Boyd Amputation Using the Tension Band Technique.

BACKGROUND: Amputation at the level of the hindfoot results in an equinus deformity from an imbalance of muscle-tendons acting across the ankle. Boyd's reconstruction for hindfoot amputations is a well-known technique that retains the calcaneus and fuses it with the distal tibia at the ankle mortise. It provides an excellent weight-bearing stump and in most cases does not require an artificial limb but its use has been restricted because of the difficulty in obtaining high union rates in the tibiocalcaneal fusion. MATERIALS AND METHODS: Five patients (four unilateral and one bilateral) underwent leg amputations from January 2012 to November 2013 using the Boyd technique for reconstructing the stump and were stabilized with a tension band. The study sample consisted of adult patients who had traumatic reasons for the amputation. Patients under 18 years old with a hindfoot that was inadequate for Boyd reconstruction (i.e., insufficient soft tissue coverage or no posterior tibial artery pulse) were excluded. One (case #2) had systemic comorbidities (e.g., hypertension, diabetes, chronic vascular insufficiency) as well as being a smoker. Three men and two women (mean age 39 years; range 21-61 years) were included. Three patients underwent amputation on the right side, one on the left side, and one bilaterally (case #5). All patients presented with Gustillo and Anderson IIIC open fractures. The mean time from lesion to amputation was 2.25 weeks (range 1-4 weeks). The mean follow-up duration was 16 (range 12-24) months. The post-surgery examination included a clinical examination and radiography. A 6 minute walk test (6 MWT) was performed on week 32 after the amputation. This study was carried out with the approval of our institution's ethics committee. All patients provided a written informed consent form in accordance with the World Medical Association and the Declaration of Helsinki. RESULTS: All six stumps fused successfully. The 6 MWT results were comparable to those found in the literature for other lower limb amputees. CONCLUSION: The tension band technique used as part of the Boyd amputation to achieve tibiocalcaneal fusion was effective in all five trauma patients. Sound fusion was achieved in all cases with the 6 MWT scores comparable to that in the literature. This technique should be considered an osteosynthesis option for the Boyd procedure. LEVEL OF EVIDENCE: Level IV, retrospective study. HOW TO CITE THIS ARTICLE: Mongon MLD, Sposito AL, Nunes GMN, et al. Boyd Amputation Using the Tension Band Technique. Strategies Trauma Limb Reconstr 2019;14(2):102-105.

Factors associated with maternal mortality among patients meeting criteria of severe maternal morbidity and near miss.

OBJECTIVE: To evaluate factors associated with maternal death among women experiencing life-threatening conditions during pregnancy, childbirth, or within 42 days of termination of pregnancy. METHODS: A secondary analysis of data prospectively collected in a Brazilian multicenter cross-sectional study between July 2009 and June 2010 was conducted. Women were identified who delivered at a hospital in Ceará and who had potentially life-threatening conditions. Stepwise logistic regression was used to identify factors associated with maternal death. RESULTS: Overall, 941 women were identified and 11 died. Among criteria for severe maternal morbidity, eclampsia (adjusted odds ratio [aOR] 203.70, 95% CI 5.03 to 8254.20; P=0.005) and intensive care unit (ICU) admission (aOR 69.30, 95% CI 6.63-724.26; P<0.001) were risk factors for progression to death, whereas use of magnesium sulfate (aOR 0.002, 95% CI <0.01-0.11; P=0.002) was a protective factor. Meeting near-miss criteria other than survival (aOR 5.96, 95% CI 1.69-20.98; P=0.005) was associated with maternal death. Of criteria for near miss, management criteria were most strongly associated with maternal death: all 11 women who died met some management criteria. CONCLUSION: Among WHO's criteria for severe maternal morbidity and near miss, eclampsia, low oxygen saturation, ICU admission, intubation, mechanical ventilation, and cardiopulmonary resuscitation were most associated with maternal death. Use of magnesium sulfate was a protective factor.

HIV or human papillomavirus co-infection among Brazilian individuals infected with hepatitis B and/or hepatitis C.

OBJECTIVE: To investigate the incidence of co-infection with HIV and human papillomavirus (HPV) among Brazilian individuals with hepatitis B virus (HBV) or hepatitis C virus (HCV) infection. METHODS: A prospective study was conducted that enrolled 103 individuals from the Ceará region of Brazil between January 4, 2010, and August 9, 2012. Eligible participants were men (n=45) or women (n=58) infected with HBV and/or HCV. Pap smears were collected from female patients. Material from male (urethra) and female (cervix) patients was then collected via DNA-HPV test and visual inspection with acetic acid. RESULTS: In all, 48 participants tested positive for HBV and 55 tested positive for HCV; 2 had dual infection with HBV and HCV. Co-infection with HIV was detected among 15 participants, whereas 20 participants were found to be co-infected with HPV. CONCLUSION: A high prevalence of co-infection with HIV and HPV was detected among Brazilian individuals with HBV and/or HCV.

Fabric softeners: nearly instantaneous characterization and quality control of cationic surfactants by easy ambient sonic-spray ionization mass spectrometry.

A tiny droplet of typical samples of fabric softeners from different commercial brands placed on a smooth paper surface was subjected to easy ambient sonic-spray ionization mass spectrometry (EASI-MS). With no need for sample-preparation or pre-separation procedures, EASI-MS and EASI-MS/MS identify nearly instantaneously the main surfactants and the homologous series employed in their formulations. Adulterated and low quality samples containing no or less efficient softeners are also easily recognized.

Câncer cervical: prevenção primária ou secundária? / Cervical cancer: primary or secondary level prevention?

O MInistério da Saúde tem como meta a prevenção da mortalidade materna por câncer cervical através de um programa de rastreamento com o teste de Papanicolaou, visando a detecção precoce da doença, prevenção secundária e o tratamento adequado das lesões

Calf augmentation with supraperiostic solid prosthesis associated with fasciotomies.

This article describes, for the first time, the supraperiostic technique used for aesthetic purposes to remedy hemiatrophy, genu valgum, poliomyelitis sequela, and thin legs. For genu valgum and thin legs, a solid prosthesis was used, whereas for severe hemiatrophy a double light prosthesis was used as a tissue expansor, with excellent reports. The advantages of this technique are delineated further in this article.