Robotic Transfer of the Latissimus Dorsi Associated With Levator Scapulae and Rhomboid Minor Mini-Open Transfers for Trapezium Palsy.

Robotic surgery has been used for a long time. With advantages over traditional surgical methods, it is earning space and expanding use to daily medical practice in several surgical specialties. This Technical Note presents an endoscopic robotic posterior shoulder approach using the DaVinci® robot. It can allow the surgeon to perform latissimus dorsi transfer endoscopically and associate it with levator scapulae and rhomboid minor mini-open transfers to treat accessory nerve lesions with trapezium muscle palsy. This technique is an alternative to Eden-Lange and triple-tendon transfer.

Endoscopic Release of the Brachial Plexus.

Thoracic outlet syndrome is a debilitating condition, impairing the function of the upper limb, and can be considered an entrapment of neurovascular structures dedicated to the upper limb. Its open treatment uses a large approach, and to date, only the structures under the clavicle have been endoscopically approached. The purpose of this Technical Note is to describe an endoscopic brachial plexus decompression at all possible entrapment areas between the neck and the arm.

Pivot Superior Capsular Reconstruction of the Shoulder.

Massive rotator cuff tears involving the posterosuperior rotator cuff remain difficult to treat, particularly in the younger population. Fatty infiltration of the muscle, excessive chronic tendon retraction, and degeneration are the main irreversible factors predisposing to high failure rates of direct repair. Many techniques exist for superior capsular reconstruction (SCR), mainly using allograft. However, the higher costs of dermal grafts and morbidity of fascia lata autograft led us to find another option for SCR of the shoulder using the semitendinosus autograft as a pivot in a better biomechanical configuration. The pivot SCR technique has shown good functional and biomechanical results. We have found this technique to be a reliable and less expensive option for irreparable lesions of the rotator cuff.

Tratamento da artrose unicompartimental medial do joelho com artroplastia unicompartimental tipo Repicci II: relato preliminar de 42 casos / Treatment of medial unicompartmental arthrosis of the knee with Repicci II unicompartmental arthroplasty: preliminary report of 42 cases

OBJETIVO: Relatar a evolução de pacientes com artrose unicompartimental medial do joelho submetidos à artroplastia unicompartimental tipo Repicci II, com o propósito de avaliar a validade do procedimento. MÉTODOS: Participaram do estudo 36 pacientes com artrose unicompartimental do joelho, seis dos quais apresentavam acometimento bilateral, totalizando 42 joelhos. A idade variou de 54 a 82 anos, com média de 67 anos. Trinta e dois pacientes eram do sexo feminino e 10 do masculino. Os critérios clínicos de seleção foram: pacientes acima dos 50 anos de idade, nível de atividade leve/moderado, amplitude articular de pelo menos 90º de flexão e -10º de extensão, deformidade em varo menor ou igual a 5º, ausência de instabilidade ligamentar anterior e dor restrita ao compartimento medial. Os critérios radiográficos foram: artrose confinada ao compartimento medial com ausência ou mínima artrose patelofemoral. Utilizou-se a classificação de Ahlbãck para quantificar o grau de extensão da artrose, indicando-se cirurgia nos graus II, III e IV. Para acompanhamento dos resultados, utilizou-se a escala da Knee International Society. RESULTADOS: O tempo médio de seguimento foi de 36 meses. Não ocorreram casos de infecção pós-operatória, trombose venosa profunda ou embolia. Dois pacientes evoluíram com dor importante sem melhora com acompanhamento clínico, sendo necessária a revisão com prótese total do joelho. Não foram observados casos de soltura asséptica, afundamento do componente tibial ou desgaste precoce do polietileno. O escore médio pré-operatório foi de 45 para o joelho e de 57 para a função global do paciente. O escore pós-operatório foi de, respectivamente, 76 e 90 pontos. CONCLUSÃO: A artroplastia unicompartimental tipo Repicci II é uma boa opção no tratamento da artrose unicompartimental medial do joelho, trazendo resultados consistentes e implicando alto nível de satisfação dos pacientes, desde que técnica cirúrgica aprimorada, escolha...

OBJECTIVE:To report the evolution with medial unicompartmental arthrosis of the knee submitted to Repicci II unicompartmental arthroplasty in order to evaluate the validity of the procedure. METHODS: 36 patients with unicompartmental arthrosis of the knee were included in the study, six of them with bilateral involvement, in a total of 42 knees. Age ranged from 54 to 82, with a mean of 67 years. Thirty-two patients were female, and 10 male. Clinical section criteria were: patients had to be older than 50, with light/moderate level activity, joint amplitude of at least 90º of flexion and -10º of extension, varus deformity of less than or equal to 5º, no anterior ligament instability, and pain restricted to the medial compartment. Radiographic selection criteria were: arthrosis confined to the medial compartment, with none or minimal patellofemoral arthrosis. The Ahlbãck classification was used to quantify the degree of extension of the arthrosis, surgery being indicated for grades II, III, and IV. The Knee International Society scale was used to follow results. RESULTS: The mean follow-up period was 36 months. There were no cases of post-operative infection, deep venous thrombosis, or embolism. Two patients developed major pain with no improvement in the follow-up, and a revision with total knee prosthesis was required. No cases of aseptic loosening or early polyethylene wear were seen. The mean pre-operative score was 45 for the knee and 57 for the overall function of the patient. The post-operative score was 76 and 90, respectively. CONCLUSION: Repicci II unicompartmental arthroplasty is a good option of the treatment of medial unicompartmental arthrosis of the knee, and it achieves consistent results leading to high patient satisfaction provided that an improved surgical technique, the right choice of implants, and a strict selection of patients are observed.

Metástase renal bilateral de um carcinoma de esôfago / Bilateral renal metastases from an esophageal carcinoma

Metástases renais de carcinoma primário de esôfago são pouco diagnosticadas, sendo muitas vezes relatadas como achados em estudos de necrópsia.Relatamos um caso que evoluiu para óbito por uremia devido à infiltração renal bilateral. Paciente de 37 anos, branco, sexo masculino, foi admitido comhistória de disfagia. Investigação revelou carcinoma espinocelular de esôfago pouco diferenciado grau III. Tratado com radioterapia. Oito meses depois o paciente procurou serviço médico com queixa de dor lombar, sendo diagnosticada metástase renal bilateral. Evoluiu com uremia e óbito 10 dias após a biópsia.

Renal metastases from esophageal carcinomas are very uncommon and frequently reported as a necropsy finding. We described a case who died in renal failure in consequence a bilateral infiltration of kidneys. A 37-year-old man was admitted with dysphagia. Investigation revealed an esophageal espinocellular carcinoma. He was managed with radiotherapy. Eight months later, the patient had lumbar pain, and the diagnosis of bilateral renal metastases was done.He developed renal failure and died ten days later.

Carcinoma de células renais em rim transplantado: relato de caso / Renal cell carcinoma in a transplanted kidney: case report

Carcinoma de células renais no enxerto tem sido raramente relatado. Apresentamos um caso diagnosticado oito anos após o transplante renal em ecografiade rotina, tratado com tumorectomia e manutenção do enxerto. Relato do caso: Paciente de 42 anos, branco, sexo masculino, história de hipertensão delonga data evoluindo com insuficiência renal crônica terminal, tendo sido submetido à hemodiálise durante dois anos, e a um transplante renal com doadorvivo haploidêntico há oito anos, recebendo azatioprina e prednisona como terapia imunossupressora. Durante exame ecográfico de rotina, constatadaimagem nodular de 2,2 x 1,7 cm de diâmetro em enxerto renal. Tratado com tumorectomia e manutenção do enxerto. Após dois anos a função renal, mantém-se estável e não há evidência de metástases. Discussão: Carcinoma de células renais é raro em rim transplantado, havendo controvérsia sobre o tipode tratamento cirúrgico, tumorectomia com manutenção do enxerto ou transplantectomia e retorno à diálise. Apresentamos um caso submetido à tumorectomiaque mantém função renal estável dois anos após a cirurgia.

Renal liposarcoma

INTRODUCTION: Liposarcoma is a malignant mesenchymal tumor frequently located in retroperitoneum, and rarely presenting an isolated lesion in kidney. CASE REPORT: Female, Caucasian, 49-year old patient, with family history of renal polycystic disease, was selected for organ donation. During preoperative examinations a renal pleomorphic liposarcoma was detected. She was treated with radical nephrectomy and remains asymptomatic, without evidences of recurrence in control ecographic examinations after a 4-year follow-up. COMMENTS: Renal liposarcoma is a rare tumor. We report one case incidentally diagnosed during a routine pre-transplantation assessment in renal donor.

Renal liposarcoma.

INTRODUCTION: Liposarcoma is a malignant mesenchymal tumor frequently located in retroperitoneum, and rarely presenting an isolated lesion in kidney. CASE REPORT: Female, Caucasian, 49-year old patient, with family history of renal polycystic disease, was selected for organ donation. During preoperative examinations a renal pleomorphic liposarcoma was detected. She was treated with radical nephrectomy and remains asymptomatic, without evidences of recurrence in control ecographic examinations after a 4-year follow-up. COMMENTS: Renal liposarcoma is a rare tumor. We report one case incidentally diagnosed during a routine pre-transplantation assessment in renal donor.