Salvage of failed proximal interphalangeal arthroplasty with vascularised toe joint transfer: Report of two cases.

Failed implants of the proximal interphalangeal joint may result in bone and soft tissue deficits and joint instability with limited reliable options for reconstruction besides an arthrodesis procedure. The purpose of this report is to illustrate the use of vascularized second toe joint for salvage of failed, multi-operated proximal interphalangeal joint in two active patients. Pre-existing scars are used to define the approach and choice of donor site. Flow through anastomosis was performed on the finger digital artery. At final follow-up, the transplanted joints achieved 80-90 degrees of motion and the patients were able to return to their desired level of activities. The procedure is a good alternative for the fit patient wanting to achieve a stable finger with preservation of motion in catastrophic failure of prosthetic proximal interphalangeal joint arthroplasty.

BREAST-Q Translation and Linguistic Validation to European Portuguese.

INTRODUCTION: Evaluating the impact of surgical treatment on health-related quality of life of breast cancer patients has become increasingly relevant, particularly for reconstructive procedures. The BREAST-Q consists of a broadly used patient-reported outcome measure to assess the impact of breast surgery on the health-related quality of life of these patients. The aim of this study was to translate and linguistically validate the BREAST-Q reconstructive module to European Portuguese. MATERIAL AND METHODS: The translation and linguistic validation process was based on the International Society for Pharmacoeconomics and Outcomes Research guidelines and started after obtaining permission from the original authors (developers). It involved two direct English to European Portuguese translations and a back translation, maintaining conceptual and cultural equivalence, an expert panel discussion, cognitive interviews with five patients and a final consensus. RESULTS: The forward translations led to the revision of three conceptually distinct items. The backward translation resulted in predominantly wording discrepancies and the three conceptual disparities noted in the back translation were revised on a consensual version. All material was openly discussed with the original authors and in an expert panel meeting. One item was changed after the cognitive interviews. The final consensual version was obtained. CONCLUSION: This stepwise approach allowed to linguistically validate the BREAST-Q reconstructive module to European Portuguese so that it can be used in the Portuguese population. Additionally, the applied methodology may serve to support and guide other instruments for linguistic validation.

Introdução: A avaliação do impacto do tratamento cirúrgico na qualidade de vida relacionada com a saúde de doentes com cancro da mama é cada vez mais relevante, particularmente para procedimentos reconstrutivos. O questionário BREAST-Q é um instrumento de avaliação de resultados reportados pelos doentes amplamente utilizado para avaliar o impacto da cirurgia mamária na qualidade de vida relacionada com a saúde. O objetivo deste estudo foi a tradução e validação linguística do módulo reconstrutivo do questionário BREAST-Q para o Português Europeu. Material e Métodos: O processo de tradução e validação linguística foi baseado nas normas da International Society for Pharmacoeconomics and Outcomes Research. Iniciou-se pela obtenção da autorização dos autores para realizar a tradução. Foram feitas duas traduções diretas independentes de inglês para português europeu e uma tradução reversa, mantendo a equivalência conceptual e cultural, discussão por um painel de especialistas, entrevistas cognitivas a cinco doentes e um consenso final. Resultados: As traduções diretas levaram à revisão de três itens nos quais foram encontradas diferenças conceptuais. A tradução reversa resultou em diferenças predominantemente literárias. Apenas um item foi alterado após as entrevistas cognitivas. Todo o material registado durante o processo de tradução foi discutido abertamente com os autores originais e com o painel de especialistas, culminando numa versão final consensual. Conclusão: Esta abordagem estruturada permitiu validar linguisticamente o módulo reconstrutivo do BREAST-Q para português europeu, permitindo a sua utilização na população portuguesa. Adicionalmente, a metodologia aplicada poderá servir de suporte e guia para outras validações linguísticas.

Induced Brugada syndrome: Possible sources of arrhythmogenesis.

Brugada syndrome is an inherited cardiac condition with the potential for development of life-threatening arrhythmias in relatively young individuals without significant structural cardiac abnormalities. The condition is characterized by a distinct coved-type ST segment elevation in the right precordial leads (V1-V3). This hallmark pattern (type 1) is often dynamic and sometimes concealed, and may be unmasked in certain conditions or under the effect of certain agents, which include variation of sympathovagal balance, hormones, metabolic factors and drugs. These factors may not only modulate electrocardiographic morphology and induce the characteristic type 1 pattern, but also predispose to ventricular arrhythmias. The risk of malignant arrhythmias in acute events with induced type 1 pattern may be imminent, particularly if the patient in fact has Brugada syndrome. The physician should be aware of the modulating factors that may underlie a Brugada pattern, and be able to recognize, identify and promptly correct them. The mechanisms responsible for the type 1 pattern and possible associated ventricular arrhythmias induced by these modulating factors have attracted growing attention and interest. Furthermore, not all induced Brugada ECG patterns are observed in patients with Brugada syndrome, existing the possibility for acquired Brugada patterns/syndrome and Brugada phenocopies. This paper reviews the modulating factors associated with induced type 1 pattern as possible causes of arrhythmogenesis, particularly in Brugada syndrome patients, describes some of the probable underlying mechanisms, and discusses the concepts of acquired Brugada syndrome and Brugada phenocopies.