Morbilidade da zona dadora após ligamentoplastia do LCA

After anterior cruciate ligamentoplasty, anterior knee pain, sensibility and muscular strength deficits are one of the most important variables affecting the final result on a well positioned neo-ligament, being this outcomes intrinsically related to the type and location of the graft utilized Após ligamentoplastia do cruzado anterior, a dor anterior do joelho e o défice de força muscular e sensitivo são das mais importantes variáveis a influenciar o resultado final de uma cirurgia tecnicamente correcta, estando estas intrinsecamente relacionadas com o tipo e localização do enxerto utilizado

Single or Combined Maquet III Osteotomy: Long Term Results

INTRODUCTION: In 1963, based on biomechanics studies, Maquet proposed the advancement of the patellar tendon insertion as a mean of treating patellofemoral pain. The rationale for this procedure was a reduction in the patellofemoral compression force vector by changing the angular relationship between patella tendon and quadriceps tendon. One of the additional procedures, on a malalign knee, was performing a cupuliform osteotomy above the tibial tuberosity (COATT). OBJECTIVES: Evaluating, on a retrospective and comparative trial, the clinical and radiological long-term outcomes of the patients who underwent a single (M) or combined (MC) Maquet III osteotomy, in order to determine if this surgery as or not fulfilled its initially objectives. METHODS: All surgical records of the Service, between 1970 and 1991, were reviewed. We identify 116 cases registered as “M” or “MC” Maquet III osteotomy. A questionnaire as been prepared for collecting data. We evaluated the preoperative complaints, postoperative complications and range of motion recovery time, as well as the postoperative pain absence period. All patients underwent an objective assessment by the Visual Analog Scale (VAS) and the Kujala Patellofemoral Scoring System (KPFSS). A radiological assessment was also made in order to evaluate the arthrosis degree and compartment affected, the Bicondylo-Patellar Angle (BPA) and the Caton-Deschamps Index (CDI). Mann-Whitney, t-Student and Chi-Square tests were applied for statistical evaluation. p <0.05 was considered statistically significant. RESULTS: According to the study criteria, from the 116 selected patients we could review in our clinics 49 Maquet III osteotomies (n= 25 “M” group vs n=24 “MC” group) . On the “M” group, the average age at surgery was 37.6 ±12.0 years and the postoperative follow-up 27.1 ±3.15 years, versus 56,5 ±6,8 years at surgery and a 23,2 ±3,4 postoperative follow up years on the “MC” group. Prior range of motion was accomplished 4.8 ±3.5 months after surgery on the “M” group versus 6,7 ±3,5 months on the “MC” group (p=0,017). About complications, on the “M” group we have 16,0% (n=4) versus 16,6% (n=4) (p=0,763). The “M” group presented40% (n=10) patients who haven’t referred pain until nowadays versus 38,5% (n=5) (p=0,85), and the average period of of pain absence was 20.5 ±5.7 years on the “M” group versus 11,0 ±1,7 (p=0,001). At the COX score, 58,3% (n=14) of the “M” group had good to excellent outcomes versus 53,8% (n=7) (p=0,793). VAS at rest was 1.7 ±0.7, in activity 4.4±3.0 and KPFSS 61.9 ±22.3 points on the “M” group versus 1,1 ±0,3 (p=0,016), 4,3 ±2,0 (p=0,883) and 54,7 ± 16,9 (p=0,364) points on the “MC” group. Radiologically, BPA was 6.3 ±3.9° and CDI 0.9 ±0.1 on the “M” group versus 11,8 ±3,9 (p=0,000) and 0,9 ±0,2 (p=0,99) on the “MC” group. Nowadays, at the“M” group,58,3% (n=14) had a grade I/II of Kellgren&Lawrence at patellofemoral joint and 79,2.% (n=19) at the femorotibial joint versus 53,8% (n=7) (p=0,793) and 46,2% (n=6) (p=0,041). CONCLUSION: With a cut off follow-up period higher than 20 years, the Maquet III group presented58,3% of good to excellent outcomes with patients presenting a majority of low grade osteoarthritic knee. The COATT procedure hasn’t increased the postoperative complications nor worsen the funcional outcomes. On the other side, the femorotibial grade of arthritis was higher on this group

Multi-heme Cytochromes in Shewanella oneidensis MR-1:Structures, functions and opportunities

Multi-heme cytochromes are employed by a range of microorganisms to transport electrons over distances of up to tens of nanometers. Perhaps the most spectacular utilization of these proteins is in the reduction of extracellular solid substrates, including electrodes and insoluble mineral oxides of Fe(III) and Mn(III/IV), by species of Shewanella and Geobacter. However, multi-heme cytochromes are found in numerous and phylogenetically diverse prokaryotes where they participate in electron transfer and redox catalysis that contributes to biogeochemical cycling of N, S and Fe on the global scale. These properties of multi-heme cytochromes have attracted much interest and contributed to advances in bioenergy applications and bioremediation of contaminated soils. Looking forward there are opportunities to engage multi-heme cytochromes for biological photovoltaic cells, microbial electrosynthesis and developing bespoke molecular devices. As a consequence it is timely to review our present understanding of these proteins and we do this here with a focus on the multitude of functionally diverse multi-heme cytochromes in Shewanella oneidensis MR-1. We draw on findings from experimental and computational approaches which ideally complement each other in the study of these systems: computational methods can interpret experimentally determined properties in terms of molecular structure to cast light on the relation between structure and function. We show how this synergy has contributed to our understanding of multi-heme cytochromes and can be expected to continue to do so for greater insight into natural processes and their informed exploitation in biotechnologies

Avaliação a médio prazo da reconstrução do ligamento cruzado anterior: osso-tendão-osso versus semi-tendinoso gracilis

Para o êxito da reconstrução do LCA contribuem factores tão diversos como técnica cirúrgica, posicionamento dos túneis, meios de fixação e tipo de plastia entre outros. Durante muito tempo a utilização da plastia osso-tendão-osso (OTO) foi o padrão, mas o recurso a plastia dos tendões do semi-tendinoso e gracilis (ST-G) têm mostrado grande valia, embora o consenso esteja longe de ser encontrado. Neste trabalho pretendeu-se avaliar, a médio prazo, os resultados funcionais da reconstrução do LCA com enxerto OTO e ST-G, numa população que não pratica desporto de competição. No estudo efectuado, a gaveta anterior foi negativo em 91,4% OTO versus 100% ST-G; a manobra de Trillat-Lachman foi negativa em 82,9% OTO versus 74,3% ST-G, verificou-se uma maior laxidez no grupo ST-G, "mole" em 17,1% ST-G (0%OTO). A escala funcional de Lysholm foi de 95,7 no grupo OTO e 97,2 no ST-G. A escala IKDC englobou no grupo A: 51,4% dos casos OTO e 57,1% dos ST-G; no grupo B: 48,6% OTO e 25,7% ST-G; no grupo C: 17,1% ST-G e 0% OTO. A manutenção do nível de actividade (aferido pela escala de Tegner) foi de 94,3% no grupo OTO e de 97,1% no ST-G. 17,1% dos doentes do grupo OTO referiram dor na região anterior do joelho (0% ST-G). Apesar de retrospectivo o trabalho permite comparar grupos idênticos, tratados e seguidos por um único cirurgião. No essencial os dados obtidos confirmam os bons resultados de ambas as plastias, sem factores de diferença entre elas, excepção feita à maior incidência de dor anterior do joelho que pode constituir um factor limitativo

Osteotomia de valgização com efeito maquet: uma solução na gonartrose bicompartimental: resultados a longo prazo

Coventry, Maquet e outros demonstraram que as osteotomias da tíbia proximal são uma opção no tratamento da gonartrose unicompartimental. Com o avanço no desenho protésico e instrumentais mais precisos, a Artroplastia Total do Joelho (ATJ) é hoje o tratamento de eleição da pangonartrose sintomática. Contudo, o tratamento da artrose medial ou lateral combinada com artrose patelo-femoral, em estadios iniciais e em idades jovens, mantém-se um dilema. Dos 24 casos avaliados, 21 (87,5%) foram osteotomias de valgização e 11 foram re-operados: 10 ATJ (tempo médio após osteotomia de 17,9 ±5,8 anos) e 1 artrodese (na sequência de uma infecção). A queixa predominante pré-operatória foi de dor anterior do joelho com crepitação dolorosa e sensação de instabilidade patelar (41,6%). Como complicações, 1 (4,2%) caso de deiscência da sutura e 3 (12,5%) de infecção. A amplitude articular foi retomada após 6,7 ±3,5 meses. 5 doentes (38,5%) não têm dor na actualidade e nos restantes o período de ausência de dor foi de 11,0 ±1,7 anos. A EVA em repouso foi de 1,1 ±0,3, em actividade de 4,3 ±2,0, o KPFSS de 43,7 ±16,9 e o IKDC-SKF de 47,3 ±13,4 pontos. Radiológicamente, o ABP foi de 11,8±3,9º e o ICD de 0,9 ±0,2. 53,8% apresentam, à data actual, um grau I ou II de Kellgren e Lawrence a nível femoro-patelar e 46,2% a nível femoro-tibial. Apesar de retrospectivo o trabalho permite determinar, com um tempo médio de follow-up de 23 anos, uma ausência douradora das queixas álgicas acompanhada por uma lenta evolução artrósica ao nível do joelho. A osteotomia de varização supratuberositária da tíbia com efeito Maquet revelou-se como tendo uma evolução mais desfavorável, sendo poucos os casos reunidos, o que impediu que fosse realizado um estudo comparativo

Hypertriglyceridemic Pancreatitis: Conventional Treatment Versus Therapeutic Plasma Exchange

Introdução:A pancreatite aguda (PA) por hipertrigliceridemia (HTG) pode ser tratada com troca plasmática terapêutica (TPT), com redução rápida dos valores de triglicerídeos. Contudo, não existem estudos comparativos definitivos que comprovem o real benefício desta terapêutica. Objetivo: Comparação dos métodos de tratamento (troca plasmática terapêutica versus convencional) em doentes com PA HTG, durante um período de 12 anos (2000-2012). Métodos: Estudo retrospetivo descritivo e inferencial de 37 doentes, avaliando: sexo, idade, antecedentes pessoais, gravidade, valores de TG e evolução consoante o tratamento (“TPT” ou terapêutica convencional “C”). Resultados: Os dois grupos TPT e C mostraram-se homogéneos quanto ao sexo (p = 0,647), idade (43,5 ± 9,74 anos TPT versus 45,30 ± 9,90 anos C; p = 0.320), pancreatite prévia (40% TPT vs 40,7% C; p = 1,0) alcoolismo crónico (50% TPT vs 70,4% C; p = 0,275) e gravidade pelo score de APACHE II (p = 0,054) e Ranson às 48 horas (p = 0,258). Dos doentes 45,95% apresentava mais de um fator de risco secundário para HTG. O grupo TPT apresentou maiores valores de TG à admissão: 4850 ± 2802 mg/dL vs 1845 ± 1858 mg/dL (p = 0,001). Não se verificaram diferenças na duração do internamento 14,2 ± 6,8 dias vs 13,5 ± 9,0 dias (p = 0,56) ou na taxa de mortalidade (p = 0,47). À data de alta a redução dos TG foi superior no grupo TPT: 4433,70 ± 2896,08 mg/dL - 91,41% vs 1582,95 ± 2051,06 mg/dL – 83,92% (p = 0,002). De referir seis intercorrências minor durante a troca plasmática terapêutica. Discussão/Conclusões: Apesar do viés de seleção (estudo retrospetivo), foi constatada uma maior redução dos TG por esta técnica. As intercorrências inerentes à técnica de troca plasmática terapêutica foram de simples resolução.info:eu-repo/semantics/publishedVersio

A Physiological Approach to Recurrent Nephrolithiasis and its Genetic Determinants

We report a case of a 63-year-old patient with recurrent nephrolithiasis for over 40 years and a significant family history of nephrolithiasis. The patient underwent full investigation at our department. He presented hypercalcemia, hypophosphatemia and hypercalciuria, with parathyroid hormone level in the normal range. A calcium load test and a fluorocholine PET-CT excluded primary hyperparathyroidism. Abnormal secretion of parathyroid hormone-related protein and sarcoidosis were also excluded. Genetic analysis showed mutations encoding for 25(OH)-vitamin D3-24-hydroxylase (CYP24A1) and Na-dependent phosphate cotransporter 2c (SLC34A3). This case affords insights into the biological pathways that underlie the role of genetic inheritance and accrued risk of development of nephrolithiasis.info:eu-repo/semantics/publishedVersio

Polypill use for the prevention of cardiovascular disease: a position paper

Cardiovascular (CV) guidelines stress the need for global intervention to manage risk factors and reduce the risk of major vascular events. Growing evidence supports the use of polypill as a strategy to prevent cerebral and cardiovascular disease, however it is still underused in clinical practice. This paper presents an expert consensus aimed to summarize the data regarding polypill use. The authors consider the benefits of polypill and the significant claims for clinical applicability. Potential advantages and disadvantages, data regarding several populations in primary and secondary prevention, and pharmacoeconomic data are also addressed.info:eu-repo/semantics/publishedVersio

Pancreatite Hipertrigliceridémica: Tratamento Convencional Versus Troca Plasmática Terapêutica

Introduction: Acute pancreatitis (AP) induced by hypertriglyceridemia (HTG) can be treated with therapeutic plasma exchange (TPE), resulting in rapid reduction of triglyceride level. However, there are no definitive comparative studies that prove the real benefits of this therapy. Objectives: Comparison of treatment methods (TPE versus conventional) in patients with HTG AP during a period of 12 years (2000-2012). Methods: Retrospective, descriptive and inferential analysis of 37 patients, evaluating: gender, age, personal pathologic history, severity of disease, HTG values and evolution depending on treatment with therapeutic plasma exchange (“TPE”) or with conventional therapy (“C”). Results: Both groups TPE and C demonstrated homogeneity considering gender (p = 0.647), age (43.5 ± 9.74 years TPE vs 45.30 ± 9.90 years C; p = 0.320), prior AP episode (40% TPE vs 40.7% C; p = 1.0), chronic alcohol consumption (50% TPE vs 70.4% C; p = 0.275) and severity disease scores: APACHE II (p = 0.054) and Ranson (p = 0.258). More than one secondary HTG risk factor was presented in 45.95% of patients . TPE group presented higher TG levels at admission: 4850 ± 2802 mg/dL vs 1845 ± 1858 mg/dL (p = 0.001). No significant statistical differences were observed considering length of hospital stay [14.2 ± 6.8 days vs 13.5 ± 9.0 days (p = 0.56)] or mortality rate (p = 0.47). At discharge, TG reduction was greater in TPE group: 4433.70 ± 2896.08 mg/dL – 91.41% vs 1582.95 ± 2051.06 mg/dL – 83,92% (p = 0.002). Six minor complications associated to TPE occurred. Discussion/Conclusion: Despite the selection bias (retrospective study), a greater TG reduction was observed with TPE technique. Complications associated with the technique were simple to resolveinfo:eu-repo/semantics/publishedVersio