RESUMO
Introducción: el músculo pronador cuadrado funciona como un estabilizador dinámico de la articulación radiocubital distal. Su reparación posterior a la fijación interna con placa de bloqueo volar en fracturas distales del radio es controvertida. Objetivo: determinar si la reparación del músculo pronador cuadrado influye en los resultados clínicos y funcionales de pacientes con fractura de radio distal que se sometieron a reducción abierta y fijación interna con placa de bloqueo volar. Materiales y métodos: se realizó una revisión sistemática y metanálisis. Las bases de datos analizadas fueron PubMed/Medline, Embase y Bireme/Lilacs (búsqueda realizada hasta el 20 de febrero del año 2023). Los términos de búsqueda fueron: distal radius fracture AND volar plate AND pronator quadratus. Se determinó la calidad metodológica según el manual de revisiones Cochrane. Resultados: en total se incluyeron 4 ensayos clínicos aleatorizados de adecuada calidad metodológica, lo cual corresponde al análisis de 213 participantes. Existen mejores resultados en la puntuación DASH a los 12 meses de seguimiento en el grupo de no reparación del músculo pronador cuadrado DM 2,8 [IC 95%: 0,51;5,10]. No hubo diferencias significativas al año de seguimiento en las puntuaciones de dolor, rangos de movilidad de la muñeca, fuerza de agarre e incidencia de complicaciones. Conclusión: no existe evidencia que sustente la reparación rutinaria del músculo pronador cuadrado posterior a la fijación interna con placa de bloqueo volar en las fracturas de radio distal. (AU)
Introduction: the pronator quadratus muscle functions as a dynamic stabilizer of the distal radioulnar joint, and its repair after internal fixation with volar locking plate in distal radius fractures is controversial. Objective: to determine whether the repair of the pronator quadratus muscle influences the clinical and functional outcomes of patients with distal radius fracture who underwent open reduction and internal fixation with volar locking plate. Materials and methods: a systematic review and meta-analysis were conducted. The analyzed databases were Pubmed/Medline, Embase, and Bireme/Lilacs (search performed until February 20th, 2023). The search terms were distal radius fracture AND volar plate AND pronator quadratus. Methodological quality was determined according to the Cochrane Reviewer's Handbook. Results: a total of 4 randomized clinical trials of adequate methodological quality, corresponding to the analysis of 213 participants, were included. Better DASH scores were observed at 12 months of follow-up in the non-repair group of the pronator quadratus muscle, with a mean difference of 2.8 [95% CI 0.51; 5.10]. There were no significant differences at one-year follow-up in pain scores, wrist mobility ranges, grip strength, and incidence of complications. Conclusion: there is no evidence to support routine repair of the pronator quadratus muscle after internal fixation with volar locking plate in distal radius fractures. (AU)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Fraturas do Rádio/cirurgia , Procedimentos Cirúrgicos Operatórios/métodos , Traumatismos do Punho/cirurgia , Fixação Interna de Fraturas/métodos , Placas Ósseas , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Amplitude de Movimento Articular , Resultado do Tratamento , Fixação Interna de Fraturas/reabilitaçãoRESUMO
INTRODUCTION: Early lymphocyte recovery after allogeneic hematopoietic stem cell transplantation (HSCT) is related to the prevention of serious infections and the clearing of residual tumor cells. METHODS: We analyzed the absolute lymphocyte count at 20 (D+20) and 30 (D+30) days after HSCT in 100 patients with malignant hematologic diseases and correlated with the risk of transplant-related mortality, overall survival (OS), disease-free survival (DFS), nonrelapsed mortality (NRM), and risk of infection. RESULTS: Patients presenting with lymphocyte counts of <300 × 103/µL on D+30 have a 3.76 times greater risk of death in <100 days. Over a medium follow-up of 20 months OS, DFS, and NRM were similar between the groups. CONCLUSION: In our group of patients delayed lymphocyte recovery after HSCT was a predictor of early death post-HSCT.
Assuntos
Transplante de Células-Tronco Hematopoéticas , Leucemia/sangue , Leucemia/terapia , Contagem de Linfócitos , Síndromes Mielodisplásicas/sangue , Síndromes Mielodisplásicas/terapia , Adolescente , Adulto , Idoso , Intervalo Livre de Doença , Feminino , Humanos , Leucemia/mortalidade , Masculino , Pessoa de Meia-Idade , Síndromes Mielodisplásicas/mortalidade , Valor Preditivo dos Testes , Estudos Retrospectivos , Taxa de Sobrevida , Fatores de Tempo , Transplante Homólogo , Resultado do Tratamento , Adulto JovemRESUMO
We have explored species-specific preferences for nitrate (NO3(-)) and ammonium (NH4(+)) as an alternative niche separation in ecosystems where nitrogen (N) is present mostly in inorganic forms. The Patagonian steppe is dominated by shrubs and grasses. Shrubs absorb water and nutrients from deep soil layers, which are poor in N, while grasses have the opposite pattern, absorbing most of their water and nutrients from the upper layers of the soil. We hypothesized that the preferences of shrub and grass for inorganic N forms are different and that the rate of potential N uptake is greater in shrubs than in grasses. To test this hypothesis, we grew individuals of six dominant species in solutions of different NH4(+):NO3(-) concentration ratios. Nitrate uptake was found to be higher in shrubs, while ammonium uptake was similar between plant functional types. The NH4(+):NO3(-) uptake ratio was significantly lower for shrubs than grasses. Shrubs, which under field conditions have deeper rooting systems than grasses, showed a higher N absorption capacity than grasses and a preference for the more mobile N form, nitrate. Grasses, which had lower N uptake rates than shrubs, preferred ammonium over nitrate. These complementary patterns between grasses and shrubs suggest a more thorough exploitation of resources by diverse ecosystems than those dominated by just one functional type. The loss of one plant functional group or a significant change in its abundance would therefore represent a reduction in resource use efficiency and ecosystem functioning.
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Desenvolvimento Vegetal/fisiologia , Plantas/metabolismo , Solo/química , Compostos de Amônio/análise , Análise de Variância , Argentina , Hidroponia , Modelos Biológicos , Nitratos/análise , Especificidade da EspécieRESUMO
Synovial sarcomas of the hypopharynx are a rare form of soft tissue sarcomas. In the head and neck, they are most commonly found on the pharyngeal wall in areas that do not have synovial cells. We review a case of a 23 year-old pregnant female who presented to our hospital with acute airway obstruction due to a large hypopharynx lesion. She underwent emergency tracheotomy and tumor debulking. Pathology revealed synovial sarcoma. After the procedure the patient went into labor delivering a 29 weeks premature child. Six weeks after being discharged from the hospital the patient had a partial pharyngectomy performed to excise the remnant base of the tumor. She has had no recurrence at the 30-month post-operative period.
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Neoplasias Hipofaríngeas , Complicações Neoplásicas na Gravidez , Sarcoma Sinovial , Feminino , Humanos , Neoplasias Hipofaríngeas/diagnóstico , Neoplasias Hipofaríngeas/cirurgia , Gravidez , Complicações Neoplásicas na Gravidez/diagnóstico , Complicações Neoplásicas na Gravidez/cirurgia , Sarcoma Sinovial/diagnóstico , Sarcoma Sinovial/cirurgia , Adulto JovemRESUMO
BACKGROUND: Current techniques for management of primary hyperpara-thyroidism (pHPT) rely on preoperative localization studies in order to perform a direct exploration of the neck. This case series reports the results of minimally invasive parathyroidectomy (MIP) performed in twenty-two consecutive pHPT patients with suspected parathyroid adenoma. METHODS: All patients with symptomatic pHPT and or aberrant biochemical markers underwent preoperative evaluation including calcium and parathyroid hormone (PTH) serum levels, and a Tc-99 Sestamibi (MIBI) scintigraphy scan. The day of surgery Tc-99 MIBI was administered intravenously to localize diseased parathyroid glands. Within the next two hours after administration of IV contrast a gamma radiation detection device was applied over the neck to detect areas of prominent radiation gradient that served as landmarks during surgery. All removed tissue was again tested with the gamma radiation probe and sent for frozen sections to confirm parathyroid gland tissue. Serum calcium levels were measured immediately after surgery, 24 hours, and 3 days later at an outpatient visit. RESULTS: Twenty-two patients with symptomatic hypercalcemia (6 M, 16 F), mean age of 63 years (Range 35 to 87), completed pre-operative Sestamibi scintigraphy and follow up evaluations. Mean pre-operative calcium and PTH levels were 11.3 mg/dL and 194.2 pg/mL, respectively. Preoperative Sestamibi scintigraphy were negative in four (18%) and positive in 18 (82%) patients. Parathyroid adenoma was confirmed by frozen sections in all patients. The mean operative time was approximately 32 minutes except in 3 cases which required combined surgical procedures. There were no intra-operative complications while minor wound swelling was the only postoperative complication reported. All patients exhibited decreased serum calcium levels with resolution of symptoms within a week, and resumed a normal lifestyle. CONCLUSIONS: MIP using preoperative Tc-99 MIBI scan is an excellent and safe treatment for patients in pHPT patients with a suspected parathyroid adenoma. In our experience this technique avoids the potential complications of extensive neck exploration, reduces operative time, and has a high patient acceptance.
Assuntos
Hiperparatireoidismo Primário/cirurgia , Paratireoidectomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente InvasivosRESUMO
Merkel cell carcinoma (MCC) is a rare tumor of neuroendocrine origin. It is a highly invasive and aggressive neoplasia, that frequently presents regional and distant metatases. Therefore, there is high mortality associated with it. This report presents two male patients, one sixty three years and the other eighty eight years of age, with MCC of the cheek and invasive metastatic lesions to the head and neck areas. One of the patients died of associated distant metastatic disease and the other patient died of comorbid conditions present at time of tumor excision.
Assuntos
Carcinoma de Célula de Merkel/secundário , Neoplasias Faciais/patologia , Neoplasias Parotídeas/secundário , Neoplasias Cutâneas/patologia , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Célula de Merkel/radioterapia , Carcinoma de Célula de Merkel/cirurgia , Bochecha , Terapia Combinada , Neoplasias Faciais/cirurgia , Evolução Fatal , Humanos , Neoplasias Hepáticas/secundário , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical , Neoplasias Parotídeas/radioterapia , Neoplasias Parotídeas/cirurgia , Radioterapia Adjuvante , Neoplasias Cutâneas/cirurgiaRESUMO
We evaluated the usefulness of roentgenographic tracheal tube cuff shadow to tracheal wall diameter ratio (CTW ratio) and cuff minus tracheal diameter difference (C-T diameter) in estimating intracuff pressure (ICP) in intubated and mechanically ventilated patients. Seventy-one measurements of ICP, CTW ratio and C-T diameter were obtained from 20 mechanically ventilated male patients intubated with high volume low pressure cuffs in the surgical and medical intensive care units. The mean age was 61 years (range 30 to 83 years). ICP was measured by one observer, while CTW ratio and C-T diameter was measured by another observer. No significant relationship was seen between ICP and CTW ration (r = 0.092, p = 0.873), or between ICP and C-T diameter (r = 0.093, p = 0.42) by linear regression analysis. In conclusion, roentgenographic estimation of ICP by portable plain chest films in intensive care units was not found useful in this study.
Assuntos
Respiração Artificial , Traqueia/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Pressão , Radiografia , Respiração Artificial/instrumentaçãoRESUMO
Bronchial asthma is a common disease that is not yet completely understood. We specify the basic evaluation that asthmatic patients should undergo and discuss some aspects of pathophysiology. Guidelines to select patients for further evaluation are suggested.