Hypothermia during Surgical Treatment of Type A Aortic Dissection: A 16 Years' Experience.

Acute aortic dissection (AAD) is among the most challenging cases for surgical treatment and requires procedural expertise for its safe conduct. Aortic surgery has undergone several changes over the last years, especially concerning cerebral protection. The brilliant results obtained with the aid of selective anterograde cerebral perfusion led to a progressive increase of circulatory arrest temperature, with the rise of safe time along with a reduction of the extracorporeal circulation time and hypothermia-related side effects. However, there is still no definitive consensus concerning the optimal range of temperature to be used during circulatory arrest. Objectives. This is a retrospective observational study, and we examined 16-year trends in the presentation, diagnosis, hospital outcome and treatment of A AAD type. In our Cardiac Surgery Unit in Policlinico Umberto I of Rome, our analysis focused on patients, who received ACP during aortic surgery and we analyzed the differences between two distinct groups based on the lowest temperature reached during CPB conduction: Lower Temperature Group (LT) (T < 24°C) versus Higher Temperature Group (HT) (T ≥ 24°C) arrest circulation temperature. Methods. Data from 241 patients enrolled between August 2002 and March 2018 were analyzed. Patients were divided according to the lowest temperature reached into 2 groups: Lower Temperature group (LT) (94 patients) and Higher Temperature Group (HT) (147 patients). Results. Our results showed a significant reduction of in-hospital mortality and in-hospital results in patients with higher CPB temperature. The global incidence of complications was statistically reduced in HT group: we found a statistical significant reduction of intestinal ischemia, and a similar trend also for other complications analyzed, such as infections. Since the two groups were similar for type of surgical procedures, we considered these differences depending on the lower temperature value reached, according to the current literature. Conclusions. We found a significantly higher mortality in patients with lower temperature during CPB and a global reduction of complications and in particular a significant reduction of intestinal ischemia in patients with higher temperature during CPB. We found a similar trend in other fields of investigations, so we can conclude that circulatory arrest performed at temperature ≥24°C nasopharyngeal temperature associated with ACP is a safe strategy for aortic surgery for AAD.

Physical therapy in peripheral facial paralysis: retrospective study.

UNLABELLED: Peripheral facial paralysis requires specialized treatment. Physical therapy aims at reestablishing facial movements. The aim of this study was to describe and to analyze physical therapy results for individuals with peripheral facial paralysis. STUDY DESIGN: Retrospective study. METHOD: A retrospective study was carried out at the University Hospital, authorized by the Statistics and Medical File Services, from 1999 to 2003. Data are presented in descriptive form with mean and median values for numeric variables and frequency for categorical variables. RESULTS: Twenty-three files were analyzed during four years. Females predominated and the average age was of 32.3 years (SD+/-16.5); 14 idiopathic and five trauma cases; 12 with total motor deficit and 11 with partial motor deficit; in the 12 cases that underwent final evaluation, seven had partial and five had total recovery. The physical therapy program used was kinesiotherapy and patient education. CONCLUSION: In this study, individuals were similar to individuals in other populations. They were treated with kinesiotherapy, as suggested by the scientific literature and recovered.

Fisioterapia na paralisia facial periférica: estudo retrospectivo / Physical therapy in peripheral facial paralysis: retrospective study

A paralisia facial periférica requer tratamento especializado. A fisioterapia tem como objetivo restabelecer a mímica facial. O objetivo deste estudo foi descrever e analisar os resultados da fisioterapia para indivíduos com paralisia facial periférica. FORMA DE ESTUDO: Retrospectivo. MÉTODO: Foi realizado um estudo retrospectivo em um Hospital Universitário, com autorização do Serviço de Atendimento Médico e Estatístico, no período de 1999 a 2003. Os dados são apresentados em forma descritiva, com utilização de média e mediana para variáveis numéricas e freqüência para variáveis categóricas. RESULTADOS: Foram analisados 23 prontuários durante quatro anos. Foi identificado o predomínio do sexo feminino e a média de idade foi de 32,3 anos (DP±16,5); 14 casos idiopáticas e cinco traumáticas; 12, com comprometimento motor total e 11, parcial; nos 12 casos com avaliação final, sete evoluíram para recuperação parcial e cinco para total. A fisioterapia utilizada foi cinesioterapia e orientações. CONCLUSÃO: Neste estudo os indivíduos são similares a outras populações. Foram tratados com cinesioterapia, como sugerido pela literatura científica e evoluíram com recuperação.

Peripheral facial paralysis requires specialized treatment. Physical therapy aims at reestablishing facial movements. The aim of this study was to describe and to analyze physical therapy results for individuals with peripheral facial paralysis. STUDY DESIGN: Retrospective study. METHOD: A retrospective study was carried out at the University Hospital, authorized by the Statistics and Medical File Services, from 1999 to 2003. Data are presented in descriptive form with mean and median values for numeric variables and frequency for categorical variables. RESULTS: Twenty-three files were analyzed during four years. Females predominated and the average age was of 32.3 years (SD±16.5); 14 idiopathic and five trauma cases; 12 with total motor deficit and 11 with partial motor deficit; in the 12 cases that underwent final evaluation, seven had partial and five had total recovery. The physical therapy program used was kinesiotherapy and patient education. CONCLUSION: In this study, individuals were similar to individuals in other populations. They were treated with kinesiotherapy, as suggested by the scientific literature and recovered.

Eficacia del entrenamiento teorico-practico en anatomía palpatoria empleada a los estudiantes de la carrera de fisioterapía / Effectiveness of the theoretical-practical training in palpatory anatomy applied to the physical therapy students

El objetivo del trabajo fue verificar la eficacia del entrenamiento teórico-práctico en Anatomía Palpatoria, estableciendo una interpretación de la Anatomía de Superficie Humana, reconocida por el contacto manual en sujetos normales. Una población de 49 alumnos fueron incluidos por los criterios de inclusión, y randomizados en dos grupos. El grupo A (NA=23) siguió estudiando las disciplinas curriculares y el grupo B (NB= 26) recibió el contenido de la disciplina especial. Fueron aplicadas evaluaciones para ambos los grupos, antes y después de la realización de la disciplina. Durante los períodos pre y post-entrenamiento, la muestra estudiada asumió una distribución normal en los dos grupos. En la comparación entre los grupos y en la intra-grupos se utilizó el test ANOVA del paquete estadístico SPSS. Las medias de las notas de los grupos antes de la disciplina fueron similares, grupo Apre con (MApre)= 5,34 ñ 1,48; grupo Bpre (MBpre)= 5,40 ñ 1,18, y después de la disciplina el grupo Apost (MApost)= 6,02 ñ 1,14 y grupo Bpost (MBpost)= 7,00 ñ 0,78. En el desempe¤o aisló el grupo A antes y después de la disciplina (p= 0,31); y el grupo B antes y después de la disciplina (p= 0,000), por lo tanto, los resultados apresentaram discrepancias significativas, cuando fueron comparadas a las medias de las notas finales entre los grupos (p= 0,001). Los resultados fueron, positivos y estadísticamente significativos cuando los grupos fueron comparados. Por lo tanto, sugerimos que los cursos de graduación en Fisioterapía deben revisar su currículo y proponer una reforma con implantación inmediata de una disciplina específica, Anatomía Palpatoria, proveyendo la necesidad del entrenamiento en habilidades manuales de los estudiantes.