Type of subtotal parathyroidectomy and evolution of parathyroid hormone levels in end-stage renal disease patients: a retrospective cohort study.

PURPOSE: Parathyroidectomy (PTX) is performed in end-stage renal disease (ESRD) for the treatment of secondary hyperparathyroidism. Whether and how the number of glands removed affects parathyroid hormone (PTH) levels remain controversial. The objective of this study is to compare the biochemical and pharmacological evolution after subtotal PTX according to the number of glands removed in ESRD. METHODS: This is a unicenter longitudinal retrospective cohort study of ESRD patients who have undergone PTX [< 3 glands (group 1) vs ≥ 3 glands (group 2)] from April 2006 to October 2014 at CHU de Québec, Canada. Demographic data, comorbidities, pharmacological and biochemical parameters were collected before, 3, 6, 12 and 24 months after PTX. Linear mixed model was performed to compare the biochemical and pharmacological evolution. RESULTS: We included 37 (13 in group 1, 24 in group 2) ESRD patients with a median age of 53 (46-58) years. The population is 68% male with a median dialysis vintage of 30.7 (18.0-61.2) months. The two groups were similar in terms of demographics and comorbidities. Compared to baseline, PTH levels in groups 1 and 2 dropped significantly at 2 years (1239-361 ng/L and 1542-398 ng/L, p < 0.05) but the evolution was comparable between the two groups. CONCLUSIONS: Our results show the efficacy of subtotal PTX in lowering PTH levels in our ESRD cohort. However, the results were not different according to the number of glands removed.

An international study of the quality of life of adult patients treated with home parenteral nutrition.

BACKGROUND & AIMS: Home parenteral nutrition-quality of life (HPN-QOL©) is a self-assessment tool for the measurement of QOL in patients on HPN. The aims of this study were: to re-assess the basic psychometric properties of the HPN-QOL© in a multinational sample of adult patients; to provide a description of QOL dimensions by short and long HPN treatment duration; to explore clinical factors potentially associated to QOL scores. METHODS: Patients (n = 699) from 14 countries completed the HPN-QOL©. The questionnaires were analysed to evaluate data completeness, convergent/discriminant validity and internal-consistency reliability. The association of overall QOL and HPN treatment duration as well as other clinical factors were investigated using multivariable linear regression models. RESULTS: The analysis of the multitrait-scaling and internal consistency indicates a good fit with the questionnaire structure for most items. Item discriminant validity correlation was satisfactory and psychometric evaluation of the HPN-QOL© in the different English, French and Italian language patient sub-groups confirmed psychometric equivalence of the three questionnaire versions. The results of the multivariable linear regression showed that QOL scores were significantly associated with HPN duration (better in long-term), underlying disease (better in Crohn's disease and mesenteric ischaemia) and living status (worse in living alone) and, after adjusting for the other factors, with the number of days of HPN infusion per week. CONCLUSIONS: The HPN-QOL©, is a valid tool for measurement of QOL in patients on HPN, to be used in the clinical practice as well as in research.

Surgical results from treating children with syndactyly through the collective effort system at "SOS Hand Recife" between 2005 and 2009

Objective: to evaluate the results from and parents' satisfaction with treatment for children with syndactyly who were operated at the "SOS Hand Recife" hospital between 2005 and 2009. Methods: data for assessing the results were gathered from the patients' medical files. The subjective scores, which were ascertained prospectively, were as follows: greater than or equal to 9, good result; between 6 and 8, fair result; less than 6, poor result. The results were analyzed statistically. This study was approved by the institution's ethics committee. Results: among the 35 cases, 21 (60%) consisted of simple syndactyly and 14 (40%) were complex; 22 (62.8%) were boys and 13 (37.1%) were girls. The complex cases were predominantly among males. The main complications were infection (11.4%), bleeding (11.4%) and pain (8.6%). There were more complications in the complex cases (42.8%) than in the simple cases (33.3%). The mean scores from the parents' subjective evaluations were as follows: 7.6 for esthetics (7.7 in simple cases and 7.3 in complex cases; 8.2 for function (8.6 in simple cases and 7.6 in complex cases); 8.3 for the parents' general satisfaction level (8.6 in simple cases and 8.0 in complex cases); and 85.7% of the parents would recommend the surgery to others while 14.5% would not. A strong association was observed between the specialist's objective assessment and the scores given by the parents (p < 0.05). Conclusion: the surgical results from treating syndactyly presented differences between the simple and complex types, even though the parents' esthetic evaluations and satisfaction were similar...

Objetivo: avaliar resultados e satisfação dos pais quanto ao tratamento de crianças portadoras de sindactilia operadas entre 2005 e 2009 no Hospital SOS Mão Recife. Métodos: foram coletados, nos prontuários, os dados para avaliação dos resultados. Os escores subjetivos, verificados prospectivamente, foram: igual ou superior a 9, bom resultado; entre 6 e 8, resultado regular; abaixo de 6, mau resultado. Os resultados foram analisados estatisticamente. A pesquisa foi aprovada pelo Comitê de Ética da Instituição. Resultados: dos 35 casos, 21 (60%) foram sindactilias simples e 14 (40%) complexas; 22 (62,8%) eram meninos e 13 (37,1%) meninas. Houve predominância masculina nos casos complexos. As principais complicações foram: infecção (11,4%), sangramento (11,4%) e dor (8,6%). Ocorreram mais complicações nos casos complexos (42,8%) contra 33,3% nos simples. A avaliação subjetiva dos pais revelou: quanto à estética, média de 7,6, porém com média de 7,7 nos casos simples e 7,3 nos complexos; na função, a média foi de 8,2, 8,6 e 7,6, respectivamente, nas simples e nas complexas; em relação ao grau de satisfação dos pais, 8,3 (geral), 8,6 e 8 respectivamente; sobre a possibilidade de os pais recomendarem a cirurgia a outros, 85,7% recomendariam, contra 14,3% contrários. Foi observada forte associação entre a avaliação objetiva do especialista e os escores atribuídos pelos pais (p < 0,05). Conclusão: os resultados cirúrgicos da sindactilia apresentam diferenças entre os tipos simples e complexo, apesar de o aspecto estético e a satisfação dos pais serem semelhantes...

Surgical results from treating children with syndactyly through the collective effort system at "SOS Hand Recife" between 2005 and 2009.

OBJECTIVE: to evaluate the results from and parents' satisfaction with treatment for children with syndactyly who were operated at the "SOS Hand Recife" hospital between 2005 and 2009. METHODS: data for assessing the results were gathered from the patients' medical files. The subjective scores, which were ascertained prospectively, were as follows: greater than or equal to 9, good result; between 6 and 8, fair result; less than 6, poor result. The results were analyzed statistically. This study was approved by the institution's ethics committee. RESULTS: among the 35 cases, 21 (60%) consisted of simple syndactyly and 14 (40%) were complex; 22 (62.8%) were boys and 13 (37.1%) were girls. The complex cases were predominantly among males. The main complications were infection (11.4%), bleeding (11.4%) and pain (8.6%). There were more complications in the complex cases (42.8%) than in the simple cases (33.3%). The mean scores from the parents' subjective evaluations were as follows: 7.6 for esthetics (7.7 in simple cases and 7.3 in complex cases; 8.2 for function (8.6 in simple cases and 7.6 in complex cases); 8.3 for the parents' general satisfaction level (8.6 in simple cases and 8.0 in complex cases); and 85.7% of the parents would recommend the surgery to others while 14.5% would not. A strong association was observed between the specialist's objective assessment and the scores given by the parents (p < 0.05). CONCLUSION: the surgical results from treating syndactyly presented differences between the simple and complex types, even though the parents' esthetic evaluations and satisfaction were similar.

OBJETIVO: avaliar resultados e satisfação dos pais quanto ao tratamento de crianças portadoras de sindactilia operadas entre 2005 e 2009 no Hospital SOS Mão Recife. MÉTODOS: foram coletados, nos prontuários, os dados para avaliação dos resultados. Os escores subjetivos, verificados prospectivamente, foram: igual ou superior a 9, bom resultado; entre 6 e 8, resultado regular; abaixo de 6, mau resultado. Os resultados foram analisados estatisticamente. A pesquisa foi aprovada pelo Comitê de Ética da Instituição. RESULTADOS: dos 35 casos, 21 (60%) foram sindactilias simples e 14 (40%) complexas; 22 (62,8%) eram meninos e 13 (37,1%) meninas. Houve predominância masculina nos casos complexos. As principais complicações foram: infecção (11,4%), sangramento (11,4%) e dor (8,6%). Ocorreram mais complicações nos casos complexos (42,8%) contra 33,3% nos simples. A avaliação subjetiva dos pais revelou: quanto à estética, média de 7,6, porém com média de 7,7 nos casos simples e 7,3 nos complexos; na função, a média foi de 8,2, 8,6 e 7,6, respectivamente, nas simples e nas complexas; em relação ao grau de satisfação dos pais, 8,3 (geral), 8,6 e 8 respectivamente; sobre a possibilidade de os pais recomendarem a cirurgia a outros, 85,7% recomendariam, contra 14,3% contrários. Foi observada forte associação entre a avaliação objetiva do especialista e os escores atribuídos pelos pais (p<0,05). CONCLUSÃO: os resultados cirúrgicos da sindactilia apresentam diferenças entre os tipos simples e complexo, apesar de o aspecto estético e a satisfação dos pais serem semelhantes.

Triceps innervation pattern: implications for triceps nerve to deltoid nerve transfer.

There are multiple nerve branches supplying the triceps. Traditionally, the nerve to the long head of triceps is utilized for nerve transfer to neurotize the deltoid muscle in patients with brachial plexus injuries. However, no anatomical studies were done to investigate which triceps nerve would be preferred for nerve transfer. This anatomical study was carried out to describe the innervation pattern of the triceps muscle to investigate the preferred triceps nerve for nerve transfer. Twenty-five cadaveric arms were dissected. The long head of the triceps received a single branch in 23 cases (92%) and double branches in 2 cases (8%) only. The medial head had a single branch in 22 cases (88%) and double branches in 3 cases (12%). The lateral head was the most bulky one and received more than one branch in all cases (100%), ranging from 2 to 5 branches. The transfer of the most proximal branch to the lateral head of the triceps seems to be the most preferred choice for deltoid muscle innervation.

NOSOLOGY OF HAND DISEASES IN CHILDREN AND ADOLESCENTS OPERATED IN PROVISIONAL FACILITIES IN A MODEL HOSPITAL - PERNAMBUCO STATE, BRAZIL.

UNLABELLED: To report the frequencies of congenital hand diseases in patients who underwent surgery on a collective mobilization basis at SOS Hand, Recife, Pernambuco, between 2005 and 2009. METHODS: Information was collected from 833 children and adolescents who were examined in eight missions. RESULTS: Among the patients, 306 (36.7%) underwent surgery: 240 (78.4%) because of congenital malformation and 66 (21.6%) because of acquired lesions. The most frequent congenital malformations were: syndactyly, 72 cases (30.0%); polydactyly, 30 cases (12.5%); bifid thumb, 19 cases (7.9%); complex hand malformation, 14 cases (5.8%); cleft hand, 13 cases (5.4%); trigger finger, 12 cases (5.0%); camptodactyly, 11 cases (4.6%); and brachysyndactyly, 9 cases (3.7%). The most frequently acquired injuries were: obstetric traumatic lesions, 26 cases (39.4%); hand trauma sequelae, 18 cases (27.3%); cerebral paralysis sequelae, 7 cases (10.6%); electric shock sequelae, 5 cases (7.6%); and burn sequelae, 4 cases (6.1%). CONCLUSION: The nosology of hand diseases is similar to that of large series of elective surgery, especially regarding congenital deformities. The frequency of acquired hand lesions seems to be higher than the frequency in international series. The collective mobilization system for hand surgery is important for decreasing the need for this activity in public institutions, and it has been shown to be very efficient. The success of the project may provide support for the Brazilian National Health System to enroll hand surgeons in the on-call system, in emergency units.

Nosologia das doenças da mão de crianças e jovens operados em mutirões realizados em hospital de referência no estado de pernambuco / Nosology of hand diseases in children and adolescents operated in provisional facilities in a model hospital - pernambuco state, Brazil

OBJETIVO: Relatar a frequência das doenças congênitas da mão operadas em sistema de mutirão no SOS Mão de Recife entre 2005 e 2009. MÉTODOS: Foram coletadas as informações de 833 crianças e adolescentes examinados em oito missões. RESULTADOS: Entre os pacientes, 306 (36,7 por cento) foram operados; 240 (78,4 por cento) por malformações congênitas e 66 (21,6 por cento) por lesões adquiridas. As malformações congênitas mais frequentes foram: sindactilia, 72 (30,0 por cento) casos; polidactilia, 30 (12,5 por cento) casos; polegar bífido, 19 (7,9 por cento) casos; malformação complexa da mão, 14 (5,8 por cento) casos; mão em fenda, 13 (5,4 por cento) casos; dedo em gatilho, 12 (5,0 por cento) casos; camptodactilia, 11 (4,6 por cento) casos; e braquisindactilia, nove (3,7 por cento) casos. As lesões adquiridas mais frequentes foram: lesões por trauma obstétrico, 26 (39,4 por cento) casos; sequela de trauma de mão, 18 (27,3 por cento) casos; sequela de paralisia cerebral, sete (10,6 por cento) casos; sequela de choque elétrico, cinco (7,6 por cento) casos; e sequela de queimadura, quatro (6,1 por cento) casos. CONCLUSÃO: A nosologia das doenças de mão é similar a de grandes séries de cirurgias eletivas, particularmente no que diz respeito às deformidades congênitas. As frequências das lesões adquiridas parecem ser mais altas do que as das séries internacionais. O sistema de mutirão de cirurgia de mão é importante para diminuir a carência dessa atividade em instituições públicas e tem se mostrado muito eficiente. O êxito do projeto pode oferecer subsídio para o Sistema Único de Saúde admitir cirurgiões da mão em sistema de plantão ou sobreaviso nas unidades de emergência.

OBJECTIVE: To report the frequencies of congenital hand diseases in patients who underwent surgery in a provisional clinic as part of the Hand of Recife SOS- Recife, Pernambuco, from 2005 to 2009. METHODS: The information was collected from 833 children and adolescents cared for in eight missions. RESULTS: Among the patients, 306 (36.7 percent) underwent surgery; 240 (78.4 percent) for congenital malformation, and 66 (21.6 percent) for acquired lesions. The most frequent malformations were: syndactyly, 72 (30.0 percent) cases; polydactyly, 30 (12.5 percent) cases; bifid thumb, 19 (7.9 percent) cases; complex hand anomaly, 14 (5.8 percent) cases; cleft hand, 13 (5.4 percent) cases; trigger finger, 12 (5.0 percent) cases; camptodactyly, 11 (4.6 percent) cases; and brachysyndactyly, 9 (3.7 percent) cases. The most frequent acquired injuries were: obstetric brachial plexus paralysis, 26 (39.4 percent) cases; hand trauma sequelae, 18 (27.3 percent) cases; cerebral paralysis sequelae, 7 (10.6 percent) cases; electrical shock sequelae, 5 (7.6 percent) cases; and hand burn injury, 4 (6.1 percent) cases. CONCLUSION: The nosology of hand diseases is, as a whole, similar to the great series of elective hand surgeries, especially regarding congenital hand abnormalities. The frequencies of acquired hand lesions seem to be higher than in the international series. The provisional clinic hand surgery system is important in decreasing the need for this activity in public institutions, and it has been shown to be very effective. The good outcomes of the missions may offer support for The Brazilian Health System to enroll hand surgeons in the on-call system in the emergency units.

Results of end-to-side nerve coaptation in severe obstetric brachial plexus lesions.

OBJECTIVE: Options for nerve repair are limited in brachial plexus lesions with multiple root avulsions because an insufficient number of proximal nerve stumps are available to serve as lead-out for nerve grafts. End-to-side nerve repair might be an alternative surgical technique for repair of such severe lesions. In this technique, an epineurial window is created in a healthy nerve, and the distal stump of the injured nerve is coapted to this site. Inconsistent results of end-to-side nerve repairs in traumatic nerve lesions in adults have been reported in small series. This article evaluates the results of end-to-side nerve repair in obstetric brachial plexus lesions and reviews the literature. METHODS: A retrospective analysis was performed of 20 end-to-side repairs in 12 infants. Evaluation of functional recovery of the target muscle was performed after at least 2 years of follow up (mean, 33 mo). RESULTS: Five repairs failed (25%). Seven times (35%) good function (Medical Research Council at least 3) of the target muscle occurred in addition to eight partial recoveries (40%). In the majority of patients, however, the observed recovery cannot be exclusively attributed to the end-to-side repair. The reinnervation may be based on axonal outgrowth through grafted or neurolyzed adjacent nerves. It seems likely that recovery was solely based on the end-to-side repair in only two patients. No deficits occurred in donor nerve function. CONCLUSION: This study does not convincingly show that the end-to-side nerve repair in infants with an obstetric brachial plexus lesion is effective. Its use cannot be recommended as standard therapy.

Long-term results of primary repair of brachial plexus lesions in children.

The results of brachial plexus reconstruction in adults are poor, despite the sophistication of the various methods used. However, the same methods used in neonates after obstetrical brachial plexus injury will give far better results because of the shorter distance, stronger potential of regeneration, and capacity of brain adaptation. Complete paralyses, associated root ruptures, and avulsions are very severe, and the end results cannot be evaluated before the end of growth. Although the end results show that the shoulder and elbow do not do as well as in upper-type lesions, the results at the level of the hand are encouraging, showing 75% with useful function after 8 years, even in patients with avulsion injuries of the lower roots. These results demonstrate the value of the early exploration and repair of the obstetric plexus. We also review our series of traumatic brachial plexus palsy in children. The results are poorer than in neonates, where may be related, in part, to a greater percentage of associated lesions in these patients.

Forearm supination deformity after obstetric paralysis.

We retrospectively evaluated 66 patients who had radius osteotomies (44 patients; average age, 79.9 months) or soft tissue procedures (22 patients; average age, 57.4 months) to improve persistent supination at rest secondary to obstetric brachial plexus lesions and select the optimal treatment indication for each patient. Followups averaged 64.3 months and 72.57 months, respectively. In the osteotomy group there was a significant difference when preoperative supination at rest (average 31 degrees), intraoperative pronation obtained (average 114 degrees), and position of the forearm at last followup (average 92 degrees), were compared, whereas in the soft tissue procedures group there was not a significant difference between intraoperative pronation obtained (average 116 degrees) and forearm position at rest at last followup (average 108 degrees). Shoulder function was not affected by any of these interventions. Elbow extension was decreased at the last followup in both groups. Wrist and finger extension were improved in both groups. Complications included two delayed unions, one nonunion, and nine recurrences, all secondary to radius osteotomies. The procedure of choice for each patient must be based on preoperative forearm motion, condition of the proximal and distal radioulnar joints, triceps function, deformities of the shoulder and elbow, and hand function.

Management of complete obstetric brachial plexus lesions.

From 1978 to 2002, the authors have operated on 723 babies for obstetric brachial plexus repair. Complete paralyses and associated root ruptures and avulsions are severe, and the results cannot be evaluated before the end of growth. A series of 73 patients operated on from 1978 to 1994 were followed with a mean follow-up of 6.4 years. Secondary operations (mainly on the shoulders) were necessary 123 times. Although the results show that the shoulders and elbows did not do as well as in upper-type lesions, the results at the level of the hand were encouraging, showing 75% useful results after 8 years, even in patients with avulsion injuries of the lower roots. These results demonstrate the usefulness of early exploration and repair of the obstetric plexus.

Study of anatomical bases of a latero-dorsal flap of the forearm preserving the radial artery

The authors studied the dorso-lateral cutaneous branches of the radial artery in 26 forearms of fresh cadavers following injection of latex. Three toeight branches were identified, with frequent anastomoses. Extensive venous drainage was also observed. One to three cutaneous branches arose within a 3-cm region close to the radial styloid precess. This provides a basis for an island flap supplied by these branches and thus, it is possible to mantain the radial artery intact