Pyrocarbon Humeral Head in a Shoulder Hemiarthroplasty: Preliminary Results at 3 Years Follow-Up and Review of the Current Literature

Shoulder hemiarthroplasty is a viable option in young patients with an intact rotator cuff in order to preserve the native glenoid. To avoid the dreaded and expected wear of the glenoid in very active shoulders, implants with humeral head coated with a high resistant and elastic material—pyrolytic carbon—are now an option. The authors present the first pyrocarbon coated arthroplasty performed at our Orthopedic Department in a patient with osteonecrosis of the humeral head. At three years of follow-up, the patient is pain free and without limitations in his daily work. The Constant score was applied preand postoperatively, and an improvement of 32 points was reported. Larger cohorts with long-term follow-up are required to confirm our promising results.info:eu-repo/semantics/publishedVersio

Da invisibilidade ao protagonismo da agricultura familiar: uma análise a partir do semiárido nordestino

No Brasil, historicamente a organização da produção agropecuária resguarda perspectivas políticas, econômicas e sociais contraditórias, com padrões estabelecidos nas esferas políticas e acadêmicas que abrigam uma dicotomia entre dois modelos tecnológicos: a agricultura patronal e a agricultura familiar camponesa, utilizando mão-de-obra familiar, em pequenas áreas de terra, cultivos diversificados e às vezes suficientes para a subsistência, obtendo algum excedente destinado ao comércio no mercado interno. Todavia, no semiárido do Nordeste brasileiro, ao sul do Ceará, no município de Mauriti, encontrou-se uma situação exemplar de agriculturas familiares como uma experiência valorosa e de positividade. O objetivo da tese foi desvelar e compreender as condições constitutivas dessa agricultura familiar. Através do estudo aprofundado de um caso, reconhecer as especificidades deste fenômeno, onde a agricultura familiar é diversa e produtiva, averiguando as relações entre a mudança na estrutura fundiária, a partir do censo agrícola de 1940, o acesso às políticas públicas de desenvolvimento da agricultura familiar, os atores e suas intervenções políticas, econômicas e sociais que constituíram uma conjuntura de fatores e produziram uma diversidade, um mosaico de agriculturas familiares, sustentadas pela ação sinérgica terra+capital+trabalho= produção+empoderamento. A metodologia utilizada para atender aos objetivos foi tipo quanti-qualitativa, composta por levantamentos documentais, pela análise e recriação de dados secundários das principais políticas públicas para a agricultura familiar, indicadores sociais e dados secundários (Censos, PRONAF, PAA, PNAE, Garantia SAFRA), pelas narrativas de representantes dos diversos tipos de organização da agricultura familiar do município. Os resultados apontam para a desestruturação da grande propriedade desde 1940 e uma tendência a minifundização. O ingresso do Partido dos Trabalhadores na gestão municipal aproximou os agricultores familiares das políticas públicas, resultando na diferenciação produtiva do município em relação aos demais municípios da microrregião. Por conseguinte, o conjunto articulado de certas ações contribuiu para o protagonismo da agricultura familiar. Concluiu-se que a desconcentração da estrutura fundiária, o reconhecimento institucional, o acesso ao crédito via políticas públicas e opções estratégicas de gestão dos sistemas produtivos e comércio da produção, alinhavados pela gestão pública municipal, formam um campo de possibilidades favoráveis ao empoderamento e protagonismo da agricultura familiar, mesmo no semiárido nordestino.Historically, In Brazil, the organization of agricultural production has had contradictory political, economic and social perspectives, with established patterns in political and academic spaces that have an opposition between two technological models: employer agriculture and family agriculture, using family labor, in small areas of land, diversified crops and sometimes sufficient for subsistence, obtaining some surplus destined to the internal market. However, in the Brazilian Semiarid region, south of Ceará, in the municipality of Mauriti, an example of family farming was found as a valuable and positive experience. The objective of the thesis was to discover and understand the conditions of constitution of this familiar agriculture. Through the in-depth study of a case, recognize the specificities of this phenomenon, where family farming is diverse and productive, ascertaining the relations between the change in land structure, from the agricultural census of 1940, access to public policies for the development of agriculture family, actors and their political, economic and social interventions that constituted a set of factors and produced a diversity, a mosaic of family farms, supported by the synergistic equation: land ownership, capital, labour = production + empowerment. The methodology used to meet the objectives was quanti-qualitative, documentary surveys, analysis and re-creation of secondary data of the main public policies for family agriculture, social indicators and secondary data (Census, PRONAF, PAA, PNAE, Garantia SAFRA), through narratives of representatives of the various types of family agriculture organization of the municipality. The results point to the fragmentation of large property since 1940 and a trend towards minifundization. The participation of the Partido dos Trabalhadores in municipal management brought family farmers closer to the public policies, resulting in the productive differentiation of the municipality in relation to the other municipalities of the micro-region. Consequently, the articulated set of certain actions contributed to the protagonism of family agriculture. It was concluded that the deconcentration of the land structure, institutional recognition, access to credit through public policies and strategic options for the management of productive systems and trade in production, aligned with municipal public management, form a field of possibilities favorable to empowerment and protagonism of family agriculture, even in the Northeastern Semiarid region

Free Non-vascularized Toe Phalangeal Transfers in Symbrachydactyly: Outcome Analysis

Free nonvascularized toe phalangeal transfer is an established surgical option for the reconstruction of hypoplastic digits. The purpose of the present study was to evaluate our experience with this procedure and to assess bone growth and digit function as well foot morbidity. Material and Methods We retrospectively evaluated the clinical records for all children with symbrachydactyly submitted to free nonvascularized toe phalangeal transfer between 2002 and 2017. A total of 8 patients were included. We summoned the patients to na appointment to clinically assess the range ofmotion, the stability, and the alignment of the neo-joint. We radiographically measured the final length and the expected percentage of growth of the transferred phalanx. We also evaluated the foot for comorbidities. Results The mean age at the time of the first surgery was 19 months (range: 8–42 months). A total of 20 phalanges were harvested: 16 total proximal phalanges, 2 middle phalanges, 1 subtotal proximal phalanx, and 1 accessory thumb phalanx. The distal part of one proximal phalanx was trimmed because the skin pocket was too tight. Two patients underwent a secondary procedure to release the syndactyly. One transfer required revision surgery due to distal tip necrosis and exposition of the transferred phalanx. In the present series, the overall clinical and radiographic outcomes were compatible to those reported in other studies. Discussion The main limitation of the nonvascularized toe phalanx transfer is the preexisting soft tissue envelope of the finger and the limited growth potential of the transferred bone. Conclusion Irrespective of the amount of growth achieved in the transferred phalanx, the actual transfer and growth attained should not be viewed as the end result, but rather as a means of providing a stable and functional joint.La transferência no vascularizada y libre de la falange del pie es una opción quirúrgica establecida para la reconstrucción de dedos hipoplásicos. El objetivo de este estudio fue analizar nuestra experiencia con este procedimiento y evaluar el crecimiento óseo y la función digital, así como la morbilidad del pie. Material y Métodos Analizamos retrospectivamente el proceso clínico de los niños (n ¼ 8) con simbraquidactilia que se sometieron a una transferencia no vascularizada y libre de la falange del pie entre 2002 y 2017. Hicimos una consulta para evaluar clínicamente el rango de movilidad, la estabilidad, y la alineación de la nueva articulación. Medimos la longitud final y el porcentaje de crecimiento esperado de la falange transferida. Evaluamos el pie para la comorbilidad. Resultados La edad media al momento de la cirugía fue de 19 meses (rango: 8–42 meses). Se recogieron un total de 20 falanges: 16 falanges proximales totales, 2 falanges medianas, 1 falange proximal subtotal, y 1 falange accesoria del pulgar. La parte distal de una falange proximal se sacrificó porque la envoltura de la piel estaba demasiado apretada. Dos pacientes se sometieron a un procedimiento secundario por la liberación de sindactilia. Una transferencia requirió revisión debido a la necrosis de la porción distal y la exposición de la falange transferida. En la presente serie, los resultados clínicos y radiográficos generales fueron compatibles con los descritos por otros estudios. Discusión Las principales limitaciones de la transferencia no vascularizada y libre de las falanges del pie son la envoltura preexistente de tejidos blandos y el potencial de crecimiento limitado del hueso transferido. Conclusión Independientemente del crecimiento obtenido con la transferencia de la falange, esto no debe verse como el resultado final, sino como un medio paramejorar la estabilidad y la funcionalidad de la nueva articulación.info:eu-repo/semantics/publishedVersio

Hind-Foot Synovial Sarcoma Treated With Wide Resection and Sural Fasciocutaneous Flap – A Case Report

Synovial sarcoma comprises about 5% to 10% of soft tissue sarcomas. Initial growth is often slow and a small circumscribed tumour may misleadingly appear to a benign lesion by clinical examination and imaging, occurring in up to 50% of cases. The modalities of treatment of foot malignant conditions depend on histological diagnosis and staging. A radical surgical procedure in the distal region of the lower limb is often difficult due to a limited soft-tissue situation and can result in soft-tissue defects. Plastic surgical techniques remain particularly indispensable in the treatment of such distal tumors.info:eu-repo/semantics/publishedVersio

Comunicação e referenciação da comunidade fumadora da Covilhã

Introdução: A cessação tabágica é uma estratégia crucial de controlo de tabagismo e de grande custo-efetividade. Em 2012, foi aprovado um programa prioritário nacional de prevenção e controlo de tabagismo. Promover e apoiar a cessação tabágica é uma estratégia crucial para reduzir a prevalência de fumadores na população portuguesa. Apesar da custo-efetividade dos programas de cessação tabágica estar bem demonstrada, poucos fumadores recorrem a um programa de cessação em Portugal. Como tal, é muito importante conhecer as vias de comunicação com os fumadores, no sentido de os motivar e incentivar a deixar de fumar, idealmente com o apoio de um programa de cessação tabágica. Objetivos: Caraterizar a população dos fumadores que recorrem à consulta de cessação tabágica; avaliar as vias que levam ao conhecimento e utilização do programa de cessação e as vias de referenciação dos fumadores que recorrem à consulta de cessação tabágica do Centro Hospitalar Cova da Beira; analisar e caraterizar as tentativas prévias de cessação; avaliar se existem diferenças entre os fumadores provenientes da comunidade e os fumadores referenciados a partir do hospital. Metodologia: Estudo observacional transversal descritivo. Análise dos protocolos clínicos dos fumadores que recorreram à consulta de cessação tabágica de Centro Hospitalar Cova da Beira entre 2010-2012. A colheita dos dados registados no protocolo da consulta é feita sistematicamente na consulta de avaliação inicial. Foi realizada a análise descritiva univariável e bivariável, utilizando-se os testes estatísticos de Qui-Quadrado e MacNemar para as variáveis categóricas e odds ratio quando adequado; t de student e Mann-Whitney para as variáveis contínuas. Os dados sociodemográficos, o estado de saúde geral e o comportamento tabágico foram comparados com um estudo anterior que caraterizou os fumadores que recorreram ao programa nos 2 primeiros anos da consulta. Resultados: Foram incluídos no estudo 300 utentes, na sua maioria homens (68,7%), com idade média de 47,7±11,97 anos (14?75); a média da duração do comportamento tabágico foi de 30,3±12,38; 65,8% dos fumadores são provenientes do hospital, 34,2% são da comunidade; a maioria dos fumadores consome cigarros manufaturados e 5,7% dos fumadores fumam exclusivamente tabaco de enrolar; a carga tabágica dos fumadores foi, em média, 33,6±19,35 unidades/maço/ano; a maioria apresenta motivação e dependência moderadas; os fumadores do estudo iniciaram o consumo tabágico mais cedo e recorreram mais tarde à consulta do que os fumadores que recorreram à consulta entre 2008-2009. Mais de metade dos fumadores teve conhecimento do programa pelo médico, 1/4 pelo amigo/familiar/conhecido, 3,5% pelos media, 2,0% através do hospital/sinalética; cerca de metade dos fumadores tomaram a iniciativa de solicilitar a consulta e os restantes foram referenciados pelo médico; as especialidades médicas que mais referenciam são a pneumologia, a cardiologia e a medicina interna; a medicina geral e familiar referenciou apenas 2 fumadores; cerca de 3/4 afirmaram ter realizado pelo menos uma tentativa prévia de cessação tabágica; a maioria ficou menos de um ano sem fumar; 38,9% deixaram de fumar sem apoio profissional/farmacológico e 20,0% deixaram de fumar durante o internamento hospitalar sem prescrição de terapêutica de substituição nicotínica. Dos que fizeram tentativa prévia, 29,9% referiram ter sido apoiados/aconselhados a parar de fumar por algum profissional de saúde: 70,1% pelo farmacêutico, 20,9% pelo médico, 6,0% pelo técnico de saúde e 3,0% pelo apoio/aconselhamento conjunto do médico e equipa de enfermagem. Os fumadores da comunidade recorreram mais cedo à consulta e apresentam duração do comportamento tabágico e carga tabágica inferiores aos fumadores do meio hospitalar. Conclusão: Este estudo demonstra a precária divulgação da consulta de cessação tabágica e a escassa referenciação pelas diferentes especialidades médicas. A consulta de cessação deverá ser divulgada através de uma rede dinâmica de referenciação. Como formas de promoção da cessação tabágica deverá investir-se: 1) na formação multidisciplinar em tabagismo para todos os profissionais de saúde no hospital e nos cuidados primários, envolvendo prioritariamente os enfermeiros em ambos os níveis de prestação dos cuidados; 2) na integração sistemática da cessação tabágica no tratamento das doenças crónicas; 3) na utilização da sinalética no hospital; 4) na divulgação na comunidade através dos media e no envolvimento dos farmacêuticos comunitários, incentivando os fumadores a cessarem mais cedo. A comparticipação da terapêutica farmacológica e a inclusão da terapêutica específica de cessação tabágica na prescrição hospitalar é crucial.Introduction: Smoking cessation is a crucial strategy for the control of smoking and of high cost-effectiveness. In 2012, a national priority program of prevention and control of smoking was approved. Promoting and supporting smoking cessation is a crucial strategy to reduce the prevalence of smokers in the Portuguese population. Despite the well established cost-effectiveness of smoking cessation programs, few smokers resort to a smoking cessation program in Portugal. Therefore, it is very important to know the ways of communication with smokers, to motivate and encourage quitting, ideally with the support of a smoking cessation program. Objectives: To characterize the smokers who resort to a hospital-based smoking cessation clinic (CHCB Hospital); to access smokers’ awareness and types of referral to a hospital-based smoking cessation clinic; to analyze smokers’ previous quit attempts; to assess differences among community smokers and hospital-referrals. Methodology: Cross-sectional study. Analysis of clinical protocols of CBHC Hospital smoking cessation program for the years 2010-2012. Clinical questionnaires are standard protocols developed by the Portuguese Society of Pulmonology Smoking Working Group. These are systematically applied during clinical visits. We conducted univariate and bivariate descriptive analysis using Chi Square and McNemar tests for categorical variables; and Mann - Whitney and t student tests for continuous variables. Sociodemographic data, general health and smoking behavior were compared with a previous study that characterized smokers who had used the program in the first 2 years of smoking cessation clinic. Results: Participants: 300 smokers; mostly men (68,7%), mean age 47,7±11,97 years (14?75); mean duration of smoking: 30,3±12,38 years; 65,8% hospital-referrals, 34,2% community smokers; most smokers reported consume of manufactured cigarettes and only 5,7% of the smokers use rolling tobacco; the smoking load was on average 33,60±19,35 UMA; most smokers reported moderate nicotine dependence and moderate motivation to quit; most smokers started smoking earlier and resorted later to the hospital-based smoking cessation clinic than the smokers who resorted between 2008-2009. Half were aware of hospital-based smoking cessation clinic by a physician, 24,7% by a friends/family, 3,5% through media, 2,0% through hospital signage; about half were self-referrals and half physicians-referrals (mostly pulmonologists/cardiologists/internal medicine); two smokers were referred by general practitioners; most smokers reported at least one previous attempt, remaining abstinent on average less than a year; 38,7% quitted “cold turkey”; 20,0% quitted during hospital stay (“cold turkey”). Among smokers who reported at least one previous attempt, 29,9% received smoking cessation support: 70,1% by community pharmacist, 20,9% by physician, 6,0% by other health care provider and 3,0% by physician and nursing team. Community smokers resorted earlier to the hospital-based smoking cessation clinic and reported lower duration of smoking and lower smoking load than hospital-referrals. Conclusion: This study demonstrates the poor dissemination of the hospital-based smoking cessation clinic and a scarce referral by different medical specialties. There is room for improvement regarding smoking cessation network referral through: 1) multidisciplinary training on smoking cessation brief advice/referral for all health care providers, especially nurses and general practitioners; 2) systematic integration of smoking cessation in chronic diseases care; 3) use of hospital signage; 4) engaging community and encouraging more smokers to quit earlier through media/social networks/internet/community pharmacists. It is crucial smoking cessation pharmacotherapy reimbursement

The rare isolated adult Chaput-Tillaux fracture: two case reports and review of the literature

The authors present two isolated chaput-tillaux fractures in an adult skeleton. A high level of suspicion is required to prevent diagnostic failure. Computerized tomography scan detects hidden fractures and enables a more detailed preoperative assessment of each case. Most of the cases reported in the literature are associated with other ankle lesions. This typical juvenile pattern is rare in the adults and ideal treatment is yet to be determined.info:eu-repo/semantics/publishedVersio

The rare isolated adult Chaput-Tillaux fracture: two case reports and review of the literature

The authors present two isolated chaput-tillaux fractures in an adult skeleton. A high level of suspicion is required to prevent diagnostic failure. Computerized tomography scan detects hidden fractures and enables a more detailed preoperative assessment of each case. Most of the cases reported in the literature are associated with other ankle lesions. This typical juvenile pattern is rare in the adults and ideal treatment is yet to be determined.

Difficult diagnosis of a neurogenic thoracic outlet syndrome and review of the current literature

Thoracic outlet syndrome (TOS) is an uncommon disorder, without a clear clinical presentation or a fully accepted definition. The patients usually present a set of symptoms arising from compression of the brachial plexus or subclavian vessels during their passage through the thorax, between the base of the cervical region and the axilla. The authors present a case of a 20 year old woman with sporadic paresthesia in the territory of C7-T1 nerve root. At the physical examination she had a positive Wright's test. The imaging studies revealed the presence of a right cervical rib. A partial rib resection was performed with exploration of the braquial plexus and at the current follow up; 24 months after the surgery, the patient is asymptomatic. Our objective is to present a case of TOS and to highlight the clinical-management and treatment challenges of this pathology.info:eu-repo/semantics/publishedVersio

Radio‐cephalic fistula recovered with drainage to median basilic vein by straightening of the forearm cephalic vein: A case report

The distal arteriovenous fistula (AVF) has less complications and better patency than the proximal fistula, when it works properly. The complications of outflow of the fistula are complex, and it is necessary to analyze all solutions to solve the problem. We introduce a novel approach to solve outflow problems of a radio-cephalic AVF by straightening of the forearm cephalic vein with drainage into the median basilic vein.info:eu-repo/semantics/publishedVersio

Radio‐cephalic fistula recovered with drainage to median basilic vein by straightening of the forearm cephalic vein: A case report

The distal arteriovenous fistula (AVF) has less complications and better patency than the proximal fistula, when it works properly. The complications of outflow of the fistula are complex, and it is necessary to analyze all solutions to solve the problem. We introduce a novel approach to solve outflow problems of a radio-cephalic AVF by straightening of the forearm cephalic vein with drainage into the median basilic vein.info:eu-repo/semantics/publishedVersio