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1.
Foot Ankle Spec ; : 19386400241235831, 2024 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-38500002

RESUMO

Tibialis anterior tendon (TAT) ruptures are rare, equating to less than 1% of all musculotendinous injuries. These injuries can be acute or atraumatic, with the latter often associated with chronic degenerative tendinopathy. Surgical repair is indicated when conservative measures fail in meeting functional demands. Direct end-to-end repair is the preferred method for TAT ruptures but may not be feasible with a large tendon defect. Various surgical techniques have been described to address this pathology, including allograft tendon interposition or extensor hallucis longus (EHL) transfer. The authors present a unique technique utilizing a minimal incision TAT turn-down with dermal matrix allograft augmentation, and, in addition, a case implementing this technique in a patient with a large insertional defect. The patient's postoperative course and outcomes were favorable, with improvements in pain, satisfaction, functional scores, and strength. The surgical technique offers versatility and can be adapted to different tendon defect sizes. It also allows for minimal-incision exposure, beneficial for patients with comorbidities or compromised skin integrity. In conclusion, the authors present a case report and surgical technique for the management of large-deficit, chronic TAT ruptures using split TAT turn-down. This technique provides a potential solution for cases where direct end-to-end repair is not feasible.Level of Evidence: Level V.

4.
Pract Radiat Oncol ; 10(5): e425-e431, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32004703

RESUMO

PURPOSE: Treating critically ill patients in radiation oncology departments poses multiple safety risks. This study describes a method to improve the speed of radiation treatment for patients in the intensive care unit by eliminating the need for computed tomography (CT) simulation or on-table treatment planning using patients' previously acquired diagnostic CT scans. METHODS AND MATERIALS: Initially, a retrospective planning study was performed to assess the applicability and safety of diagnostic scan-based planning (DSBP) for 3 typical indications for radiation therapy in patients in the intensive care unit: heterotopic ossification (10), spine metastases (cord compression; 10), and obstructive lung lesions (5). After identification of an appropriate diagnostic CT scan, treatment planning was performed using the diagnostic scan data set. These treatment plans were then transferred to the patients' simulation scans, and a dosimetric comparison was performed between the 2 sets of plans. Additionally, a time study of the first 10 patients treated with DSBP in our department was performed. RESULTS: The retrospective analysis demonstrated that DSBP resulted in treatment plans that, when transferred to the CT simulation data sets, provided excellent target coverage, a median D95% of 96% (range, 86%-100%) of the prescription dose with acceptable hot spots, and a median Dmax108% (range, 102%-113%). Subsequently, DSBP has been used for 10 critically ill patients. The patients were treated without CT simulation, and the median time between patient check-in to the department and completion of radiation therapy was 28 minutes (range, 18-47 minutes.) CONCLUSIONS: This study demonstrates that it is possible to safely use DSBP for the treatment of critically ill patients. This method has the potential to simplify the treatment process and improve the speed and safety of treatment.


Assuntos
Estado Terminal , Humanos , Radiometria , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
6.
Laryngoscope ; 130(2): 465-473, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31173373

RESUMO

OBJECTIVE: Epiglottitis is typically considered a pediatric disease; however, there is growing evidence that the incidence of adult epiglottitis has changed since the introduction of the Haemophilus influenzae vaccine. The literature is composed of multiple small series with differing findings. To date, there has been no attempt to collaborate evidence on predictors of airway intervention in this disease. METHODS: The population of interest was adults with a diagnosis of epiglottitis. The primary outcome in this review was incidence of airway intervention. A comprehensive literature search was conducted of the MEDLINE and Embase databases, and a separate random-effects model meta-analysis was undertaken for all outcome data. Moderator tests for comparison between prevaccine and postvaccine estimates were made, and absolute risk difference (RD) and relative risk (RR) calculations were made for all predictors of airway intervention. RESULTS: Thirty studies and a total of 10,148 patients were finally included for meta-analysis. A significant decrease in airway intervention was seen post vaccine introduction introduction from 18.8% to 10.9% (P = 0.01). The presence of an abscess (RD 0.27, P = 0.04; RR 2.45, P < 0.001), stridor (RD 0.64, P < 0.001; RR 7.15, P < 0.001), or a history of diabetes mellitus (RD 0.11, P = 0.02; RR 2.15, P = 0.01) were associated with need for airway intervention. CONCLUSION: In the postvaccine era, clinicians should expect to have to secure airways in 10.9% of cases. The presence of an epiglottic abscess, stridor, or a history of diabetes mellitus are the most reliable clinical features associated with need for airway intervention. LEVEL OF EVIDENCE: NA Laryngoscope, 130:465-473, 2020.


Assuntos
Manuseio das Vias Aéreas/métodos , Epiglotite/terapia , Adulto , Epiglotite/prevenção & controle , Epiglotite/virologia , Vacinas Anti-Haemophilus , Humanos
7.
Glob Chang Biol ; 25(8): 2703-2713, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31237022

RESUMO

Invasive species threaten global biodiversity, food security and ecosystem function. Such incursions present challenges to agriculture where invasive species cause significant crop damage and require major economic investment to control production losses. Pest risk analysis (PRA) is key to prioritize agricultural biosecurity efforts, but is hampered by incomplete knowledge of current crop pest and pathogen distributions. Here, we develop predictive models of current pest distributions and test these models using new observations at subnational resolution. We apply generalized linear models (GLM) to estimate presence probabilities for 1,739 crop pests in the CABI pest distribution database. We test model predictions for 100 unobserved pest occurrences in the People's Republic of China (PRC), against observations of these pests abstracted from the Chinese literature. This resource has hitherto been omitted from databases on global pest distributions. Finally, we predict occurrences of all unobserved pests globally. Presence probability increases with host presence, presence in neighbouring regions, per capita GDP and global prevalence. Presence probability decreases with mean distance from coast and known host number per pest. The models are good predictors of pest presence in provinces of the PRC, with area under the ROC curve (AUC) values of 0.75-0.76. Large numbers of currently unobserved, but probably present pests (defined here as unreported pests with a predicted presence probability >0.75), are predicted in China, India, southern Brazil and some countries of the former USSR. We show that GLMs can predict presences of pseudoabsent pests at subnational resolution. The Chinese literature has been largely inaccessible to Western academia but contains important information that can support PRA. Prior studies have often assumed that unreported pests in a global distribution database represent a true absence. Our analysis provides a method for quantifying pseudoabsences to enable improved PRA and species distribution modelling.


Assuntos
Agricultura , Ecossistema , Brasil , China , Índia
8.
Ear Nose Throat J ; 98(4): 232-237, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30939910

RESUMO

We sought to establish the effect of introducing a multidisciplinary tracheotomy management team (MDT). Tracheotomies are high-cost interventions with potentially devastating complications. Multidisciplinary teams have been introduced in many hospitals with the aim of reducing complications, however, data supporting them are lacking. There is currently insufficient evidence to conclude MDTs reduce length of hospital or intensive care unit (ICU) stay, and there is little information on cost analysis. A chart review identified patients who had a tracheotomy inserted at a major metropolitan teaching hospital with an acute spinal medicine service 2 years before and after the MDT was implemented. The primary outcome was time to decannulation. Other outcomes included tracheotomy complications, the proportion of patients decannulated, length of ICU and hospital stay, and admission cost. Our search identified 174 (78 prior and 96 post-MDT) patients. Baseline demographics were similar between groups. There was no difference in time to decannulation, the decannulation rate, or the length of hospital or ICU stay. Complication rates were low in both groups. There was an increase in the proportion of patients who received speaking valves and a reduction in cost of admission in a subgroup of patients who did not undergo head and neck surgery. There is insufficient evidence to support the widespread introduction of tracheotomy MDTs. Institutions considering introducing a tracheotomy team should carefully consider their case-mix, volume, and available resources as well as the structure and responsibilities of the team, and the timing of its activities within the working week. The potential benefits of MDTs including teaching of staff, and collaboration of teams should be acknowledged. Given the potentially significant implications for cost to the health system, a randomized trial is needed to guide policy in this area.


Assuntos
Equipe de Assistência ao Paciente , Avaliação de Resultados da Assistência ao Paciente , Traqueotomia , Adulto , Idoso , Redução de Custos , Cuidados Críticos , Feminino , Custos Hospitalares , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Traqueotomia/efeitos adversos , Traqueotomia/economia
9.
J Foot Ankle Surg ; 58(4): 779-784, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31010771

RESUMO

The treatment of neglected or chronically ruptured Achilles tendon is challenging. Various treatments for large defects associated with chronic Achilles ruptures have been described. Many surgeons recommend the use of a tendon transfer, turndown rotational flap, advancement flap, or reconstruction with Achilles tendon allograft with calcaneal bone block. Long-term outcomes of these procedures are unknown. We present 2 cases with the use of an Achilles tendon with calcaneus bone block allograft. At >8-year follow-up duration, both patients are afforded satisfactory levels of activity and are without pain or gait disturbance. This procedure is a viable option for Achilles ruptures with large defects, ruptures with small intact distal tendon portions, or re-ruptures of previously repaired Achilles tendons. The long-term outcomes of these case reports suggest that Achilles tendon reconstruction with bone block allograft is a viable option.


Assuntos
Tendão do Calcâneo/cirurgia , Transplante Ósseo/métodos , Calcâneo/transplante , Procedimentos de Cirurgia Plástica/métodos , Traumatismos dos Tendões/cirurgia , Tendão do Calcâneo/diagnóstico por imagem , Tendão do Calcâneo/lesões , Adulto , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Ruptura/cirurgia , Transplante Homólogo
10.
J Foot Ankle Surg ; 56(5): 1076-1080, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28645550

RESUMO

The Broström-Gould procedure is an effective procedure for chronic lateral ankle instability. However, long-term studies are limited, and the durability of this procedure remains unclear. A systematic review of the published data was undertaken to determine the outcomes and incidence of revision after long-term follow-up. Eleven studies involving 669 Broström-Gould procedures met the inclusion criteria. The revision rate was 1.2% at a weighted mean follow-up period of 8.4 years. Our systematic review of the available data revealed that the Broström-Gould procedure results in low revision rates for chronic lateral ankle instability. However, additional prospective comparative analyses are needed regarding this topic.


Assuntos
Instabilidade Articular/cirurgia , Ligamentos Laterais do Tornozelo/cirurgia , Procedimentos Ortopédicos/métodos , Amplitude de Movimento Articular/fisiologia , Âncoras de Sutura , Articulação do Tornozelo/fisiopatologia , Articulação do Tornozelo/cirurgia , Doença Crônica , Feminino , Seguimentos , Humanos , Instabilidade Articular/diagnóstico , Ligamentos Laterais do Tornozelo/lesões , Masculino , Procedimentos Ortopédicos/efeitos adversos , Recuperação de Função Fisiológica/fisiologia , Reoperação/métodos , Fatores de Tempo , Resultado do Tratamento
11.
Am J Otolaryngol ; 38(2): 237-243, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28129912

RESUMO

OBJECTIVE: Unilateral sphenoid sinus opacification (SSO) on imaging is a common incidental radiologic finding. Inflammatory sinus disease is rarely isolated to one sinus cavity therefore SSO raises the potential for neoplastic etiology. The clinical significance of SSO was evaluated and compared to maxillary sinus opacification (MSO). METHODS: A systematic review of unilateral sinus opacification was performed via Medline (1966-January 12th, 2015) and Embase (1980-January 12th, 2015), limited to English literature and human subjects. Case series of patients treated with radiologic evidence of unilateral sinus opacification either from maxillary or sphenoid sinuses and with pathology results were included. Individual cases were classified as neoplastic, malignant, or a condition requiring surgical intervention (i.e. fungal ball). Exclusion criteria were single case reports, lack of primary data, series of complications, or single pathology series. Case-by-case analysis was performed for both SSO and MSO. RESULTS: Search strategy revealed 3264 studies. A total of 31 studies including 1581 patients met the inclusion criteria. In these studies, SSO was described in n=1215 (76.9%) and MSO in n=366 (23.1%). For SSO, the final diagnosis was neoplasia 18%, (malignancy in 10.9%). 58.3% of cases required surgical intervention and 13% were inflammatory. For MSO, neoplasia represented 18.3% (malignancy 7.1%), surgical intervention required in 47% of cases and 27.6%. were inflammatory. CONCLUSION: Isolated MSO and SSO is a marker of neoplasia in 18% and malignancy in 7-10% of patients presenting with these radiologic findings. Clinicians should be wary of conservative management given the high incidence of neoplasia and consider a lower threshold for early surgical intervention.


Assuntos
Doenças dos Seios Paranasais/diagnóstico por imagem , Seio Esfenoidal/diagnóstico por imagem , Humanos , Neoplasias dos Seios Paranasais/diagnóstico por imagem
12.
J Exp Med ; 211(6): 1079-91, 2014 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-24842371

RESUMO

Autosomal recessive mutations in UNC13D, the gene that encodes Munc13-4, are associated with familial hemophagocytic lymphohistiocytosis type 3 (FHL3). Munc13-4 expression is obligatory for exocytosis of lytic granules, facilitating cytotoxicity by T cells and natural killer (NK) cells. The mechanisms regulating Munc13-4 expression are unknown. Here, we report that Munc13-4 is highly expressed in differentiated human NK cells and effector CD8(+) T lymphocytes. A UNC13D c.118-308C>T mutation, causative of FHL3, disrupted binding of the ETS family member ELF1 to a conserved intronic sequence. This mutation impairs UNC13D intron 1 recruitment of STAT4 and the chromatin remodeling complex component BRG1, diminishing active histone modifications at the locus. The intronic sequence acted as an overall enhancer of Munc13-4 expression in cytotoxic lymphocytes in addition to representing an alternative promoter encoding a novel Munc13-4 isoform. Mechanistically, T cell receptor engagement facilitated STAT4-dependent Munc13-4 expression in naive CD8(+) T lymphocytes. Collectively, our data demonstrates how chromatin remodeling within an evolutionarily conserved regulatory element in intron 1 of UNC13D regulates the induction of Munc13-4 expression in cytotoxic lymphocytes and suggests that an alternative Munc13-4 isoform is required for lymphocyte cytotoxicity. Thus, mutations associated with primary immunodeficiencies may cause disease by disrupting transcription factor binding.


Assuntos
Linfócitos T CD8-Positivos/imunologia , Síndromes de Imunodeficiência/imunologia , Células Matadoras Naturais/imunologia , Proteínas de Membrana/imunologia , Mutação Puntual/imunologia , Western Blotting , Linfócitos T CD8-Positivos/metabolismo , Células Cultivadas , Citotoxicidade Imunológica/genética , Citotoxicidade Imunológica/imunologia , DNA Helicases/genética , DNA Helicases/imunologia , DNA Helicases/metabolismo , Regulação da Expressão Gênica/imunologia , Humanos , Síndromes de Imunodeficiência/genética , Síndromes de Imunodeficiência/metabolismo , Íntrons/genética , Células Matadoras Naturais/metabolismo , Linfo-Histiocitose Hemofagocítica/genética , Linfo-Histiocitose Hemofagocítica/imunologia , Linfo-Histiocitose Hemofagocítica/metabolismo , Proteínas de Membrana/genética , Proteínas de Membrana/metabolismo , Proteínas Nucleares/genética , Proteínas Nucleares/imunologia , Proteínas Nucleares/metabolismo , Ligação Proteica/genética , Ligação Proteica/imunologia , Isoformas de Proteínas/genética , Isoformas de Proteínas/imunologia , Isoformas de Proteínas/metabolismo , Interferência de RNA , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Fator de Transcrição STAT4/genética , Fator de Transcrição STAT4/imunologia , Fator de Transcrição STAT4/metabolismo , Fatores de Transcrição/genética , Fatores de Transcrição/imunologia , Fatores de Transcrição/metabolismo
13.
Heart Lung Circ ; 23(8): 703-10, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24709393

RESUMO

BACKGROUND: Improved survival of heart transplant (HTx) recipients and increased acceptance of higher risk donors allows development of late pathology. However, there are few data to guide surgical options. We evaluated short-term outcomes and mortality to guide pre-operative assessment, planning, and post-operative care. METHODS: Single centre, retrospective review of 912 patients who underwent HTx from February 1984 - June 2012, identified 22 patients who underwent subsequent cardiac surgery. Data are presented as median (IQR). RESULTS: Indications for surgery were coronary allograft vasculopathy (CAV) (n=10), valvular disease (n=6), infection (n=3), ascending aortic aneurysm (n=1), and constrictive pericarditis (n=2). There was one intraoperative death (myocardial infarction). Hospital stay was 10 (8-21) days. Four patients (18%) returned to theatre for complications. After cardiac surgery, survival at one, five and 10 years was 91±6%, 79±10% and 59±15% with a follow-up of 4.6 (1.7-10.2) years. High pre-operative creatinine was a univariate risk factor for mortality, HR=1.028, (95%CI 1.00-1.056; p=0.05). A time dependent Cox proportional hazards model of the risk of cardiac surgery post-HTx showed no significant hazard; HR=0.87 (95%CI 0.37-2.00; p=0.74). CONCLUSIONS: Our experience shows cardiac surgery post-HTx is associated with low mortality, and confirms that cardiac surgery is appropriate for selected HTx recipients.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Cardiopatias , Transplante de Coração , Adulto , Intervalo Livre de Doença , Feminino , Seguimentos , Cardiopatias/etiologia , Cardiopatias/mortalidade , Cardiopatias/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida
14.
New Phytol ; 202(3): 901-910, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24517626

RESUMO

Crop pests and pathogens pose a significant and growing threat to food security, but their geographical distributions are poorly understood. We present a global analysis of pest and pathogen distributions, to determine the roles of socioeconomic and biophysical factors in determining pest diversity, controlling for variation in observational capacity among countries. Known distributions of 1901 pests and pathogens were obtained from CABI. Linear models were used to partition the variation in pest species per country amongst predictors. Reported pest numbers increased with per capita gross domestic product (GDP), research expenditure and research capacity, and the influence of economics was greater in micro-organisms than in arthropods. Total crop production and crop diversity were the strongest physical predictors of pest numbers per country, but trade and tourism were insignificant once other factors were controlled. Islands reported more pests than mainland countries, but no latitudinal gradient in species richness was evident. Country wealth is likely to be a strong indicator of observational capacity, not just trade flow, as has been interpreted in invasive species studies. If every country had US levels of per capita GDP, then 205 ± 9 additional pests per country would be reported, suggesting that enhanced investment in pest observations will reveal the hidden threat of crop pests and pathogens.


Assuntos
Produtos Agrícolas/economia , Produtos Agrícolas/microbiologia , Internacionalidade , Produtos Agrícolas/crescimento & desenvolvimento , Produtos Agrícolas/parasitologia , Geografia , Produto Interno Bruto , Publicações
15.
Microvasc Res ; 92: 72-8, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24423617

RESUMO

Three-dimensional (3D) cell culture assays are important tools in the study of vessel assembly. Current techniques for quantitative analysis of vascular network structure have provided important insight into 3D vessel assembly. However, these methods typically require immunohistochemical staining, which requires sample destruction, or fluorescent cell labeling, which may alter cell behavior. The methods also may require sophisticated and expensive microscopy. More robust, easily quantifiable techniques are needed for imaging vascular networks non-invasively. We present an imaging method based on widefield optical sectioning and digital deconvolution (WOSD) that enables imaging of vascular networks in 3D culture without the use of cell labeling, staining, or sample destruction. WOSD can be performed using a standard optical microscope and allows non-invasive 3D monitoring of vascular network formation. This method is illustrated by imaging vascular networks in a 3D hydrogel system. WOSD enabled production of quantifiable 3D images of the network structure. Accuracy of the technique was evaluated by comparing data from WOSD with confocal images of fixed and fluorescently stained samples. Data for vessel length, diameter, and density are consistent between the two methods. The WOSD approach can be applied using standard laboratory equipment and shows great promise for use in analysis of 3D vascular network formation.


Assuntos
Vasos Sanguíneos/anatomia & histologia , Vasos Sanguíneos/crescimento & desenvolvimento , Imageamento Tridimensional/métodos , Neovascularização Fisiológica , Algoritmos , Vasos Sanguíneos/citologia , Técnicas de Cocultura , Sistemas Computacionais , Células Endoteliais/citologia , Células Endoteliais da Veia Umbilical Humana , Humanos , Microscopia/métodos , Microscopia Confocal/métodos , Modelos Cardiovasculares , Miócitos de Músculo Liso/citologia
16.
J Biomed Opt ; 17(11): 116028, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23192382

RESUMO

Dynamic indocyanine green imaging uses a scanning laser ophthalmoscope and a fluorescent dye to produce movies of the dye-filling pattern in the retina and choroid of the eye. It is used for evaluating choroidal neovascularization. Movies are examined to identify the anatomy of the pathology for planning treatment and to evaluate progression or response to treatment. The popularity of this approach is affected by the complexity and difficulty in interpreting the movies. Software algorithms were developed to produce images from the movies that are easy to interpret. A mathematical model is formulated of the flow dynamics, and a fitting algorithm is designed that solves for the flow parameters. The images provide information about flow and perfusion, including regions of change between examinations. Imaged measures include the dye fill-time, temporal dispersion, and magnitude of the dye dilution temporal curves associated with image pixels. Cases show how the software can help to identify clinically relevant anatomy such as feeder vessels, drain vessels, capillary networks, and normal choroidal draining vessels. As a potential tool for research into the character of neovascular conditions and treatments, it reveals the flow dynamics and character of the lesion. Future varieties of this methodology may be used for evaluating the success of engineered tissue transplants, surgical flaps, reconstructive surgery, breast surgery, and many other surgical applications where flow, perfusion, and vascularity of tissue are important.


Assuntos
Neovascularização de Coroide/diagnóstico , Angiofluoresceinografia/métodos , Verde de Indocianina , Algoritmos , Angiofluoresceinografia/estatística & dados numéricos , Corantes Fluorescentes , Humanos , Modelos Teóricos , Oftalmoscopia , Fenômenos Ópticos , Tomografia de Coerência Óptica , Gravação em Vídeo
17.
PLoS One ; 6(2): e11532, 2011 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-21379571

RESUMO

BACKGROUND: Retinal hemorrhages have been described as a component of high altitude retinopathy (HAR) in association with altitude illness. In this prospective high altitude study, we aimed to gain new insights into the pathophysiology of HAR and explored whether HAR could be a valid early indicator of altitude illness. METHODOLOGY/PRINCIPAL FINDINGS: 28 mountaineers were randomly assigned to two ascent profiles during a research expedition to Mt. Muztagh Ata (7546 m/24,751 ft). Digital fundus photographs were taken prior to expedition at 490 m (1,607 ft), during expedition at 4497 m (14,750 ft = base camp), 5533 m (18,148 ft), 6265 m (20,549 ft), 6865 m (22,517 ft) and 4.5 months thereafter at 490 m. Number, size and time of occurrence of hemorrhages were recorded. Oxygen saturation (SpO2) and hematocrit were also assessed. 79% of all climbers exhibited retinal hemorrhages during the expedition. Number and area of retinal bleeding increased moderately to medium altitudes (6265 m). Most retinal hemorrhages were detected after return to base camp from a high altitude. No post-expeditional ophthalmic sequelae were detected. Significant negative (SpO2 Beta: -0.4, p<0.001) and positive (hematocrit Beta: 0.2, p = 0.002, time at altitude Beta: 0.33, p = 0.003) correlations with hemorrhages were found. CONCLUSIONS/SIGNIFICANCE: When closely examined, a very large amount of climbers exhibit retinal hemorrhages during exposure to high altitudes. The incidence of retinal hemorrhages may be greater than previously appreciated as a definite time lag was observed between highest altitude reached and development of retinal bleeding. Retinal hemorrhages should not be considered warning signs of impending severe altitude illness due to their delayed appearance.


Assuntos
Altitude , Hemorragia Retiniana/diagnóstico , Hemorragia Retiniana/etiologia , Adulto , Idoso , Doença da Altitude/complicações , Doença da Altitude/diagnóstico , Doença da Altitude/fisiopatologia , Pressão Sanguínea/fisiologia , Diagnóstico Tardio , Feminino , Fundo de Olho , Humanos , Masculino , Pessoa de Meia-Idade , Montanhismo/fisiologia , Oftalmoscopia , Radiografia , Hemorragia Retiniana/diagnóstico por imagem , Hemorragia Retiniana/fisiopatologia , Fatores de Tempo , Adulto Jovem
18.
Invest Ophthalmol Vis Sci ; 51(9): 4480-91, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20805570

RESUMO

PURPOSE: A relationship has been reported between the presence of peripheral neuropathy and the density and shape of corneal nerve fibers. Peripheral neuropathy is a debilitating condition that arises from many common health problems, and its presence is often confirmed with an invasive clinical test called intramuscular electromyography (EMG). In this study, the possibility of developing an alternative or adjunct test to EMG based on the appearance of nerve fibers in corneal micrographs was explored. Since corneal imaging is virtually noninvasive compared with EMG, such a test may be administered more liberally and frequently, before neuropathy symptoms occur. METHODS: A software program that automatically traces nerve fibers in corneal micrographs and generates measures based on these traces was implemented. This software was applied to a database of images collected by confocal laser scanning corneal microscopy from diabetic subjects whose levels of neuropathy were measured with EMG and from healthy subjects. RESULTS: Trends in the nerve fiber density and various measures of shape were calculated and observed, to explore the possibility of using these measures as a clinical tool for corroborating symptoms, confirming an evaluation, or evaluating risk factors for developing neuropathy. CONCLUSIONS: Preliminary statistical trends show a potential for measuring and observing neuropathy severity or for providing an objective risk measure for a patient's ensuing condition. More work is needed in the development of the measures and in their testing to prove that the measures can be made repeatable in a clinical environment.


Assuntos
Córnea/inervação , Processamento de Imagem Assistida por Computador/métodos , Microscopia Confocal/métodos , Fibras Nervosas/patologia , Doenças do Sistema Nervoso Periférico/patologia , Software , Adulto , Idoso , Idoso de 80 Anos ou mais , Eletromiografia , Humanos , Microscopia Confocal/instrumentação , Pessoa de Meia-Idade , Modelos Estatísticos , Doenças do Sistema Nervoso Periférico/epidemiologia , Fatores de Risco , Índice de Gravidade de Doença , Design de Software
19.
Health Place ; 16(5): 942-51, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20691391

RESUMO

Little research has examined the effect of physician supply on health-related measures at the individual and community level simultaneously. Using telephone survey data from six counties in upstate New York, a commuting radius was constructed between the zip codes of respondents and their primary care physicians. The relationships between local physician supply, the probability of having a primary care physician, and receiving preventive health care checks were analyzed. Both logistic regression and multilevel modeling results indicated the local supply of primary care physicians affects the probability of having a primary care physician, which in turn affects preventive healthcare service utilization.


Assuntos
Acessibilidade aos Serviços de Saúde , Médicos de Atenção Primária/provisão & distribuição , Serviços Preventivos de Saúde/estatística & dados numéricos , Inquéritos Epidemiológicos , Humanos , New York , Avaliação de Resultados em Cuidados de Saúde , Estados Unidos
20.
Foot Ankle Spec ; 2(4): 194-9, 2009 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-19825774

RESUMO

A combination of the medial displacement calcaneal osteotomy with the Evans lateral column-lengthening osteotomy has been suggested when hindfoot valgus, forefoot abduction, and midtarsal joint instability are significant. However, the deforming forces must be flexible. The goal of this procedure is to restore alignment, stabilize the foot, and improve overall function. This double-calcaneal osteotomy addresses all components of the pes planus deformity. This article reports the use of a unilateral external fixator to callus distract the Evans calcaneal osteotomy while compressing the posterior medial calcaneal displacement osteotomy, which to the authors' knowledge has not been performed or reported in the literature. At the final post-operative visit of this clinical patient, the foot was rectus, and X-rays demonstrated an increased calcaneal inclination angle from 10 degrees preoperatively to 15 degrees postoperatively, a decreased talar declination angle from 39 degrees preoperatively to 26 degrees postoperatively, and the cuboid abduction angle decreased from 32 degrees preoperatively to 9 degrees postoperatively. The patient was pain free and extremely satisfied with the surgery, especially with the use of the external fixator.


Assuntos
Calcâneo/cirurgia , Fixadores Externos , Pé Chato/cirurgia , Osteotomia/métodos , Adulto , Feminino , Humanos
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