Assuntos
Artrodese/métodos , Instabilidade Articular/cirurgia , Articulação Metacarpofalângica/cirurgia , Ossos Sesamoides/cirurgia , Polegar/cirurgia , Adolescente , Humanos , Instabilidade Articular/fisiopatologia , Masculino , Articulação Metacarpofalângica/fisiopatologia , Polegar/fisiopatologiaRESUMO
INTRODUCTION: Patients who have previously undergone meniscectomy are known to potentially suffer subsequent knee problems including degenerative changes. Meniscal transplantation has been proposed as a possible solution to these problems. This article aims to review the current literature to consolidate the evidence surrounding the use of human meniscal allograft transplantation. MATERIALS AND METHODS: Three databases (PubMed, Embase and Medline) were searched to find English language articles pertaining to meniscal allograft transplantation. Each article was critiqued by two authors using a structured appraisal tool, and stratified according to the level of evidence. RESULTS: No Level I or II studies were identified. Many studies had small study groups with limited follow-up and patient selection and description of patient factors varied greatly. This made comparing data difficult. There were also very few papers concentrating on isolated meniscal transplantation. Four types of graft are used--fresh, fresh-frozen, cryopreserved and freeze-dried (lyophilised) graft. Cryopreserved and fresh-frozen allografts are deemed most suitable. Most authors advocate the use of non-irradiated grafts from screened donors to reduce transmission of infection. Best results occur when using bony anchors to fix the graft, although this requires accurate graft positioning. Patients have an improved outcome if they have less severe degenerative changes within the knee prior to transplantation. CONCLUSIONS: No statistically significant studies looking at isolated meniscal transplantations have been found. The evidence suggests that meniscal allograft transplantation provides improvement of pain and function in the short and intermediate term. The effect on future joint degeneration is still unknown. The ideal patient group includes patients less than 40 years of age with knee pain, proven meniscal injury and a normally aligned, stable joint without severe degenerative changes.
Assuntos
Artralgia/cirurgia , Articulação do Joelho , Meniscos Tibiais/transplante , Transplante Homólogo/métodos , Adulto , Artroscopia/efeitos adversos , Humanos , Seleção de Pacientes , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
INTRODUCTION: Patients with metastatic melanoma have a poor prognosis with a median survival of approximately 6 months. There is a paucity of data regarding the natural history of the disease in the small subset of patients who are suitable for hepatic resection for metastatic disease confined to the liver. PATIENTS AND METHODS: Five patients were identified from a prospectively collected database of over 1000 liver resections performed in Basingstoke between 1986 and 2004. Clinical details and survival were analysed. RESULTS: Two patients died within 12 months of resection from extrahepatic disease. The other three patients are alive and disease-free at 76, 92 and 147 months, respectively. DISCUSSION: In carefully selected cases, hepatic resection for metastatic melanoma to the liver can result in long-term survival. Criteria for selection of patients as suitable for resection remain unclear.
Assuntos
Hepatectomia/métodos , Neoplasias Hepáticas/cirurgia , Melanoma/cirurgia , Idoso , Neoplasias Oculares/patologia , Feminino , Seguimentos , Humanos , Neoplasias Hepáticas/secundário , Masculino , Melanoma/secundário , Pessoa de Meia-Idade , Estudos Prospectivos , Neoplasias Cutâneas/patologia , Taxa de Sobrevida , Resultado do TratamentoRESUMO
Atlantoaxial rotatory subluxation should be considered in the presentation of traumatic torticollis. This case report discusses the characteristic radiographic findings and appropriate management.
