Polímero derivado de mamona acrescido de cálcio, associado ou não à medula óssea autógena na reparação de falhas ósseas

Foram avaliados o processo de reparação tecidual e o comportamento do implante de polímero vegetal extraído do óleo de mamona acrescido de 40% de carbonato de sódio, associado ou não à impregnação com medula óssea autógena, em falhas ósseas experimentais em rádios de 30 coelhos e em sítio heterotópico em seis animais. Em quinze coelhos, a falha óssea no rádio direito foi preenchida por cilindros de polímero de mamona (grupo P) com dimensão semelhante à da falha; a falha no rádio direito dos outros coelhos recebeu aspirado de medula óssea autógena junto com o implante (grupo M). A falha óssea no membro esquerdo de cada coelho não recebeu nenhum tratamento e serviu como controle. Os seis coelhos restantes receberam seis implantes no músculo reto abdominal (sítio heterotópico), sendo que, em três animais, os implantes estavam embebidos em aspirado de medula óssea autógena. No local do implante, em ambos os grupos, foi observado aumento da radiopacidade, sem desvio de eixo ósseo ou reabsorção das extremidades ósseas receptoras. O grupo P apresentou áreas irregulares de calcificação na região periférica e sobre o polímero e o M apresentou um padrão de radiopacidade mais intenso, regular e precoce em relação ao P. Na avaliação histológica, em ambos os grupos, foi observada formação de tecido ósseo imaturo com tendência à organização, brotos isolados de formação de osso novo sobre o polímero em seus poros superficiais e nos poros internos que se comunicavam. Quando foi associado à medula, o implante permitiu a ocorrência de osteocondução e osteogênese progressiva; houve migração de capilares, tecidos perivasculares e células osteoprogenitoras entre os poros, com tecido fibrovascular invadindo a superfície do implante; a incorporação dos implantes deu-se de maneira lenta e estava incompleta até as nove semanas do estudo; o implante foi biocompatível no período avaliado. Em sítio heterotópico, o implante foi incapaz de osteoindução e histologicamente, em ambos os sítios de implantação foram identificadas células gigantes e tecido fibroso envolvente.In order to evaluate tissue repair after the use of castor oil polymer implant additioned with 40% sodium carbonate, isolated or associated to autogenous bone marrow in heterotopic site and in experimental bone gaps in radii of rabbits, 30 White New Zealand rabbits were submitted to bilateral radial ostectomy. In 15 rabbits the bone gap of the right side was filled with polymer cylinders (group P) of similar size of the gaps; the remaining rabbits received autogenous bone marrow with the implant (group M). The bone defects of the left limb did not receive any treatment and served as control. Six rabbits received 6 implants in the Rectus abdominus muscle (heterotopic site) and in three of these rabbits the implants was associated with bone marrow. In the radiographic study both groups presented increased radiopacity at the implant site without bone axis deviation or resorption of the receptor bone ends. Group P presented irregular calcification areas at the peripheral region and over the polymer. Group M presented a more intense, regular and precocious radiopacity pattern in relation to group P. In microscopical evaluation there was evidence of immature bone tissue formation tending to organize itself, isolated sprouts of neoformed bone over the polymer and its superficial pores. It was concluded that implant allows osteogenenesis and osteoconduction in bone gaps, and bone formation was progressive, especially when additioned bone marrow aspirate; there was capillary, perivascular tissue and osteoprogenitor cells migrating into the pores; with fibrovascular tissue permeating implant surface; implants incorporation was slowly and was found incomplete until 9 weeks; the implant was able to induce foreign body reaction without toxic or secondary reactions to its presence. In heterotopic and orthotopic sites, the implant was not able to induce bone formation, inciting mild foreign-body reaction with giant cells and surrounding fibrous layer

Avaliações radiográfica e microscópica da reparação óssea após osteotomia isquiopúbica bilateral experimental em cadelas

Sete cadelas, sem raça definida, clinicamente sadias, com peso entre 10 e 20 kg, tiveram a cavidade pélvica abordada após osteotomia isquiopúbica bilateral e, posteriormente, foram submetidas a avaliações clínico-cinirgicas e micro e macroscópicas post montem. A osteotomia isquiopúbica bilateral permitiu boa exposição e manipulação dos órgãos intrapélvicos, e o desconforto pós-operatório foi considerado mínimo em 100% dos animais. D retomo à deambulação ocorreu, em média, 24 horas após a cirurgia, o apetite e a micção foram restabelecidos em 24 horas e a defecação, em média, 48 horas depois. Em todos os periodos de observação houve mobilidade na região de osteossintese, após palpação post montem, independentemente da presença ou ausência de tecido conjuntivo fibroso envolvendo o fragmento ósseo autégeno usado na reparação da pelve. Radiograficamente, nenhum fragmento ósseo apresentou união completa até o finai do experimento; nas avaliações, aos b() e 75 dias, houve perda da densidade do fragmento ósseo usado na reconstituição da pelve. Microscopicamente, houve deposição focai de tecidos fibrovascular, cartilaginoso e ósseo a partir da pelve hospedeira, e áreas de reabsorção foram notadas tanto no fragmento ósseo usado na reconstituição quanto na pelve. O acesso ventral à cavidade pélvica após a osteotomia isquiopúbica bilateral possibilitou ampla exposição do trato urogenital e do reto, excetuando-se a porção dorsal, permitindo intervenções cirúrgicas intrapélvicas com mínimo desconforto pós-operatório.Seven clinically healthy mongrel female adult dogs weighing between 10 and 20 kg were submitted to bilateral pubic and ischial osteotomy, which allowed good exposure and manipulation of intrapelvic organs with minimal postoperative discomfort in all the animals. Deambulation recovery occurred 24 hours after surgery, on average, and appetite and urination were reestablished within 24 hours and defecation within 48 hours after surgery. In post-morrem examination, a slight mobility in the osteosynthesis area was observed independent of the presence of fibrous connective tissue involving the autogenous bone and the host pelvis, during all the observation periods. X rays evaluations showed that 100% of the animals presented incomplete union until the end of the experiment. Decreased bone density in the piece used in the pelvis reconstruction was observed on the 60^th and 75^th days. There was local deposition of a fibrovascular and cartilagineous tissue and bone reconstruction from the host pelvis and re-absorption- was observed in the bone. fragment and pelvis. The ventral access to the pelvic cavity after bilateral pubic and ischial osteotomy provided adequate recta] and urogenital tract exposure except for the dorsal aspect of the rectum, with minimum postoperative discomfort

Efeitos da aplicação do laser diodo de Arseneto de Gálio (AS-GA) na osteoartrite experimental em coelhos

Foram avaliados os efeitos do laser a diodo de Arseneto de Gálio (As-Ga) aplicado no joelho de coelhos portadores de osteoartrite induzida pela aplicação intra-articular de carragenina. A avaliação clínica in vivo demonstrou diminuição dos sinais inflamatórios e da dor, permitindo melhor desempenho e maior amplitude de movimento do joelho dos coelhos tratados, em comparação aos dos animais não tratados. As avaliações macro e microscópica post-mortem evidenciaram processos degenerativos decorrentes da administração de carragenina em ambos os grupos, tratado com laser e não-tratado (controle). Os resultados permitiram inferir que o laser diminuiu os mediadores químicos, reduzindo a resposta inflamatória e lesões locais, inclusive a degradação dos glicosaminoglicanos. A análise histológica da membrana sinovial demonstrou a presence de células inflamatórias, distribuídas difusamente ou em focos, em maior intensidade nos grupos controle. A laserterapia retardou o caráter progressivo da osteoartrite induzida no joelho de coelhos.The aim of this study was to evaluate the effects of gallium arsenate (Ga-As) diode laser application on rabbits knees with ostheoarthritis induced by intrarticularinjection of carrageenan. Clinical evaluation in vivo showed that there was reduction in inflammatory signs and pain, with treated animals presenting a better performance and greater amplitude of movements, if compared with untreated animals. The degenerative processes resulting from the administration of carrageenan were evidenced in both groups by post mortem gross and microscopic appearance in both treated and control groups, which allowed inferring that laser diminished the presence of chemical mediators, reducing the inflammatory response and local lesions, including the degradation of glycosaminoglycans. Histological analysis of the synovial membrane revealed the presence of inflammatory cells distributed diffusely or in foci, the intensity of which was higher in control groups. The progression rate of induced ostheoarthritis was slowed down by lasertherapy

Avaliações radiográfica e microscópica da reparação óssea após osteotomia isquiopúbica bilateral experimental em cadelas

Sete cadelas, sem raça definida, clinicamente sadias, com peso entre 10 e 20 kg, tiveram a cavidade pélvica abordada após osteotomia isquiopúbica bilateral e, posteriormente, foram submetidas a avaliações clínico-cinirgicas e micro e macroscópicas post montem. A osteotomia isquiopúbica bilateral permitiu boa exposição e manipulação dos órgãos intrapélvicos, e o desconforto pós-operatório foi considerado mínimo em 100% dos animais. D retomo à deambulação ocorreu, em média, 24 horas após a cirurgia, o apetite e a micção foram restabelecidos em 24 horas e a defecação, em média, 48 horas depois. Em todos os periodos de observação houve mobilidade na região de osteossintese, após palpação post montem, independentemente da presença ou ausência de tecido conjuntivo fibroso envolvendo o fragmento ósseo autégeno usado na reparação da pelve. Radiograficamente, nenhum fragmento ósseo apresentou união completa até o finai do experimento; nas avaliações, aos b() e 75 dias, houve perda da densidade do fragmento ósseo usado na reconstituição da pelve. Microscopicamente, houve deposição focai de tecidos fibrovascular, cartilaginoso e ósseo a partir da pelve hospedeira, e áreas de reabsorção foram notadas tanto no fragmento ósseo usado na reconstituição quanto na pelve. O acesso ventral à cavidade pélvica após a osteotomia isquiopúbica bilateral possibilitou ampla exposição do trato urogenital e do reto, excetuando-se a porção dorsal, permitindo intervenções cirúrgicas intrapélvicas com mínimo desconforto pós-operatório.Seven clinically healthy mongrel female adult dogs weighing between 10 and 20 kg were submitted to bilateral pubic and ischial osteotomy, which allowed good exposure and manipulation of intrapelvic organs with minimal postoperative discomfort in all the animals. Deambulation recovery occurred 24 hours after surgery, on average, and appetite and urination were reestablished within 24 hours and defecation within 48 hours after surgery. In post-morrem examination, a slight mobility in the osteosynthesis area was observed independent of the presence of fibrous connective tissue involving the autogenous bone and the host pelvis, during all the observation periods. X rays evaluations showed that 100% of the animals presented incomplete union until the end of the experiment. Decreased bone density in the piece used in the pelvis reconstruction was observed on the 6oth and 75th days. There was local deposition of a fibrovascular and cartilagineous tissue and bone reconstruction from the host pelvis and re-absorption- was observed in the bone. fragment and pelvis. The ventral access to the pelvic cavity after bilateral pubic and ischial osteotomy provided adequate recta] and urogenital tract exposure except for the dorsal aspect of the rectum, with minimum postºperative discomfort

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London