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OBJECTIVE: Reconstructive surgery of the anterior cruciate ligament (ACL) is quite common, previous studies have documented that adequate pain control in the early phases of the postoperative period translates into early mobility and a rapid start of rehabilitation. Therefore, the search for new strategies for postoperative pain control is justified. The aim of this study was to compare intra-articular to the epidural administration of ropivacaine and midazolam as postoperative analgesia after arthroscopic ACL reconstruction with hamstring autograft (HA). MATERIAL AND METHODS: Double-blinded, prospective randomized clinical trial included 108 consecutive patients aged from 18 to 50 years that had undergone arthroscopic ACL reconstruction with HA. The patients were randomly assigned to 2 groups. The first group received intraarticular ropivacaine and midazolam. The second group received epidural ropivacaine and midazolam. The need for rescue analgesia, the postoperative pain experienced, side effects and complications of the analgesic drugs were evaluated. RESULTS: The intra-articular group received statistically significantly higher mean doses of rescue analgesia on the first two days (2.8 â± â1.0 vs. 1.3 â± â0.6 in the epidural group; p â= â0.001). Visual Analogue Scale scores at flexion were statistically significantly higher in the intra-articular group over the entire study period. The intra-articular group also reported a statistically significantly lower range-of-motion 87 â± â15 vs. 102 â± â11 in the epidural group (p â= â0.001). CONCLUSIONS: Epidural administration of ropivacaine combined with midazolam in patients undergoing primary ACL reconstruction with HA was clinically and significantly better relative to rescue analgesia and the intensity of pain in the first 48 postoperative hours when compared to intraarticular administration. There was no difference in terms of adverse effects and complications.
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Anestésicos Locais , Reconstrução do Ligamento Cruzado Anterior , Artroscopia , Midazolam , Dor Pós-Operatória , Ropivacaina , Humanos , Ropivacaina/administração & dosagem , Ropivacaina/uso terapêutico , Adulto , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Reconstrução do Ligamento Cruzado Anterior/métodos , Masculino , Feminino , Midazolam/administração & dosagem , Midazolam/uso terapêutico , Método Duplo-Cego , Pessoa de Meia-Idade , Estudos Prospectivos , Anestésicos Locais/administração & dosagem , Anestésicos Locais/uso terapêutico , Adolescente , Injeções Intra-Articulares , Artroscopia/métodos , Analgesia Epidural/métodos , Adulto Jovem , Amidas/administração & dosagem , Amidas/uso terapêutico , Medição da Dor , Autoenxertos , Resultado do TratamentoRESUMO
Background: Previous biomechanical studies of the meniscotibial ligament have determined that it contributes to meniscal stability. An injury to it can cause the meniscus to extrude, and reconstruction of that ligament significantly reduces extrusion. Purpose: To assess the biomechanical effects of sectioning the lateral meniscotibial ligament (LMTL) and the meniscofibular ligament (MFL) with respect to the radial mobility of the lateral meniscus and to evaluate the biomechanical effects of the capsulodesis and centralization techniques. Study Design: Controlled laboratory study. Methods: The lateral meniscus of 22 porcine knees was evaluated. They were mounted on a testing apparatus to apply muscle and ground-reaction forces. The meniscus was evaluated at 30° and 60° of knee flexion using 2 markers placed on the posterior cruciate ligament and the lateral meniscus after applying an axial compression of 200 N to the knee joint. Measurements were recorded under 5 conditions: intact lateral meniscus, injury of the LMTL, subsequent injury of the MFL, the use of the open capsulodesis technique, and the reconstruction of the LMTL and the MFL with the centralization technique. Results: The distance between the 2 markers was significantly greater in the extrusion group (combined lesion of the LMTL and MFL) than in the intact or reconstruction groups (capsulodesis and centralization techniques; P < .001 in all cases). In the cases of load application, no significant differences were observed between the control group (intact meniscus) and the groups on which the reconstruction techniques were performed. There were also no differences when comparing the results obtained between both reconstruction techniques. In all settings, the distance between the 2 markers increased with the increase in the knee flexion angle. Conclusion: In a porcine model, the LMTL and the MFL participated as restrictors of the radial mobility of the lateral meniscus during loading. Their injury caused a significant increase in lateral meniscal extrusion, and the centralization and the capsulodesis procedures were able to reduce extrusion. Clinical Relevance: This study demonstrates the capacity of the LMTL and the MFL to restrict the radial mobility of the lateral meniscus during loading and how it is affected when they are injured.
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Peroxisomicine A1 (PA1) is a toxin isolated from the Karwinskia genus plants whose target organs are the liver, kidney, and lung. In vitro studies demonstrated the induction of apoptosis by PA1 in cancer cell lines, and in vivo in the liver. Apoptosis has a wide range of morphological features such as cell shrinkage, plasma membrane blistering, loss of microvilli, cytoplasm, and chromatin condensation, internucleosomal DNA fragmentation, and formation of apoptotic bodies that are phagocytized by resident macrophages or nearby cells. Early stages of apoptosis can be detected by mitochondrial alterations. We investigated the presence of apoptosis in vivo at the morphological, ultrastructural, and biochemical levels in two target organs of PA1: kidney and lung. Sixty CD-1 mice were divided into three groups (n = 20): untreated control (ST), vehicle control (VH), and PA1 intoxicated group (2LD50). Five animals of each group were sacrificed at 4, 8, 12, and 24 h post-intoxication. Kidney and lung were examined by morphometry, histopathology, ultrastructural, and DNA fragmentation analysis. Pre-apoptotic mitochondrial alterations were present at 4 h. Apoptotic bodies were observed at 8 h and increased over time. TUNEL positive cells were detected as early as 4 h, and the DNA ladder pattern was observed at 12 h and 24 h. The liver showed the highest value of fragmented DNA, followed by the kidney and the lung. We demonstrated the induction of apoptosis by a toxic dose of PA1 in the kidney and lung in vivo. These results could be useful in understanding the mechanism of action of this compound at toxic doses in vivo.
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STUDY DESIGN: Single arm, quasi-experimental study design. BACKGROUND: To describe the effects of whole-body cryotherapy on pain, disability, and serum inflammatory markers in patients with chronic low back pain. METHODS: A quasi-experimental trial was performed on adult patients between 18 and 65 years with chronic low back pain. After obtaining informed consent, participants underwent 20 sessions of whole-body cryotherapy (at -160 °C) during a 5-week time span. Patient reported pain and disability measures (Pain Numerical Rating Scale [PNRS], Oswestry Disability Index [OSI], and Roland Morris Questionnaire [RMQ]) were obtained at each of the twenty sessions. Blood samples were obtained to analyze serum inflammatory markers at baseline, 10th and 20th session. RESULTS: Forty-one participants were included in the study. A significant decrease was observed between the initial and final PNRS, ODI, and RMQ scores (p < 0.001). A significant reduction in the PNRS was found after 4 sessions of whole-body cryotherapy (p < 0.001). We observed decreasing values of pro-inflammatory serum marker IL-2 (p = 0.046) and a significant increase in the anti-inflammatory serum marker IL-10 (p = 0.003). No adverse events were reported during the study. CONCLUSIONS: Whole-body cryotherapy is an effective therapy for pain and disability treatment in chronic low back pain. It also produces changes in serum markers of inflammation, decreasing pro-inflammatory markers and increasing anti-inflammatory markers.
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Dor Crônica , Dor Lombar , Adulto , Humanos , Dor Lombar/terapia , Avaliação da Deficiência , Inquéritos e Questionários , Crioterapia , Anti-Inflamatórios , Resultado do Tratamento , Dor Crônica/terapiaRESUMO
OBJECTIVE: Firearm violence has a high economic impact, representing the third most expensive injury and associated with the fourth highest hospitalisation cost. This study was performed to determine the clinical and epidemiological characteristics of patients with injuries due to firearm projectile during a period of increased violence related to organised crime in our country. METHODS: A retrospective study (2010-2017) was conducted to analyse the clinical data of patients admitted due to firearm projectile injury. Clinical and epidemiological characteristics of each patient were recorded, and patients were stratified by sex and age. Compared low-energy versus high-energy gunshot injuries, complications and treatment. RESULTS: A total of 1309 gunshot wounds in appendicular skeleton and spine fractures. The mean age of the patients was 29±11.5 years. Upper extremities wounds in 358 cases, lower extremities wounds in 727 cases and 224 fractures in spine region. There were no significant differences between low-velocity and high-velocity projectiles in anatomic affected region, complications and treatment. CONCLUSIONS: We concluded that firearm projectiles cause a variety of injuries both in soft and bone tissues and caused a major rate of complications in our patients even with low- or high-energy weapons. The majority of patients affected were the civilian population. Most patients with gunshot wounds were young males. We observed a low mortality rate in our patients. LEVEL OF EVIDENCE: III; retrospective cohort study.
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Fraturas Ósseas , Ferimentos por Arma de Fogo , Adolescente , Adulto , Fraturas Ósseas/complicações , Hospitalização , Humanos , Masculino , Estudos Retrospectivos , Violência , Ferimentos por Arma de Fogo/complicações , Ferimentos por Arma de Fogo/epidemiologia , Adulto JovemRESUMO
This article focuses on obtaining ultra high molecular weight polyethylene (UHMWPE) material reinforced with functionalized single-walled carbon nanotubes (f-SWCNTs) and the manufacturing of unicompartmental knee implants via Single-Point Incremental Forming process (SPIF). The physicochemical properties of the developed UHMWPE reinforced with 0.01 and 0.1 wt% concentrations of f-SWCNTs are investigated using Raman and Thermogravimetic Analysis (TGA). Tensile mechanical tests performed in the nanocomposite material samples reveal a 12% improvement in their Young's modulus when compare to that of the pure UHMWPE material samples. Furthermore, the surface biocompatibility of the UHMWPE reinforced with f-SWCNTs materials samples was evaluated with human osteoblast cells. Results show cell viability enhancement with good cell growth and differentiation after 14 incubation days, that validates the usefulness of the developed nanocomposite material in the production of hip and knee artificial implants, and other biomedical applications.
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Prótese do Joelho , Nanotubos de Carbono , Humanos , Teste de Materiais , Polietilenos , Propriedades de SuperfícieRESUMO
OBJETIVO: Comparar la eficiencia de las cuatro técnicas quirúrgicas más utilizadas para el manejo de la espondilitis tuberculosa. MÉTODO: Estudio retrospectivo en el que se incluyeron pacientes adultos con diagnóstico confirmado de espondilitis tuberculosa, afectación de dos niveles vertebrales o menos y sin deformidad vertebral grave. Se recopilaron y revisaron los expedientes médicos, los estudios de imagen y los datos demográficos de los pacientes intervenidos para analizar retrospectivamente los resultados clínicos y funcionales de cada grupo. Las variables primarias fueron la erradicación de la infección, la fusión vertebral y las complicaciones. Entre las variables secundarias se estudiaron el sangrado intraoperatorio, la estancia hospitalaria y el tiempo quirúrgico. RESULTADOS: Entre los grupos analizados no hubo diferencias significativas (p ≥ 0.05) en la mayoría de las variables analizadas, pero sí (p ≤ 0.001) respecto al sangrado, el tiempo quirúrgico, la estancia intrahospitalaria y las complicaciones, a favor del abordaje posterior único. CONCLUSIONES: El abordaje posterior único logró una eficacia clínica similar a la del resto de los abordajes en términos de erradicación de la infección y fusión vertebral; sin embargo, se asoció a menores tiempo quirúrgico, sangrado, estancia hospitalaria y complicaciones. OBJECTIVE: To compare the efficiency of the 4 most used surgical techniques for the management of tuberculous spondylitis. METHOD: Retrospective study in which adult patients with a confirmed diagnosis of tuberculous spondylitis, involvement of two vertebral levels or less, and without severe vertebral deformity were included. The medical records, imaging studies, and demographic data of the operated patients were collected and reviewed to retrospectively analyze the clinical results of each group. The primary variables were cure of infection, spinal fusion, and complications. The secondary variables included intraoperative bleeding, hospital stay, and surgical time. RESULTS: There were no significant differences (p ≥ 0.05) in most of the variables analyzed, however, there were (p ≤ 0.001) regarding bleeding, surgical time, hospital stay and complications between the groups analyzed, with a lower result in all cases for the single posterior approach. CONCLUSIONS: The single posterior approach obtained a clinical efficacy similar to the rest of the approaches in terms of eradication of the infection and vertebral fusion, however, it was associated with less surgical invasion (surgical time and bleeding), a shorter hospital stay and complications.
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Fusão Vertebral , Adulto , Humanos , Tempo de Internação , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Few cases of avulsion fractures of the tibial tuberosity with simultaneous rupture of the patellar tendon have been reported in the literature. Therefore, its mechanism and incidence have not been determined conclusively. This type of fracture is considered a serious injury that requires prompt diagnosis and early surgical repair. There is no therapeutic algorithm or standard method of treatment due to the infrequency of the injury. In this case report, we conducted an exhaustive review and synthesis of the existing literature including all previously reported cases. CASE SUMMARY: We present a 16-year-old male soccer player with a case of a tibial tuberosity fracture with distal avulsion of the patellar tendon 5 d prior to surgical treatment. The patient presented with a loss of the extensor mechanism of the knee, edema, the inability to walk, and pain. X-rays showed a high patella and a 180-degree avulsion of the tibial tuberosity. The diagnosis was confirmed by magnetic resonance imaging and computed tomography. The patient underwent open reduction and internal fixation of the fracture with a cannulated screw and washer as well as patellar tendon repair with two metallic anchors. The rehabilitation protocol consisted of initial immobilization in extension followed by passive mobility and muscle strengthening exercises. The patient demonstrated excellent postoperative outcomes and returned to regular activity without complications. CONCLUSION: This case presentation and literature review comprise the most relevant clinical, radiographic, and treatment details described in the international literature to date, providing the reader with an overview of this rare condition.
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RESUMEN: Evaluar de manera integral los parámetros morfométricos de la vértebra atlas (C1) en la población mexicana de relevancia en la realización de procedimientos quirúrgicos de la unión craneocervical con el fin de proveer datos cuantitativos indispensables para su realización. Para este estudio se utilizaron un total de 576 vértebras C1 secas de población mexicana contemporánea. Se realizaron 11 mediciones respecto a la morfología de C1. Las mediciones se efectuaron bilateralmente utilizando un vernier digital milimétrico con una precisión de 0,01 milímetros y se aplicó un análisis estadístico. Un total de 576 vértebras atlas (C1), fueron medidas de manera bilateral, todas nuestras mediciones se reportaron en milímetros. El promedio del ancho de las masas lateral fue de 14,87 mm ± 1,38 mm. El promedio de la altura de las masas laterales fue de 4,05 mm ± 0,93 mm. El promedio del ancho del foramen transverso fue de 5,93 mm ± 0,98 mm. El promedio del largo del foramen transverso fue de 6,96 mm ± 0,98 mm. El promedio de la altura del foramen transverso fue de 5,76 mm ± 1,31 mm. El promedio del ancho del surco de la arteria vertebral fue de 18,87 mm ± 1,3 mm. El promedio de la distancia entre la línea media y el margen medial del surco de la arteria vertebral sobre la superficie anterior del arco posterior de C1 en su cara superior fue de 12,47 mm ± 3,14 mm. El promedio de la distancia entre la línea media y el margen medial del surco de la arteria vertebral sobre la superficie posterior del arco posterior de C1 en su cara superior fue de 18,75 mm ± 3,94 mm. El promedio de la distancia entre la línea media y el margen lateral del surco de la arteria vertebral sobre la superficie anterior del arco posterior de C1 en su cara superior fue de 19,7 mm ± 2,52 mm. El promedio de la distancia entre la línea media y el margen lateral del surco de la arteria vertebral sobre la superficie posterior del arco posterior de C1 en su cara superior fue de 29,52 mm ± 3,23. Nuestro estudio demuestra que las mediciones realizadas en nuestra población presentan diferencias significativas respecto a lo reportado actualmente en la literatura. Es necesario contar con un conocimiento de la morfología vertebral en nuestra población para disminuir la ventana de error al realizar procedimientos quirúrgicos que involucren este segmento.
SUMMARY: To evaluate in an integral way the morphometric parameters of the atlas (C1) vertebra in the Mexican population of relevance in performing surgical procedures of the craniocervical junction in order to provide quantitative and essential data for its realization. For this study, a total of 576 dry C1 vertebrae of contemporary Mexican population were used. Eleven measurements were carried out regarding the morphology of C1. The measurements were made bilaterally using a millimeter digital vernier with an accuracy of 0.01 millimeters and a statistical analysis was applied. A total of 576 atlas vertebrae (C1) were measured bilaterally, all our measurements were reported in millimeters. The average width of the lateral masses was 14.87 mm ± 1.38 mm. The average height of the lateral masses was 4.05 mm ± 0.93 mm. The average width of the transverse foramen was 5.93 mm ± 0.98 mm. The average length of the transverse foramen was 6.96 mm ± 0.98 mm. The average height of the transverse foramen was 5.76 mm ± 1.31 mm. The average width of the groove of the vertebral artery was 18.87 mm ± 1.3 mm. The average distance between the midline and the medial edge of the vertebral artery groove on the anterior surface of the posterior arch of C1 on its superior surface was 12.47 mm ± 3.14 mm. The average distance between the midline and the medial border of the vertebral artery groove on the posterior surface of the posterior arch of C1 on its upper face was 18.75 mm ± 3.94 mm. The average distance between the midline and the lateral border of the vertebral artery groove on the anterior surface of the posterior arch of C1 on its superior surface was 19.7 mm ± 2.52 mm. The average distance between the midline and the lateral border of the vertebral artery groove on the posterior surface of the posterior arch of C1 on its superior surface was 29.52 mm ± 3.23. Our study shows that the measurements made in our population present differences with respect to what is currently reported in the literature. It is necessary to have knowledge of vertebral morphology in our population to reduce the error window when performing surgical procedures involving this segment.
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Humanos , Atlas Cervical/anatomia & histologia , Estudos Transversais , Corpo Vertebral/anatomia & histologiaRESUMO
Resumen ANTECEDENTES: El tratamiento del tumor de Buschke-Löwenstein durante el embarazo aún se discute, por lo que se prefiere iniciarlo en el puerperio. OBJETIVO: Reportar un caso de tumor de Buschke-Löwenstein, además de conocer y ampliar su protocolo de tratamiento, pues se considera un reto, debido a la recidiva, alto grado de malignidad y escasa bibliografía relacionada con la enfermedad durante el embarazo. CASO CLÍNICO: Paciente de 17 años, con embarazo previable y diagnóstico de infección de VPH de bajo riesgo, con condiloma genital incipiente, sin tratamiento, inadecuado control prenatal y sin inmunodepresión. Ingresó a la unidad hospitalaria con embarazo pretérmino, por pérdida del bienestar fetal en el tercer trimestre. Mediante ultrasonido se descartó la afectación fetal; sin embargo, se encontró anemia materna y fetidez genital, por lo que se decidió efectuar la resección de la tumoración. El procedimiento transcurrió sin contratiempos. Hasta la fecha no muestra recidiva. El embarazo llegó a término y finalizó por vía abdominal, sin complicaciones. CONCLUSIONES: El tumor de Buschke-Löwenstein es una neoplasia poco común relacionada con inmunodepresión, raramente aparece durante el embarazo y se prefiere iniciar el tratamiento en el puerperio. Se considera un factor de riesgo por la amenaza de parto pretérmino, el efecto proinflamatorio y la afectación materna-fetal, debido al sangrado materno crónico. Es importante considerar el tratamiento durante el embarazo, evaluando el riesgo-beneficio.
Abstract BACKGROUND: The management of the Buschke-Löwenstein tumor in pregnancy is controversial, preferring its treatment in the puerperium. OBJECTIVE: A clinical case report, know and expand the management of the Buschke-Löwenstein tumor, since this is considered a therapeutic challenge due to its important recurrence, high degree of malignancy and its scarce bibliography in which management is carried out during pregnancy. CLINICAL CASE: A 17-years old patient with preventable pregnancy and diagnosis of low risk HPV infection, presents incipient genital condyloma, which does not want any management, antecedent of inadequate prenatal control and without conditions that indicate immunosuppression. Later, she entered with preterm pregnancy due to loss of fetal well-being in the third trimester, fetal involvement was ruled out, however, maternal anemia and genital stinking were found, so it was decided to successfully resect the tumor, without recurrence and ending pregnancy. Ending the pregnancy by abdominal route. CONCLUSIONS: Buschke-Löwenstein tumor is a rare pathology related to immunosuppression, rarely occurs in pregnancy and its resolution is preferred in the puerperium. It can become a risk factor for the threat of preterm delivery due to its proinflammatory effect and generate a compromise of the binomial due to chronic maternal bleeding. It is important not to rule out your treatment during pregnancy by assessing risk benefit.