Musculoskeletal evaluation in severe haemophilia A patients from Latin America.

There is a paucity of literature on haemophilia treatment in Latin American countries, a region characterized by rapidly improving systems of care, but with substantial disparities in treatment between countries. The aim of this study was to evaluate the musculoskeletal status of haemophilia patients from Latin America and to examine the relationship between musculoskeletal status and treatment practices across countries. The Committee of Latin America on the Therapeutics of Inhibitor Groups conducted a survey of its member country representatives on key aspects of haemophilia treatment in 10 countries. Musculoskeletal status of patients was obtained during routine comprehensive evaluations between March 2009 and March 2011. Eligible patients had severe haemophilia A (factor VIII <1%) without inhibitors (<0.6 BU mL(-1) ) and were ≥5 years of age. Musculoskeletal status was compared between three groups of countries, based primarily on differences in the availability of long-term prophylaxis. Overall, 143 patients (5-66 years of age) were enrolled from nine countries. In countries where long-term prophylaxis had been available for at least 10 years (Group A), patients aged 5-10 years had significantly better mean World Federation of Hemophilia clinical scores, fewer target joints and fewer affected joints than patients from countries where long-term prophylaxis has been available for about 5 years (Group B) or was not available (Group C). In Latin America, the musculoskeletal status of patients with severe haemophilia without inhibitors has improved significantly in association with the provision of long-term prophylaxis. As more countries in Latin America institute this practice, further improvements are anticipated.

The economics and timing of preoperative antibiotics for orthopaedic procedures.

BACKGROUND: The efficacy of antibiotics in preventing surgical site infections (SSIs) depends on the timing of administration relative to the start of surgery. However, currently, both the timing of and recommendations for administration vary substantially. AIM: To determine how the economic value from the hospital perspective of preoperative antibiotics varies with the timing of administration for orthopaedic procedures. METHODS: Computational decision and operational models were developed from the hospital perspective. Baseline analyses looked at current timing of administration, while additional analyses varied the timing of administration, compliance with recommended guidelines, and the goal time-interval. FINDINGS: Beginning antibiotic administration within 0-30 min prior to surgery resulted in the lowest costs and SSIs. Operationally, linking to a pre-surgical activity, administering antibiotics prior to incision but after anaesthesia-ready time was optimal, as 92.1% of the time, antibiotics were administered in the optimal time-interval (0-30 min prior to incision). Improving administration compliance from 80% to 90% for this pre-surgical activity results in cost savings of $447 per year for a hospital performing 100 orthopaedic operations a year. CONCLUSION: This study quantifies the potential cost-savings when antibiotic administration timing is improved, which in turn can guide the amount hospitals should invest to address this issue.

[Anomalous insertion of the pectoralis minor muscle: ultrasound findings]. / Aspect échographique des anomalies d'insertion du muscle pectoralis minor (petit pectoral).

PURPOSE: With anomalous insertion of the pectoralis minor muscle, its distal fibers pass over the coracoid process instead of inserting on it, following sometimes a trajectory very similar to that of the coracohumeral ligament. The aim of this prospective study was to evaluate the frequency of detection of this anomalous insertion by ultrasonography. MATERIALS AND METHODS: Ultrasound demonstrated the abnormal insertion of the pectoralis minor muscle by directly visualizing its fibers slipping over the coracoid process during external and internal rotation of the humerus. Three hundred and three individuals underwent ultrasound of the shoulders (64,7% female, mean age of 45 years), for a total of six hundred and six shoulders; 30% (183/606) were symptomatic. RESULTS: An abnormal insertion was demonstrated in 9,57% of the examined shoulders (58/606), with a statistically significant predominance on the left side (12,2%) compared to the right side (6,9%), and of women (12,2%) compared to men (4,7%). CONCLUSION: Ultrasound demonstrated an abnormal insertion of the pectoralis minor muscle in 9,57% of 606 examined shoulders. There was a female and left side predominance and no significant correlation with symptoms.

Knee imaging after anterior cruciate ligament reconstruction.

An increasing number of reconstructions of the anterior cruciate ligament (ACL) are performed every year, due to both the increasing occurrence of sport related injuries and the development of diagnostic and surgical techniques. The most used surgical procedure for the torn ACL reconstruction is the use of autogenous material, most often the patellar and semitendinosus tendons. Magnetic resonance (MR) imaging and spiral-CT performed after arthrography with multiplanar reconstructions are the imaging methods of choice for post-operative evaluation of ACL ligamentoplasty. This paper provides a brief bibliographic and more extensive pictorial review of the normal evolution and possible complications after ACL repair.

[Hepatic venous system and its application in the so-called split-liver transplantation technic]. / Estudo do sistema venoso hepático e sua aplicação na técnica de transplante de fígado chamada "split-liver".

Sixty fresh adult livers were obtained from cadavers together with celiac trunk, head of the pancreas and superior mesenteric artery. The right portal vein, left portal vein and their respective branches were dissected as well as the hepatic veins. There was only one right hepatic vein in 59 cases. The median hepatic vein was present in 53 (88.3%) cases and the left hepatic vein only in 46(76.3%). In 59(98.3%) cases, there were right and left portal vein but in one (1.6%) case no portal bifurcation has been found. The median portal vein has been found only in 9(15.2%) cases.