Objective: To observe the accuracy and the advantages and disadvantages of the femoral tunnels made by the two techniques. Materials and Methods: We randomly summoned nineteen patients undergoing anatomic ACL reconstr...Objective: To observe the accuracy and the advantages and disadvantages of the femoral tunnels made by the two techniques. Materials and Methods: We randomly summoned nineteen patients undergoing anatomic ACL reconstruction in a single band technique by the same surgeon: Ten by group II (GII) and nine by Group I (GI). GI: drilling in the technical in-out. GII: drilling the technique out-in. The patients underwent a CT scan with three-dimensional reconstruction of the distal femur. Was applied the technique of quadrants described by Bernard and Hertel and optimized for position by Forsythe and observed in the femoral tunnel: the accuracy of the joint entry;posterior cortical thickness in that point;emergency lateral distance to the lateral epicondyle and the overall length. Results: The coordinates of the distances obtained average was very close, with no statistical difference comparable to that obtained by Bernard and Hertel and Forsythe. The distance from the tunnel exit to the lateral epicondyle obtained average 1.46 cm in GI and 0.47 cm in GII, with a significant statistical difference. The thickness of the posterior cortex was 3.9 mm in GI and 5.4 mm in GII, with no statistical difference. The length averaged was 3.07 cm in GI and GII in 2.94 cm, with no statistical difference. Conclusions: Both techniques allow well placed tunnels, with no statistical difference. In the technique in-out the tunnel exit is closer to the lateral epicondyle. The thickness of the posterior cortex is similar. The length of the femoral tunnel is similar and around 3 cm.展开更多
Background: Total knee arthroplasty (TKA) is a highly complex and effective surgery even though its perioperative bleeding may increase the need for blood transfusion and its associated infection risk, cardiovascular ...Background: Total knee arthroplasty (TKA) is a highly complex and effective surgery even though its perioperative bleeding may increase the need for blood transfusion and its associated infection risk, cardiovascular overload, increased costs, and mortality. As the tourniquet reduces intraoperative bleeding, it may be associated with postoperative bleeding, venous thrombosis, and distal ischemia. The reperfusion may trigger a local and systemic inflammatory response. Anesthetic preconditioning (APC) with sevoflurane minimizes ischemia-reperfusion syndrome (IRS). This study evaluated the effects of APC with sevoflurane on perioperative bleeding in TKA. Methods: We allocated 30 patients into two groups: a sevo group (sevoflurane 2% for 15 minutes before the tourniquet) and a control group (propofol infusion). Laboratory tests were collected right before the tourniquet (LAB PRE, in the operating room) and after its release at four moments: LAB POST (immediately after), LAB 2 (two hours after), LAB 12 (12 hours after), and LAB 24 (24 hours after). The volume of the suction drain was measured at one, two, 12, and 24 hours after the end of the surgery. Antifibrinolytics were not administered. Results: There was no statistically significant difference in bleeding-related variables, such as drained volume and hemoglobin and hematocrit measurements. Drainage volume was higher in the first two hours after the procedure, while hematocrit decreased pre- to postoperatively and between two and 12 hours post-procedure. Conclusion: Sevoflurane as an anesthetic preconditioning did not reduce postoperative bleeding in TKA surgery.展开更多
Graves’ disease, as known today, is an autoimmune, diffuse, chronic disease of thyroid gland, as described by Robert Graves in 1835. It presents genetic predisposition and unknown etiology evidence, which is influenc...Graves’ disease, as known today, is an autoimmune, diffuse, chronic disease of thyroid gland, as described by Robert Graves in 1835. It presents genetic predisposition and unknown etiology evidence, which is influenced in its development by several factors, including environment (dietary iodine intake, stress, drugs and infections). The disease is characterized by one or more changes: hyperthyroidism, goiter, ophthalmopathy, skin changes and pretibial myxedema, around 5% less common, and other symptoms 90% to 95%. One of the most relevant clinical practice aspects in Graves’ disease patients management is to distinguish Graves’ disease in initial phase, from other types of destructive thyrotoxicosis, in addition to evaluate therapeutic methods and efficient follow up, as well as predict early recurrence or remission of disease. Scintigraphy with pertechnetate (99 mTc) and TSH levels dosage are considered the choice for this purpose. However, they present some technical difficulties, as they are not widely available and have contraindications. In this scenario, thyroid color-flow doppler ultrasonography (US Doppler) presents a viable alternative, as a widely available, low cost, non-invasive and radiation free method, providing initial diagnosis and patients with Graves’ disease follow up. In adittion, this method is used in differential diagnosis with other causes of thyrotoxicosis in the early stage.展开更多
文摘Objective: To observe the accuracy and the advantages and disadvantages of the femoral tunnels made by the two techniques. Materials and Methods: We randomly summoned nineteen patients undergoing anatomic ACL reconstruction in a single band technique by the same surgeon: Ten by group II (GII) and nine by Group I (GI). GI: drilling in the technical in-out. GII: drilling the technique out-in. The patients underwent a CT scan with three-dimensional reconstruction of the distal femur. Was applied the technique of quadrants described by Bernard and Hertel and optimized for position by Forsythe and observed in the femoral tunnel: the accuracy of the joint entry;posterior cortical thickness in that point;emergency lateral distance to the lateral epicondyle and the overall length. Results: The coordinates of the distances obtained average was very close, with no statistical difference comparable to that obtained by Bernard and Hertel and Forsythe. The distance from the tunnel exit to the lateral epicondyle obtained average 1.46 cm in GI and 0.47 cm in GII, with a significant statistical difference. The thickness of the posterior cortex was 3.9 mm in GI and 5.4 mm in GII, with no statistical difference. The length averaged was 3.07 cm in GI and GII in 2.94 cm, with no statistical difference. Conclusions: Both techniques allow well placed tunnels, with no statistical difference. In the technique in-out the tunnel exit is closer to the lateral epicondyle. The thickness of the posterior cortex is similar. The length of the femoral tunnel is similar and around 3 cm.
文摘Background: Total knee arthroplasty (TKA) is a highly complex and effective surgery even though its perioperative bleeding may increase the need for blood transfusion and its associated infection risk, cardiovascular overload, increased costs, and mortality. As the tourniquet reduces intraoperative bleeding, it may be associated with postoperative bleeding, venous thrombosis, and distal ischemia. The reperfusion may trigger a local and systemic inflammatory response. Anesthetic preconditioning (APC) with sevoflurane minimizes ischemia-reperfusion syndrome (IRS). This study evaluated the effects of APC with sevoflurane on perioperative bleeding in TKA. Methods: We allocated 30 patients into two groups: a sevo group (sevoflurane 2% for 15 minutes before the tourniquet) and a control group (propofol infusion). Laboratory tests were collected right before the tourniquet (LAB PRE, in the operating room) and after its release at four moments: LAB POST (immediately after), LAB 2 (two hours after), LAB 12 (12 hours after), and LAB 24 (24 hours after). The volume of the suction drain was measured at one, two, 12, and 24 hours after the end of the surgery. Antifibrinolytics were not administered. Results: There was no statistically significant difference in bleeding-related variables, such as drained volume and hemoglobin and hematocrit measurements. Drainage volume was higher in the first two hours after the procedure, while hematocrit decreased pre- to postoperatively and between two and 12 hours post-procedure. Conclusion: Sevoflurane as an anesthetic preconditioning did not reduce postoperative bleeding in TKA surgery.
文摘Graves’ disease, as known today, is an autoimmune, diffuse, chronic disease of thyroid gland, as described by Robert Graves in 1835. It presents genetic predisposition and unknown etiology evidence, which is influenced in its development by several factors, including environment (dietary iodine intake, stress, drugs and infections). The disease is characterized by one or more changes: hyperthyroidism, goiter, ophthalmopathy, skin changes and pretibial myxedema, around 5% less common, and other symptoms 90% to 95%. One of the most relevant clinical practice aspects in Graves’ disease patients management is to distinguish Graves’ disease in initial phase, from other types of destructive thyrotoxicosis, in addition to evaluate therapeutic methods and efficient follow up, as well as predict early recurrence or remission of disease. Scintigraphy with pertechnetate (99 mTc) and TSH levels dosage are considered the choice for this purpose. However, they present some technical difficulties, as they are not widely available and have contraindications. In this scenario, thyroid color-flow doppler ultrasonography (US Doppler) presents a viable alternative, as a widely available, low cost, non-invasive and radiation free method, providing initial diagnosis and patients with Graves’ disease follow up. In adittion, this method is used in differential diagnosis with other causes of thyrotoxicosis in the early stage.
