Technique of Tibial Tuberosity Transposition and Advancement (TTTA) With Use of TTA-Maquet Cage-Only in Dog

Background: The most common conditions that compromise the stifle joint in dogs are medial patellar luxation (MPL) and cranial cruciate ligament (CCL) rupture. Surgical procedures are usually indicated for the treatment of these diseases. One ordinary technique for the treatment of MPL is the tibial tuberosity transposition, and one prominent technique for CCL rupture is the tibial tuberosity advancement. These techniques can be associated in one surgical procedure called tibial tuberosity transposition and advancement (TTTA) for the simultaneous treatment of both stifle diseases. The aim of this study is to report the surgical treatment of a dog with MPL and CCL rupture affecting the same joint by the TTTA technique with the use of a TTA-Maquet cage-only.Case: A 3-year-old Pitbull dog weighing 39 kg was attended at Veterinary Hospital with a history of marked lameness in the left pelvic limb. The orthopedic examination showed positive results for cranial drawer motion and tibial compression tests, and a complete CCL rupture was diagnosed. The presence of patellar luxation was evaluated by manual pressure on the patella, and grade 3 of MPL was diagnosed. Both conditions were affecting the same stifle joint. In addition, survey radiographs of the affected joint were performed. Surgical treatment was indicated by the TTTA technique. Radiographic measurements were taken to calculate the cranial tibial tuberosity advancement by the tibial plateau and the common tangent methods, and a titanium TTA-Maquet cage-only of 10.5 x 20.0 mm was selected. Linear osteotomy was performed on the tibial tuberosity with the aid of an oscillating saw, based on the Maquet hole technique. The tibial tuberosity was carefully displaced cranially and the cage was inserted at the site of osteotomy. The cage ears were molded on the tibial surface and fixed with 2.4 mm self-tapping cortical screws. At the moment of the cage attachment to the tibial tuberosity, orthopedic washers of 2 mm wide were placed between the cranial ears of the cage and the tibial tuberosity, thus promoting a lateral transposition of the tibial tuberosity. The patient was maintained in the early postoperative period with Robert Jones bandage, and with antibiotic, analgesic and anti-inflammatory drugs. On the second day after the procedure partial limb support with presence of mild lameness was observed. At three months postoperatively, the animal had no claudication and MPL was corrected. The radiographic examination showed the proper process of bone repair at the osteotomy site. In the clinical evaluation performed at one year after surgery the patient was in good condition without lameness and with proper limb support and muscular gain.Discussion: The studies that evaluated the association of tibial tuberosity transposition and tibial tuberosity advancement techniques (TTTA) for the simultaneous treatment of MPL and CCL rupture demonstrated that this is a viable and effective procedure. In this report, the accomplishment of tibial osteotomy based on the Maquet hole and the advancement of the tibial tuberosity with the TTA-Maquet cage-only allowed the dynamic stabilization of the CCL deficient stifle and the early use of the affected limb. In addition, the TTTA technique proved to be effective for the correction of grade 3 of MPL in a large dog, allowing adequate recovery of the limb function without complications during a one year evaluation period

Freqüência de rabdomiólise em pacientes submetidos a tratamentooperatório para obesidade mórbida no Hospital das Clínicas da UFMG

Exportado OPUSMade available in DSpace on 2019-08-14T08:58:17Z (GMT). No. of bitstreams: 1 leonardo_dornas_de_oliveira.pdf: 348594 bytes, checksum: b305889691042d13f0d22365caeb5914 (MD5) Previous issue date: 28A obesidade é uma doença universal de caráter atualmente epidêmico e sabidamente associada à co-morbidades e maior mortalidade. Em virtude de sua natureza crônica e recorrente, com pouca resposta a medidas clínicas, o tratamento operatório (cirurgia bariátrica) tem se tornado uma modalidade terapêutica cada vez mais realizada.Complicações operatórias diversas já foram associadas a este tipo de procedimento, mas ainda há pouco conhecimento sobre complicações neurológicas da cirurgia bariátrica. Dentre elas, a rabdomiólise (RML) vem sendo só muito recentemente descrita, na maioria das vezes na forma de relatos de caso, havendo poucos estudos longitudinais. Mecanismos compressivos associados ao decúbito e maior peso corporal parecem estar envolvidos no surgimento desta complicação.O presente estudo avaliou 22 pacientes submetidos ao tratamento operatório da obesidade mórbida no Hospital das Clínicas da UFMG por bypass gástrico com Y-de-Roux (BPGYR) por via aberta objetivando análise da freqüência de RML através da dosagem de creatinofosfoquinase (CPK) após 24 horas de pós-operatório. Foram avaliadas 14 mulheres e 8 homens, com idade média de 39,9 ± 11,2 anos, Índice de massa corporal (IMC) médio de 52,4 ± 8,0 kg/m² e o tempo operatório médio de 253,2 ± 51,9 minutos. RML foi diagnosticada laboratorialmente como elevação maior do que cinco vezes o limite superior do valor de referência empregado e ocorreu em 77,3% dos pacientes. A dosagem média de CPK pós-operatória foi muito elevada (7.467,7 ± 12.177,1 UI/L), sendo superior a 5.000 UI/L em 40,9% dos pacientes, evidenciando dano muscular significativo e elevado risco potencial de complicações. Nenhum paciente apresentou insuficiência renal secundária a RML, mas ocorreu um óbito (4,5%) associado a complicações infecciosas abdominais. Sintomatologia clínica neuromuscular ocorreu em 45,5% dos pacientes, sendo mais comumente dor muscular (36,4%), principalmente em regiões glúteas e lombares (27,2%). Análises comparativas dos pacientes com e sem diagnóstico de RML mostrou significância estatística em relação ao maior tempo operatório (p=0,005) do grupo com RML e à presença de sintomatologia neuromuscular neste grupo (p=0,04).Os resultados do presente estudo se assemelham a de outros poucos disponíveis e confirmam que a ocorrência de RML em cirurgia bariátrica de BPGYR (Técnica de Capella) por via aberta é uma complicação comum, reforçando a importância da propedêutica através da dosagem rotineira de CPK após 24 horas de pós-operatório.Obesity is an epidemic worldwide disease associated with co-morbidities and increased mortality. Because it is chronic and recurrent and has little response to clinical measures, surgical treatment (bariatric surgery) is a therapeutic option more and more used.Different surgical complications have been associated with this type of procedure but there is little knowledge about neurological complications. Among them, rhabdomyolysis (RML) has been described not long ago and many times as case reports, with few longitudinal studies. Compressive mechanisms associated with supine position and bigger corporal weight probably play a role in the pathogenesis of this complication. This study evaluated 22 patients who underwent surgical treatment for morbid obesity at Hospital das Clínicas of UFMG with open Roux-en-Y gastric bypass (RYGBP) to analyze the frequency of RML using the creatine phosphokinase (CPK) after 24 hours of surgery. Fourteen women and 8 men were evaluated, with median age of 39.9 ± 11.2 years, median Body Mass Index (BMI) of 52.4 ± 8.0 kg/m² and mean surgical time of 253.2 ± 51.9 minutes. RML was diagnosed as an increase of more than five times the superior limit of normal range and occurred in 77.3% of the patients. The mean value of postoperative CPK was very high (7467.7 ± 12177.1 IU/L), being greater than 5000 IU/L in 40.5% of the patients, showing a significant muscular injury and an elevated risk of complications. No patient had renal failure related with RML but there was one death (4.5%) associated with abdominal infectious complications. Clinical neuromuscular symptoms occurred in 45.5% of patients and muscular pain was more common, especially in gluteus regions. Comparative analyzes between patients with and without RML diagnosis show statistic significance of longer surgical time (p=0.005) and occurrence of neuromuscular symptoms in RML group (p=0.04). The results of this study are similar of few others available and confirmed that occurrence of RML in open bariatric surgery with RYGBP (Capella) is a common complication and emphasize the importance of measurement the CPK after 24 hours of surgery

Aspectos epidemiológicos de pacientes traqueostomizados em unidade de terapia intensiva adulto de um hospital de referência ao Sistema Único de Saúde em Belo Horizonte

OBJETIVOS: A traqueostomia é frequentemente realizada com a finalidade de favorecer o desmame da ventilação mecânica. No entanto, não se conhece o real impacto da traqueostomia nos diversos grupos de pacientes em nosso meio. O objetivo deste trabalho foi avaliar características epidemiológicas dos pacientes submetidos à traqueostomia na unidade de terapia intensiva da Santa Casa de Belo Horizonte e traçar paralelos com outros estudos semelhantes. MÉTODOS: Estudo descritivo, retrospectivo, através de revisão de prontuários e banco de dados do sistema "QuaTI" (Qualidade em Terapia Intensiva) de 87 pacientes traqueostomizados no ano de 2007. RESULTADOS: A análise dos 87 pacientes estudados mostrou média de idade de 58 ± 17 anos, média do APACHE II de 18 ± 6, tempo médio de intubação orotraqueal de 11,17 ± 4,78 dias, mortalidade na unidade de terapia intensiva de 40,2% e mortalidade hospitalar geral de 62,1%. A média de idade dos pacientes que faleceram na unidade de terapia intensiva (65 ± 17 anos) foi maior que a daqueles que receberam alta (53 ± 16 anos)p = 0,003. A média de idade dos indivíduos que faleceram no hospital (62 ± 17anos) foi maior que a dos sobreviventes (52 ± 16 anos) p = 0,008. A senilidade (idade maior ou igual a 65 anos) constituiu fator relacionado a mortalidade na unidade de terapia intensiva (OR 2,874, IC 1,165 a 7,088 p = 0,020) e à mortalidade hospitalar geral (OR 3,202, IC 1,188 a 8,628 p = 0,019). Não foram observadas outras variáveis associados a mortalidade. CONCLUSÕES: O perfil epidemiológico de pacientes traqueostomizados na unidade de terapia intensiva deste estudo revelou elevada taxa de mortalidade ao se comparar com estudos internacionais. A senilidade esteve relacionada a pior desfecho nestes pacientes. Não foram identificados outros aspectos relacionados a mortalidade no grupo estudado

Massa tumoral secundária a infecção por Schistosoma mansoni simulando neoplasia de pulmão: relato de caso Tumoral pulmonary mass secondary to Schistosoma mansoni infection resembling neoplasia: case report

Indivíduos infectados com Schistosoma mansoni na fase crônica da doença podem apresentar comprometimento pulmonar com sintomatologia e alterações radiológicas variáveis. Os pulmões podem ser acometidos pela migração anômala de ovos do sistema porta para o sistema arterial pulmonar (através de anastomoses porto-sistêmicas) e menos comumente por migrações ectópicas de vermes adultos. Há casos com extenso comprometimento parenquimatoso e outros com predomínio de arterites, com hipertensão pulmonar e cor pulmonale. Paciente jovem, residente em área endêmica de esquistossomose, com massa pulmonar sugestiva de neoplasia foi submetida a toracotomia exploradora sem possibilidade de ressecção da massa. Exame histopatológico mostrou vários granulomas esquistossomóticos e hiperplasia do tecido conjuntivo, sem sinais de neoplasia. Evoluiu com insuficiência respiratória e instabilidade hemodinâmica no pós-operatório imediato. Recebeu tratamento específico (praziquantel) associado a prednisona. A paciente cursou com infecção pulmonar e choque séptico. Recebeu antibioticoterapia, aminas vasoativas, suporte ventilatório e tratamento hemodiálitico sem melhora. Evoluiu para óbito 28 dias após cirurgia.<br>Patients with chronic Schistosoma mansoni infection may feature a range of pulmonary symptoms and radiological findings. Eggs, and rarely adult worms, may passively enter the pulmonary circulation, usually via the portal system, where they may cause pulmonary inflammation, fibrosis, hypertension and cor pulmonale. A 25-year-old patient who lived in a schistosomiasis endemic area with a pulmonary mass suggestive of malignancy underwent exploratory thoracotomy. The mass was adherent, with no resection possibility. The lung-biopsy specimen evaluation showed several granulomas with Schistosoma mansoni eggs and hyperplasic connective tissue with no sign of malignancy. The patient had respiratory failure and hypotension immediately post-surgery. Specific treatment (praziquantel) and prednisone were given. The patient had pneumonia and septic shock. The patient was given antibiotics, vasopressors, mechanical ventilation and hemodialysis with no improvement, and subsequently died 28 days after the surgery

Correction: Vestibular Evoked Myogenic Potential (VEMP) Triggered by Galvanic Vestibular Stimulation (GVS): A Promising Tool to Assess Spinal Cord Function in Schistosomal Myeloradiculopathy.

[This corrects the article DOI: 10.1371/journal.pntd.0004672.]

Vestibular Evoked Myogenic Potential (VEMP) Triggered by Galvanic Vestibular Stimulation (GVS): A Promising Tool to Assess Spinal Cord Function in Schistosomal Myeloradiculopathy

<div><p>Background</p><p>Schistosomal myeloradiculopathy (SMR), the most severe and disabling ectopic form of <i>Schistosoma mansoni</i> infection, is caused by embolized ova eliciting local inflammation in the spinal cord and nerve roots. The treatment involves the use of praziquantel and long-term corticotherapy. The assessment of therapeutic response relies on neurological examination. Supplementary electrophysiological exams may improve prediction and monitoring of functional outcome. Vestibular evoked myogenic potential (VEMP) triggered by galvanic vestibular stimulation (GVS) is a simple, safe, low-cost and noninvasive electrophysiological technique that has been used to test the vestibulospinal tract in motor myelopathies. This paper reports the results of VEMP with GVS in patients with SMR.</p><p>Methods</p><p>A cross-sectional comparative study enrolled 22 patients with definite SMR and 22 healthy controls that were submitted to clinical, neurological examination and GVS. Galvanic stimulus was applied in the mastoid bones in a transcranial configuration for testing VEMP, which was recorded by electromyography (EMG) in the gastrocnemii muscles. The VEMP variables of interest were blindly measured by two independent examiners. They were the short-latency (SL) and the medium-latency (ML) components of the biphasic EMG wave.</p><p>Results</p><p>VEMP showed the components SL (p = 0.001) and ML (p<0.001) delayed in SMR compared to controls. The delay of SL (p = 0.010) and of ML (p = 0.020) was associated with gait dysfunction.</p><p>Conclusion</p><p>VEMP triggered by GVS identified alterations in patients with SMR and provided additional functional information that justifies its use as a supplementary test in motor myelopathies.</p></div

SL and ML electromyographic normal responses to galvanic stimulation in comparison to abnormal responses.

<p>(A) Normal responses: superimposed traces of two polarities (cathode right anode left and then cathode left and anode right) reveal inversion of waves and define short-latency (SL) and medium-latency (ML) onsets points. The continuous vertical thick line indicates the galvanic vestibular stimulus onset. (B) Abnormal responses: no identification of SL or ML waves.</p

Frequency of clinical manifestations of 22 patients with schistosomal myeloradiculopathy.

<p>Frequency of clinical manifestations of 22 patients with schistosomal myeloradiculopathy.</p

Frequency of affected spinal cord segment of patients with schistosomal myeloradiculopathy.

<p>Frequency of affected spinal cord segment of patients with schistosomal myeloradiculopathy.</p