ABSTRACT
Background: The use of reverse total shoulder arthroplasty (RSA) for the treatment of proximal humeral fractures (PHFs) is steadily increasing. Better clinical outcomes of RSA have been correlated with tuberosity reattachment and healing. The purpose of this study was to evaluate both the clinical and radiological results of reverse shoulder arthroplasty in the management of a proximal humerus fracture in the elderly. Methods: Retrospective study including 400 consecutive 3-4 part proximal humerus fractures treated with reverse shoulder arthroplasty with a minimum of 12-month follow-up. In all the cases, the greater tuberosity was reattached with a standardized suture technique and a local bone graft. All the patients were assessed at the 12-month follow-up with Constant-Murley Score (CMS). Radiographic healing of the greater tuberosity was noted. Complications and revision rates were reported. Results: Mean final CMS for this cohort was 82 points. The greater tuberosity healed in anatomic position in 85% of the cases (N = 340), obtaining an average CMS of 85 in these patients. Healing of the greater tuberosity did not occur in 13% of the cases (N = 52) and displacement more than 5 mm occurred in 2% (N = 8) of the patients for an average CMS of 60. All patients scored above 120° in forward elevation with a mean of 150°. Mean active external rotation was 35°. The lateralization shoulder angle had a mean of 91° and the distalization shoulder angle had a mean of 54°. Low-grade scapular notching was reported in <1% of the cases. A total of 60 patients presented failure of healing or displacement of the greater tuberosity. Major complications were reported in nine patients. Of these nine patients, two acquired superficial wound infections, while two had deep shoulder prosthetic infection. Two other patients developed hematomas, one sustained an acromial stress fracture, and two had a stem loosening. There were 4 reoperations. Conclusion: Reverse shoulder arthroplasty, with the use of a fracture-specific stem, allows an improved rate of greater tuberosity healing and short-term clinical outcomes in the elderly population.
ABSTRACT
BACKGROUND: TULUA, a transverse plication lipoabdominoplasty, which excludes elevation of the supraumbilical flap and includes a skin graft neoumbilicoplasty, claims greater safety and better results. An animal study was designed to compare it, with two current techniques. MATERIALS AND METHODS: Three matched groups of 12 rats had combined liposuction and abdominoplasty. Liposuction was extensive and unrestricted. Groups 1 and 2 had vertical plication and transposition umbilicoplasty, and group 3 had transverse plication and neoumbilicoplasty. Flap elevation in the epigastrium was wide to costal margins in group 1, limited to a tunnel in group 2, and no dissection in group 3. The animals were observed for 21 days and then euthanized. Intraoperative, postoperative, and postmortem variables and findings were measured and analyzed to find differences between groups. RESULTS: Transverse lipoabdominoplasty demonstrated a wider wall plication area, as well as a decrease in tension to close the wound, causing the horizontal scar to remain in a low position. In vertical plication lipoabdominoplasty groups, flap necrosis and seromas were more frequent, and the umbilical position descended due to secondary healing and scar contraction. The scar's scores were better in the transverse group and were confirmed when evaluated by external observers.In postmortem examination, horizontal plication presented less widening; perforator vessels were preserved when surgical undermining of the upper abdomen was not performed, and there were fewer seromas. CONCLUSION: In a rat model, TULUA demonstrates superior results and a decrease in complications when compared to lipoabdominoplasties with vertical plication and wide or tunneled dissection in the upper abdomen. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Subject(s)
Abdominal Wall , Abdominoplasty , Lipectomy , Lipoabdominoplasty , Abdominal Wall/surgery , Abdominoplasty/methods , Animals , Lipoabdominoplasty/methods , Rats , Treatment OutcomeABSTRACT
RESUMEN Este trabajo tiene como objetivo presentar los Pucciniales encontrados en páramos de Antioquia sobre la familia Cyperaceae. Fueron realizadas colecciones de plantas parasitadas por Pucciniales en páramos del departamento de Antioquia en altitudes desde los 2800 hasta 4050 m s.n.m.; de los 136 materiales colectados, un total de 18 correspondieron a la familia Cyperaceae. Los estados espóricos se observaron bajo el estereomicroscopio permitiendo tener información sobre los soros y a partir de allí se realizaron micropreparados en lactoglicerina mediante raspados o cortes a mano alzada, se hicieron 40 mediciones de cada una de las estructuras encontradas al microscopio y con una cámara digital acoplada a este se tomaron las microfotografías. Entre los resultados obtenidos destacan la descripción de la nueva especie Puccinia sonsonensis; el primer registro para Colombia de Puccinia caricina, Puccinia dioicae y Puccinia cephalotes y se registran por primera vez especies del género Carex parasitadas por roya en Colombia. Los resultados proveen un argumento adicional sobre la urgencia de preservación y continuar con los estudios en estas áreas.
ABSTRACT This paper aims to present the Pucciniales found in paramos of Antioquia on the Cyperaceae family. Collections were made of parasitized plants by Pucciniales in páramos of Antioquia Department with altitudes from 2800 to 4050 masl.; of the 136 collected materials, a total of 18 belonged to the Cyperaceae family. The spore states were observed under the stereomicroscope to have information about sori and from there micropreparations were made in lactoglycerin through free-hand sections and scrapings, 40 measurements were made of each of the structures found under the microscope and images were taken with a digital camera coupled. Results obtained include the description of the new species Puccinia sonsonensis; the first registration for Colombia of Puccinia caricina, Puccinia dioicae and Puccinia cephalotes, and first time record of species of the genus Carex parasitized by rust in Colombia. The results provide a additional argument the urgency of preservation and continuous study for such areas.
ABSTRACT
La implementación de un sistema de información es una actividad que requiere análisis y planificación acordes con el impacto que esta actividad pueda implicar para la organización; en este sentido, el objetivo principal de este artículo es dar a conocer el impacto organizacional que se genera durante el proceso de implementación de un sistema de información -ERP tomando como caso de estudio la empresa Comestibles SAS que adelantó este proceso durante el período 2013 - 2014. La investigación se desarrolló bajo un enfoque cuantitativo y cualitativo, con la participación de 61 personas involucradas en el proceso de implementación del sistema de información. Entre los principales resultados en las dimensiones organizacionales se puede mencionar que el mayor impacto positivo se refleja en la dimensión política de la organización; sin embargo, en las dimensiones económica, social y tecnológica se evidenciaron dificultades en el proceso que generaron impactos negativos; estos resultados pueden ser útiles para empresas con características similares al caso de estudio, que decidan asumir el reto de implementar este tipo de sistemas ERP con todos los cambios y riesgos que esto conlleva en el orden organizacional.
The implementation of an information system is an activity that requires analysis and planning according to the impact that this activity may involve for the organization; In this sense, the main objective of this article is to present organizational impact generated during the process of implementing an information system -ERP taking as a case study company Comestibles SAS forward this process during the period 2013 - 2014. the research was conducted under a quantitative and qualitative approach, with the participation of 61 people involved in the process of implementation of the information system. Among the main results in organizational dimensions it may mention that the greatest positive impact is reflected at the level of the political dimension of the organization; however in the economic, social and technological dimensions difficulties evidenced in the process that generated negative impacts; these results may be useful for companies with similar to the case study that decide to take on the challenge of implementing this type of ERP systems with all changes and risks involved at the organizational level features.
A implementação de um sistema de informação é uma atividade que requer análise e planejamento em linha com o impacto que esta atividade pode envolver para a organização; neste sentido, o principal objetivo deste artigo é apresentar impacto organizacional gerado durante o processo de implementação de um sistema de informação -ERP tomando como uma empresa de estudo de caso Comestibles SAS por diante este processo durante o período de 2013 - 2014. a pesquisa foi realizada sob uma abordagem quantitativa e qualitativa, com a participação de 61 pessoas envolvidas no processo de implementação do sistema de informação. Entre os principais resultados em dimensões organizacionais pode mencionar que o maior impacto positivo se reflete na dimensão política da organização; no entanto, nas dificuldades dimensões econômicas, sociais e tecnológicas que era evidente no processo que gerou impactos negativos; Estes resultados podem ser úteis para as empresas com similar ao estudo de caso, eles decidem assumir o desafio de implementar este tipo de sistemas ERP com todas as mudanças e riscos envolvidos nas características de ordem organizacional.
ABSTRACT
Retrograde intubation is currently part of the Difficult Airway Algorithm of the American Society of Anesthesiologists, and as such, every anesthesiologist should be competent in this procedure. Nevertheless, when performing it, one must be aware that it is not exempt of complications. We review the case of a patient who, after being intubated using this technique, developed signs and symptoms compatible with the Macklin effect. Macklin effect involves a three-step pathophysiologic process: blunt traumatic alveolar rupture, air dissection along bronchovascular sheaths, and spreading of this blunt pulmonary interstitial emphysema into the mediastinum.
