Use of negative pressure therapy in closed surgical incisions of post-bariatric dermolipectomy / Uso da terapia de pressão negativa em incisões cirúrgicas fechadas de dermolipectomia pós-bariátrica

Introduction: Negative pressure therapy gains ground in surgical practice as an intervention to improve healing. Post-bariatric patients undergoing abdominal dermolipectomy are at increased risk of local complications. There is a notable dearth of current Brazilian studies on this. This study aims to analyze the presence of complications in patients undergoing post-bariatric dermolipectomy surgery with negative pressure dressing in closed surgical incisions. Method: Descriptive study that evaluated complications of surgical incisions in 20 patients undergoing post-bariatric dermolipectomy surgery with negative pressure therapy. Data tabulated in Windows Excel software and analyzed in the Statistical Package for the Social Sciences 18.0 program. Qualitative variables were presented in simple frequency and quantitative as mean, standard deviation, and amplitude. CEP-UNISUL approved the study. Results: 20 patients undergoing negative pressure therapy, 80% (n=16) female, mean age 39.55 years (±9.08). Anchor incision was chosen in 70% (n=14) of the surgeries, with an average tissue removal of 1940 grams (±710.37) and hospitalization time of 40.20 hours (±19.18), corresponding to 1,66 daily. Only 15% (n=3) of patients had complications (dehiscence, seroma, and hematoma, which occurred in the same proportion). There was no case of necrosis. Conclusion: The use of negative pressure therapy in closed surgical incisions of post-bariatric dermolipectomy seems to contribute to reducing postoperative complications.

Introdução: Terapia de pressão negativa ganha espaço na prática cirúrgica como intervenção para melhorar cicatrização. Pacientes pós-bariátricos submetidos a dermolipectomia abdominal apresentam maior risco de complicações locais. Há uma notável escassez de estudos brasileiros atuais acerca disso. O objetivo desse estudo é analisar a presença de complicações em pacientes submetidos a cirurgia de dermolipectomia pós-bariátrica com curativo de pressão negativa em incisões cirúrgicas fechadas. Método: Estudo descritivo que avaliou complicações de incisões cirúrgicas de 20 pacientes submetidos a cirurgia de dermolipectomia pós-bariátrica com terapia de pressão negativa. Dados tabulados no software Windows Excel e analisados no programa Statistical Package for the Social Sciences 18.0. Variáveis qualitativas foram apresentadas em frequência simples e quantitativas através de média, desvio padrão e amplitude. O estudo foi aprovado pelo CEP-UNISUL. Resultados: 20 pacientes submetidos a terapia de pressão negativa, sendo 80% (n=16) do sexo feminino, com idade média de 39,55 anos (±9,08). Incisão em âncora foi escolha em 70% (n=14) das cirurgias, com retirada média de tecido de 1940 gramas (±710,37) e tempo de hospitalização de 40,20 horas (±19,18), correspondendo a 1,66 diárias. Apenas 15% (n=3) dos pacientes apresentaram complicações (deiscência, seroma e hematoma, que aconteceram na mesma proporção). Não houve caso de necrose. Conclusão: Uso da terapia de pressão negativa em incisões cirúrgicas fechadas de dermolipectomia pós-bariátrica parece contribuir na redução das complicações pós-operatórias.

Correlation Between Patterns of Bone Marrow Edema and Their Associated Soft-Tissue Injuries, as seen on Magnetic Resonance Imaging of Knee joint in Patients with a Recent History of Trauma

Introduction: Bone bruise or bone marrow edema is a common innocuous finding in magnetic resonance imaging (MRI) knee ofpatients with trauma. The pattern of bone marrow edema provides insight into the mechanism of injury which, in turn, helps to evaluatethe injuries with a more discerning eye. Five basic mechanisms of knee injury which are commonly seen in MRI scan of knee traumapatients are pivot shift, dashboard injury, hyperextension, clip injury, and lateral patellar dislocation. Each of these mechanisms causescharacteristic bone marrow edema patterns and has associated soft-tissue injuries, following the musculoskeletal biomechanics.Aim: The purpose of this study is to assess the correlation between bone marrow edema patterns and associated soft-tissue injuries.Settings and Design: This is a cross-sectional study of 200 patients conducted at the Department of Radiodiagnosis andImaging, MGM Medical College and Associated Hospitals, Indore.Materials and Methods: MRI of 200 cases of recent knee injury was analyzed to determine bone marrow edema pattern. Thepattern of edema and soft-tissue injuries was plotted and analyzed to see a significant correlation.Statistical Analysis Used: Variables were expressed as percentages and comparison was done by Chi-square analysis. Twotailed P < 0.05 was considered statistically significant.Results: Significant correlation was seen between pivot shift injury and anterior cruciate ligament (ACL) tear, pivot shift injury andmedial meniscus tear, dashboard injury and posterior cruciate ligament (PCL) tear, lateral patellar dislocation and medial patellofemoralligament (MPFL) tear, and clip injury and medial collateral ligament (MCL) tear. Pivot shift was the most common bone marrowedema pattern, accounting for 55.5% of cases and hyperextension was the least common pattern, seen in only 3% of cases.Conclusion: The pattern of bone marrow edema can provide a road map to associated soft-tissue injuries which assist in finerevaluation and can help in creating better patient management outcomes.

Frequência de alterações posturais em hemofílicos / Frequency of postural alterations in haemophiliacs

Introduction: A hemophilia is a chronic disease of genetic origin caused by a mutation of the genes which encode blood clotting factors. One of the consequences of this alteration is the involvement of the musculoskeletal system, which may influence the posture of these individuals. Objective:To estimate the frequency of postural changes in hemophilia patients, and identify possible factors associated. Methods:A cross-sectional descriptive study, conducted with individuals aged ≥ 18 years,with diagnosis of hemophilia,in follow-up at the Hematology and Hemotherapy Foundation of Bahia (HEMOBA).The participants were submitted to postural evaluation,through visual analysis, Adams test and the application of a semi-structured form.Epi Info® (v.3.5.2) was used for data analysis and to verify the existence of associations between the variables of the study were used the Exact Fisher, Qui-Square and Qui-Square Tests with the Yates correction and considered as statistically significant associations with p <0.05.Results:Twenty-nine hemophiliacs participated in this study, with mean age of 34.98 ± 12,6 years, 25 (86.2%) reported having hemophilic arthropathy. Of the 13 research participants (68.4%) presented scoliotic posture detected by the Adams test.The change was more frequent in individuals with more than one joint affected by hemophilic arthropathy, with a statistically significant value for this variable (p = 0.039).Conclusion:The frequencies of postural changes in individuals with hemophilia are elevated with a significant association for individuals over 40 years of age and with with more than one joint affected by haemophilic arthropathy. (AU)

Introdução: A hemofilia é uma doença crônica de origem genética causada por uma mutação dos genes que codificam os fatores de coagulação sanguíneos. Uma das consequências dessa alteração é o acometimento do sistema musculoesquelético, o que pode influenciar na postura desses indivíduos. Objetivo: Estimar a frequência de alterações posturais em portadores de hemofilia, e identificar possíveis fatores associados. Métodos: Estudo descritivo de corte transversal, conduzido com indivíduos com idade ≥ 18 anos, com diagnóstico de hemofilia, em acompanhamento na Fundação de Hematologia e Hemoterapia da Bahia (HEMOBA). Os participantes foram submetidos à avaliação postural, por meio da análise visual, teste de Adams e aplicação de um formulário semi-estruturado. Empregou-se o Epi Info® (v.3.5.2) para análise dos dados e, para verificar a existência de associações entre as variáveis do estudo foram utilizados os Testes exato de Fisher, Qui-quadrado (bicaudal) e Qui-Quadrado com a correção de Yates. Consideradas como estatisticamente significantes associações com p <0,05. Resultados: Participaram deste estudo 29 hemofílicos, com média de idade de 34,9 ± 12,6 anos, 25 (86,2%) informaram ter artropatia hemofílica. Dos participantes da pesquisa 13 (68,4%) apresentaram postura escoliótica detectada pelo teste de Adams. A alteração foi mais frequente nos indivíduos com mais de uma articulação afetada pela artropatia hemofílica, com valor estatisticamente significativo para esta variável (p= 0,039). Conclusão: As frequências de alterações posturais em indivíduos com hemofilia são elevadas com associação significativa para os indivíduos com idade superior a 40 anos e com mais de uma articulação afetada pela artropatia hemofílica. (AU)

Time-dependent Protein Expressions of MMP-2 and MMP-9 in Liver Contusion Rats after Impact / 法医学杂志

Objective To observe the protein expression patterns of matrix metalloproteinase (MMP)-2 and MMP-9 in the liver tissue of liver contusion rats at different time after impact. Methods Fifty healthy adult male SD rats were randomly and evenly divided into control group and experimental groups (1 h, 3 h, 6 h, 12 h, 18 h, 24 h, 3 d, 5 d, 7 d after liver contusion). A rat liver contusion model was established by a free-falling device. The rats were killed at corresponding time, and the contused hepatic lobes were extracted. The protein expressions of MMP-2 and MMP-9 in contused liver tissue of the rats in each group were observed by immunohistochemical staining (SP method) and Western blotting. Results After the liver contusion, the expression of positive cell and the protein semiquantitative result showed that the protein expression of MMP-2 enhanced at 6 h and peaked at 24 h, then decreased gradually at 3-5 d, and returned to normal levels at 7 d. The difference of expression between group and its previous adjacent group after 6 h (except 18 h) had statistical significance (P<0.05). The protein expression of MMP-9 rose obviously at 1 h after liver contusion and peaked at 18 h, then decreased gradually at 3-7 d which still higher than control group. The expression difference between group and its previous adjacent group (except 12 h and 24 h) had statistical significance (P<0.05). Conclusion The protein expressions of MMP-2 and MMP-9 in contused liver tissue after impact show good time-dependent patterns, which may provide important reference indicators for the time estimation of liver contusion.

<b>Jidabokuippo and Sokeikakketsuto for Prolonged Pain After Bruising : A Case R</b><b>eport</b> / 日本東洋医学雑誌

<p>We reported a patient whose left hypochondrial pain disappeared after treatment with jidabokuippo and sokeikakketsuto. An 81-years-old woman developed pain after bruising for 2 months. Intercostal nerve block temporarily reduced the pain ; however, considerable pain subsequently remained. The patient received Jidabokuippo and Sokeikakketsuto. Seventeen days later, the patient was relieved from the prolonged pain and had melanotic defecation. This suggests that formulas classified for the treatment of potential blood stasis may relieve prolonged pain.</p>

Age related changes in mechanical and thermal injuries: A post mortem study.

Dating of an injury in both living and dead is an important medico-legal issue in the field of crime investigation to fix the liability. A doctor is required to date injuries specifically and individually while preparing an injury report. In this paper we study the sequential changes in mechanical and thermal injuries and to compare the findings with available standard data. All the medico-legal deaths due to injuries, brought for post-mortem examination, over a period of four months were studied. On comparing with standard data, 71% (n=32) of the abrasions were dark red instead of bright red on first day. 92% (n=13) bruises appears bluish green instead of red colour on first day and on the 5th day, the colour appears black instead of greenish colour. In cases of incised and lacerated wound margins were difficult to separate on the 2nd day, instead of separating easily. Observations of this study did not match with the sequential colour changes mentioned in the available literature. Therefore, other parameters need to be explored for dating an injury.

Prediction of Subsequent Vertebral Collapse after Osteoporotic Thoracolumbar Vertebral Fractures / 대한골다공증학회지

OBJECTIVES: To evaluate the clinical significance of vertebral bone bruise (VBB) in terms of subsequent collapse after osteoporotic thoracolumbar vertebral fractures. METHODS: We reviewed 41 consecutive patients with 46 osteoporotic thoracolumbar vertebral fractures treated nonoperatively from March 2007 to February 2010. Anterior wedge angle (AWA) was measured on plain radiographs and the change of AWA between the initial and last measurement was used to represent the subsequent vertebral collapse. The size of VBB was measured and VBB ratio was calculated on T1-weighted sagittal MR image. RESULTS: The average VBB ratio was 49.1% and the average change of AWA was 7.1degrees. Only VBB ratio significantly correlated with the change of AWA (P<0.001, cc=0.660). The other factors such as age, initial AWA, and endplate status showed no significant correlation with the change of AWA (P=0.629, P=0.724, P=0.690, respectively). In DEXA group, no correlation was found between T-score and the change of AWA as well as between T-score and VBB ratio (P=0.548, P=0.370, respectively). Five fractures were diagnosed as delayed post-traumatic vertebral collapse. Their average VBB ratio was 71.2% which was significantly higher than that of the other subjects (P=0.015). The fractures with VBB ratio more than 60% was likely to progress to delayed post-traumatic vertebral collapse. CONCLUSIONS: VBB after osteoporotic thoracolumbar vertebral fracture was significantly correlated with subsequent vertebral collapse (cc=0.660). We recommend the patients with a large vertebral bone bruise, especially more than 60%, should be followed up meticulously for the early detection of delayed post-traumatic vertebral collapse.

Preliminary Study of Clinical Consequence of Type Ⅰ Bone Bruise in Acutely Sprained Knee / 中国康复理论与实践

@# Objective To evaluate prospectively clinical significance and consequence of type Ⅰ bone bruise in acutely sprained knee. Methods 23 outpatients were selected, meeting our criteria from 2005 to 2008. All the injured knees were immobilized with gypsum for 4 to 6 weeks, and the knee complaints and MRI were followed up regularly.Results 18 patients were followed up, averaged 24 months, the bone bruise showed notable resolution in average 3 months and vanished in 6.7 months averagely; the knee pain alleviated obviously in about 4.8 months; 5 out of 9 cases, who were more than 45 years old, still complained knee pain and uncomfortable after 2 years.Conclusion Grade Ⅰ knee sprain can lead to bone bruise in condyles of femur or tibia, and knee immobilization should be given to avoid the further damage; the bone bruise may be a precursor of knee osteoarthritis for people older than 45 years.

The Effects of Arnica Montana Gel for the Decreasing on the Swelling and Bruise

Homeopathic medicine is becoming increasingly popular in this country and abroad. Arnica montana has been known since the 16th century as an acute topical treatment of sprains, bruises, painful swellings, and wounds. Although arnica has a long history in folk medicine and is widely used, efficacy in a decreasing of swelling and bruise has never been clinically studied. This study investigated the safety and efficacy of an Arnica montana gel, applied the twice daily, in 15 patients(6 men and 9 women) who had trauma with swelling and bruise without external wound of the face from April of 2006 through December of 2006. The trauma with swelling and bruise was made on the dorsum of the rat, and then applied the twice daily for 1 week divided in control site and arnica-applied site on the dorsum. On the patients' subjective assessment of efficacy, 15 patients felt an effect in 1 week, and time to onset of effect averaged 2.8 days. On the experimental study of efficacy, microscopic finding of control site showed the dermis is mildly widened interstitial spaces, the interstitial fluid is mildly increased, but arnica-applied site showed the interstitial edema is not evident, the dermal collagen fibers are relatively well preserved. Topical application of Arnica montana gel for 1 week was a safe, well-tolerated, and effective treatment of swelling and bruise of the face.

Clinical Implications of Bone Bruises on MRI in Acute Traumatic ACL or PCL Injury / 대한정형외과학회잡지

PURPOSE: Bone bruises of patients with acute traumatic knee injuries, that are not found on simple radiograph, can be found on magnetic resonance imaging (MRI). The purpose of this study is to evaluate the frequency and locations of bone bruises on MRI in acute traumatic anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) injury. MATERIALS AND METHODS: 25 and 19 MRls, in which acute traumatic ACL and PCL injury was pre sent and there was no abnormality in simple radiograph, were reviewed. MRI was taken within 51 days of injury. A bone bruise was determined as a geographic and nonlinear area of signal loss on T1 images and increased signal intensity on T2 images involving the subcortical bone. RESULTS: In 16 patients with bone bruises and acute ACL injury, bone bruises were found in the lateral compartment of the knee in 15 (93.8%) patients. The most common area was the lateral tibial plateau (11 cases, 68.8%) and the second was lateral femoral condyle (9 cases, 56.3%). In 5 patients with bone bruises and acute PCL injury, bone bruises were found in the lateral compartment of the knee in all 5 (100%) patients. The most common area was lateral tibial plateau (4 cases, 80%) and the second was lateral femoral condyle (2 cases, 40%). CONCLUSIONS: In patients with acute traumatic ACL or PCL injuries the bone bruises are often found on the lateral compartment of the knee, especially lateral tibial plateau and lateral femoral condyle on MRI.

Bone SPECT after ACL Reconstruction: Prognostic Factors for Arthritis

PURPOSE: To evaluate prognostic factors for arthritis and usefulness of bone SPECT in reconstructed joint. MATERIAL AND METHOD: ACL reconstruction using bone-patellar tendon-bone graft was performed in fourteen patients from March 1996 to March 1997, and follow-up bone SPECT was done. The mean duration from ACL reconstruction to SPECT was 23 months. The knee was defined to be unstable when the difference of displacement measured using KT-2000 arthrometer was greater than 3 mm. Lesions were evaluated in sub-divided five compartments ; patello-femoral joint, anteromedial, anterolateral, postero-medial and posterolateral compartment of tibio-femoral joint. RESULT: Geographic bone bruise was found in 9 cases(15 compartments) of 14 patients and bone SPECT revealed increased uptake in all the compartments. Reticular type bone bruise was found in 6 cases(7 compartments) and no compartment revealed increased uptake. Partial meniscectomy was done in 9 cases(16 compartments), and 8 cases(13 compartments) of them revealed increased uptake. Six cases were unstable and four of them revealed increased uptake in the patello-femoral joint. Activity level was not correlated with hot uptake. CONCLUSIONS: Bone SPECT is a useful method to predict osteoarthritis after ACL reconstruction. Geo-graphic bone bruises at injury, meniscectomy and instability are important factors for prognosis after ACL reconstruction.

MRI Findings of Bone Bruises Associated with Acute Anterior Cruciate Ligament Ruptures / 中国运动医学杂志

Objective To study the magnetic resonance imaging (MRI) characteristic of bone bruises associated with acute anterior cruciate ligament (ACL) ruptures and to investigate the correlation between bone bruises and cartilage lesions. Methods The MRI findings of 37 cases of acute ACL ruptures associated with bone bruises were studied retrospestively. The classification and distribution of bone bruises were analyzed and the cartilage lesions were also observed under arthroscopy. Results A total of 57 independent bone bruises(type Ⅰ:14, type Ⅱ:32, type Ⅲ:3, type Ⅳ:6 and type Ⅴ:2) were documented by MRI in the 37 patients. 54 (94.7%) bone bruises located in lateral joint compartment with involvement of lateral femoral condyle in 31 and lateral tibial plateau in 23. Nine cases (15.8%) of articular cartilage lesions were found under arthroscopy in the area overlying bone bruises. Conclusion Bone bruises associated with acute ACL ruptures mainly located in the lateral compartment of knee, especially in anterior portion of lateral femoral condyle and posterior portion of lateral tibial plateau. Arthroscopic cartilage lesions were not corresponding to bone bruises.