The use of bone bridges in transtibial amputations

OBJETIVO: Descrever a técnica da osteoperiosteoplastia em adultos e apresentar a variação para a utilização em crianças, procurando demonstrar sua aplicabilidade como opção nas amputações transtibiais eletivas. CASUÍSTICA E MÉTODOS: O artigo apresenta um estudo prospectivo de 15 amputações transtibiais realizadas entre 1992 e 1995 em que se utilizou a técnica da osteoperiosteoplastia. A idade dos pacientes variou de 8 a 48 anos, com média de 22,53 anos. A técnica consistiu na confecção de um cilindro de periósteo retirado da tíbia, contendo fragmentos de osso cortical presos ao mesmo, para promover uma sinostose tibiofibular na extremidade distal do coto de amputação. Observou-se que os fragmentos de osso cortical eram dispensáveis quando a técnica foi empregada em crianças, pela maior capacidade osteogênica do periósteo. Isto levou a uma variação da técnica original, que consiste numa periosteoplastia sem a utilização de fragmentos de osso cortical. RESULTADOS: O tempo médio despendido com a técnica, sem variação significativa entre adultos e crianças, foi de 171 minutos. A adaptação da prótese definitiva dos pacientes foi obtida entre 20 e 576 dias, com média de 180 dias. Revisões da técnica empregada foram necessárias em três amputações (20%). CONCLUSÃO: A técnica encontra aplicação nas amputações transtibiais em que o comprimento final do coto seja próximo da transição musculotendínea do gastrocnêmio e nas revisões de cotos de amputação de crianças onde a técnica mostrou ser efetiva na prevenção das lesões decorrentes do excessivo crescimento ósseo.We sought to describe the bone bridge technique in adults, and present a variation for use in children, as well as to present its applicability as an option in elective transtibial amputations. This paper presents a prospective study of 15 transtibial amputations performed between 1992 and 1995 in which the bone bridge technique was employed. The patients' ages ranged from 8 to 48 years, with an average of 22.5 years. This technique consisted of the preparation of a cylinder of periosteum extracted from the tibia and with cortical bone fragments attached to it to promote a tibiofibular synostosis on the distal extremity of the amputation stump. We noted that the cortical bone fragments were dispensable when the technique was employed in children, due to the increased osteogenic capacity of the periosteum. This led to a variation of the original technique, a bone bridge without the use of the cortical bone fragments. RESULTS: The average time spent with this procedure, without any significant variation between adults and children, was 171 minutes. The adaptation to the definitive prosthesis was accomplished between 20 and 576 days, with an average of 180 days. Revision of the procedure was necessary in 3 amputations. CONCLUSIONS: This technique may be employed in transtibial amputations in which the final length of the stump lies next to the musculotendinous transition of the gastrocnemius muscle, as well as in the revision of amputation stumps in children, where the procedure has been shown to be effective in the prevention of lesions due to excessive bone growth

The impact of multivisceral liver resection on short- and long-term outcomes of patients with colorectal liver metastasis: A systematic review and meta-analysis

The impact of Multivisceral Liver Resection (MLR) on the outcome of patients with Colorectal Liver Metastasis (CRLM) is unclear. The present systematic review aimed to compare patients with CRLM who underwent MLR versus standard hepatectomy regarding short- and long-term outcomes. MLR is a feasible procedure but has a higher risk of major complications. MLR did not negatively affect long-term survival, suggesting that an extended resection is an option for potentially curative treatment for selected patients with CRLM

ASPECTOS DA LEGISLAÇÃO AMBIENTAL PARA A REVEGETAÇÃO DE MATAS CILIARES NO ESTADO DO PARANÁ

Este trabalho de revisão tem como objetivo discutir aspectos importantes sobre a preservação de áreas de mata ciliar, assim como dos problemas causados pela presença de espécies arbóreas exóticas, abordar sobre a legislação brasileira e do estado do Paraná na proteção às matas ciliares e na proibição das espécies exóticas invasoras e, relacionar espécies lenhosas nativas na revegetação de matas ciliares no estado. Como característica do tipo de pesquisa, focou-se nas peculiaridades da legislação existente, entre o nível federal e estadual, que confere o regulamento e especificações para tratar do assunto. Verificou-se que a legislação brasileira abriu interpretações que possibilitaram a introdução de espécies exóticas invasoras, como Pinus spp. e Eucalipos spp. Somente em 2011, a legislação brasileira tomou medidas para tentar reverter esta situação ao criar a Resolução nº 429 que estabeleceu metodologias para recuperação de áreas degradadas sem o uso de espécies exóticas. O estado do Paraná se encontrava em alerta com tal situação desde 2009, e por meio da Portaria nº 125 do Instituto Ambiental do Paraná (IAP), reconheceu uma lista de espécies exóticas invasoras, permitindo a criação ou o cultivo somente em determinados casos, incorporando, também, uma lista de espécies arbóreas nativas recomendadas na revegetação de mata ciliares a qual distribui as espécies nas divisões bioclimáticas, considerando a melhor adaptação de cada uma em cada região, viabilizando o processo de restauração das matas ciliares

Two decades of liver resection with a multidisciplinary approach in a single institution: What has changed? Analysis of 1409 cases

Objectives: To evaluate results of patients undergoing liver resection in a single center over the past two decades with a particular look at Colorectal Liver Metastasis (CRLM) and Hepatocellular Carcinoma (HCC). Method: Patients were divided into two eras, from 2000 to 2010 (Era 1) and 2011 to 2020 (Era 2). The most frequent diagnosis was CRLM and HCC, with 738 (52.4%) and 227 (16.1%) cases respectively. An evaluation of all liver resection cases and a subgroup analysis of both CRLM and HCC were performed. Preoperative and per operative variables and long-term outcomes were evaluated. Results: 1409 liver resections were performed. In Era 2 the authors observed higher BMI, more: minimally invasive surgeries, Pringle maneuvers, and minor liver resections; and less transfusion, less ICU necessity, and shorter length of hospital stay. Severe complications were observed in 14.7% of patients, and 90-day mortality was 4.2%. Morbidity and mortality between eras were not different. From 738 CRLM resections, in Era 2 there were significantly more patients submitted to neoadjuvant chemotherapy, bilateral metastases, and smaller sizes with significantly less transfusion, the necessity of ICU, and shorter length of hospital stay. More pedicle clamping, minimally invasive surgeries, and minor resections were also observed. From 227 HCC resections, in Era 2 significantly more minimally invasive surgeries, fewer transfusions, less necessity of ICU, and shorter length of hospital stay were observed. OS was not different between eras for CRLM and HCC. Conclusions: Surgical resection in a multidisciplinary environment remains the cornerstone for the curative treatment of primary and metastatic liver tumors

HEPATOSPLENIC SCHISTOSOMIASIS-ASSOCIATED CHRONIC PORTAL VEIN THROMBOSIS: RISK FACTOR FOR HEPATOCELLULAR CARCINOMA?

ABSTRACT BACKGROUND: Hepatosplenic schistosomiasis is an endemic disease prevalent in tropical countries and is associated with a high incidence of portal vein thrombosis. Inflammatory changes caused by both parasitic infection and portal thrombosis can lead to the development of chronic liver disease with potential carcinogenesis. AIMS: To assess the incidence of portal vein thrombosis and hepatocellular carcinoma in patients with schistosomiasis during long-term follow-up. METHODS: A retrospective study was conducted involving patients with schistosomiasis followed up at our institution between 1990 and 2021. RESULTS: A total of 126 patients with schistosomiasis were evaluated in the study. The mean follow-up time was 16 years (range 5–31). Of the total, 73 (57.9%) patients presented portal vein thrombosis during follow-up. Six (8.1%) of them were diagnosed with hepatocellular carcinoma, all with portal vein thrombosis diagnosed more than ten years before. CONCLUSIONS: The incidence of hepatocellular carcinoma in patients with schistosomiasis and chronic portal vein thrombosis highlights the importance of a systematic long-term follow-up in this group of patients

Long-Lasting Efficacy of Radio Electric Asymmetric Conveyer Neuromodulation Treatment on Functional Dysmetria, an Adaptive Motor Behavior

BackgroundFluctuating asymmetry (FA) is widely defined as the deviation from perfect bilateral symmetry and is considered an epigenetic measure of environmental stress. Rinaldi and Fontani hypothesized that the FA morpho-functional changes originate from an adaptive motor behavior determined by functional alterations in the cerebellum and neural circuits, not caused by a lesion, but induced by environmental stress. They called this phenomenon functional dysmetria (FD). On this premise, they developed the radio electric asymmetric conveyer (REAC) technology, a neuromodulation technology aimed at optimizing the best neuro-psycho-motor strategies in relation to environmental interaction.AimsPrevious studies showed that specific REAC neuro postural optimization (NPO) treatment can induce stable FD recovery. This study aimed to verify the duration of the NPO effect in inducing the stable FD recovery over timeMaterials and methodsData were retrospectively collected from a population of 29,794 subjects who underwent a specific semiological FD assessment and received the NPO treatment, regardless of the pathology referred.ResultsThe analysis of the data collected by the various participants in the study led us to ascertain the disappearance of FD in 100% of the cases treated, with a stability of the result detected up to 18 years after the single administration of the REAC NPO treatment.ConclusionsThe REAC NPO neurobiological modulation treatment consisting of a single administration surprisingly maintains a very long efficacy in the correction of FD. This effect can be explained as the long-lasting capacity of the NPO treatment to induce greater functional efficiency of the brain dynamics as proven in previous studies