as control. RESULTS: In the grossly abnormal surgical posterior tibial tendon specimens we observed three types of histopathologic conditions present to varying degrees: increased mucin content, fibroblast hypercellularity and neovascularization. Analysis of degenerate tendons demonstrated a 79.3% increase in total proline and a 32.4% increase in 4-hydroxyproline. In addition, damaged tissue contained a higher proportion of collagen type III (mean increase: 53.6%) associated with a concomitant increase in type V collagen (mean increase: 26.4%). These alterations were accompanied by a reduction in type I collagen (mean decrease: 41.4%). CONCLUSIONS: In posterior tibial tendon dysfunction syndrome, the degenerative process results from marked changes in both structural organization and molecular composition of matrix collagens. The higher proportion of type V and type IlI collagens in degenerated tendons is likely to contribute to a decrease in the mechanical resistance of the tissue.
Assuntos
Colágeno/metabolismo , Matriz Extracelular/metabolismo , Disfunção do Tendão Tibial Posterior/metabolismo , Idoso , Cromatografia Líquida de Alta Pressão , Colágeno/classificação , Eletroforese em Gel de Poliacrilamida , Feminino , Humanos , Hidroxiprolina/metabolismo , Pessoa de Meia-Idade , Disfunção do Tendão Tibial Posterior/complicações , Disfunção do Tendão Tibial Posterior/patologia , Prolina/metabolismo , Tendinopatia/etiologia , Tendinopatia/metabolismo , Tendinopatia/patologia , Tendões/metabolismo , Tendões/patologiaRESUMO
The authors analyze the randomized use of three ankle arthrodesis techniques. Indications for this procedure, which are pain, instability, deformity and articular degeneration, are common to the three groups. In group I the Gatellier-Adams technique was used by transfibular approach. In group II the Kenneth-Johnson technique was adopted, using Calandruccio external fixator. The same surgical procedure was adopted in group III, using crossed canulated screws as fixation device. The specific advantages and disadvantages of each method are discussed. The criteria for evaluation of the results are the final roentgenographic position of the foot and the achievement of union. The critical analysis conclude that the major indications for group I technique are cases of "in situ" arthrodesis, for group II infected cases and for group III cases with severe malalignment.
Assuntos
Articulação do Tornozelo/cirurgia , Artrodese/métodos , Adolescente , Adulto , Idoso , Articulação do Tornozelo/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos RetrospectivosRESUMO
Os autores propoem um programa de atendimento aos pacientes portadores de patologias do pé, com indicaçao de tratamento cirúrgico, que visa diminuir custos e limitar ao mínimo o tempo de permanência hospitalar. Para isso há necessidade da interaçao das diversas equipes profissionais, tais como assistente social, enfermagem, médicos e familiares. A participaçao médica neste protocolo inclui o emprego do bloqueio anestésico regional e utilizaçao de técnica cirúrgica apropriada. Baseado em 23 casos, a eficácia do programa é analisada e o método, recomendado.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Tornozelo/cirurgia , Doenças do Pé/cirurgia , Idoso de 80 Anos ou mais , Anestesia Local , Eficácia , Bloqueio Cardíaco , Tempo de Internação , Equipe de Assistência ao PacienteRESUMO
The aim of this paper is to evaluate the effectiveness of podometry to measure the pressure developed over the feet and the value of these findings to help in the prevention of the plantar neuropathic ulcer in patients bearing Hansen's disease. We evaluated 13 patients with impaired plantar pain and touch sensations and 17 normal patients. All the patients were submitted to static evaluation using the podometer. The system employed was the "Midcapteur" commercial podometer composed of a platform for acquisition of analogic data capable of registering the segmental pressures applied to the feet. These data are read by a 386 IBM/PC compatible computer that registers the graphic patterns obtained from the pressures developed and also calculates the modes of pressure distribution in the four quadrants of the foot. These data obtained by means of static podometry were compared to the clinical evaluation of pain and touch sensation of the feet in hansenian patients. The results demonstrate that podometery is an efficient method for evaluating the pressure in impaired feet in Hansen's disease and is a progression of neuropathic ulcer; it is sensitive in the identification of the spots of increased pressure in anesthetic and anomalous areas, asymmetries and in correlating the presence of ulcers with increased pressure.
Assuntos
Pé/fisiopatologia , Hanseníase/fisiopatologia , Pressão , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Avaliação como Assunto , Feminino , Úlcera do Pé/fisiopatologia , Humanos , Masculino , Manometria , Pessoa de Meia-IdadeRESUMO
The authors studied 22 patients who had 32 feet with symptomatic talocalcaneal coalition. All feet were treated with excision of the bar and interposition of an autogenous free fat graft. These cases were assessed clinically and radiographically before and after the operation. They conclude that this technique is a good surgery with gratifying results. In the final outcome, 78.1% of feet became completely painless and 21.8% achieved relief of pain. There was improvement of the deformity in 68.7% and of range of motion in 75%.