RESUMO
OBJECTIVE: Up until now, serial voiding cystourethrogram (SVCU) has been regarded as the gold standard technique in the diagnosis of vesicoureteral reflux (VUR). The aim of intraoperative SVCU during endoscopic treatment is to detect those patients eligible to receive more biosynthetic material as a result of persistent VUR. The objective of this study was to assess the usefulness of SVCU as a predictor of treatment success. MATERIALS AND METHODS: An analytical, retrospective study of patient medical records was carried out. Patients included had undergone endoscopic VUR surgery from 2000 to 2019, and they were measured in ureteral units. VUR persistence at intraoperative SVCU following treatment was compared with SVCU results after 3 months. RESULTS: Of a total of 167 ureteral units undergoing surgery, persistent reflux immediately after surgery was observed in 17 cases (10% of the sample). Only 3 cases had other urological malformations. In the SVCU carried out after 3 months, reflux was found in 38% of the sample (64 cases). When comparing the results, intraoperative SVCU demonstrated a specificity of 92.6%, and a sensitivity of 15.6%. CONCLUSIONS: Given the low sensitivity (15.6%) of intraoperative SVCU to detect cases of persistent reflux in the mid-term, and considering the risks associated with radiation in the pediatric population - which is extremely sensitive to it -, intraoperative SVCU should be ruled out as a useful indicator of endoscopic treatment success.
OBJETIVO: La cistouretrografía miccional seriada (CUMS) ha sido hasta ahora el gold standard en el diagnóstico del reflujo vesicoureteral (RVU). La finalidad de la CUMS intraoperatoria durante el tratamiento endoscópico es detectar aquellos pacientes subsidiarios de inyectar más material biosintético por persistencia del RVU. En este estudio hemos querido evaluar la utilidad de esta prueba como predictor de éxito del tratamiento. MATERIAL Y METODOS: Estudio analítico retrospectivo mediante la revisión de historias clínicas de pacientes, medidos en unidades ureterales, intervenidos de RVU de forma endoscópica entre los años 2000 y 2019. Se comparó la persistencia de RVU en la CUMS intraoperatoria tras el tratamiento con el resultado de la CUMS a los 3 meses. RESULTADOS: De un total de 167 unidades ureterales intervenidas, se observó persistencia del reflujo inmediatamente tras la intervención en 17 casos (10% de la muestra). Solo 3 asociaban otras malformaciones urológicas. En la CUMS a los 3 meses se observó reflujo en el 38% de la muestra (64 casos). Al comparar los resultados, obtenemos para la CUMS intraoperatoria una especificidad del 92,6% y una sensibilidad del 15,6%. CONCLUSIONES: Dada la baja sensibilidad (15,6%) de la CUMS intraoperatoria para detectar los casos en los que persiste el reflujo a medio plazo y, teniendo en cuenta los riesgos asociados a la radiación que supone en una población especialmente sensible como es la pediátrica, se desestima su utilidad como indicador de éxito del tratamiento endoscópico.
Assuntos
Ureter , Refluxo Vesicoureteral , Criança , Endoscopia , Humanos , Estudos Retrospectivos , Resultado do Tratamento , Refluxo Vesicoureteral/diagnóstico por imagem , Refluxo Vesicoureteral/cirurgiaRESUMO
Objetivo: La cistouretrografía miccional seriada (CUMS) ha sido hasta ahora el gold standard en el diagnóstico del reflujo vesicoureteral (RVU). La finalidad de la CUMS intraoperatoria durante el tratamientoendoscópico es detectar aquellos pacientes subsidiarios de inyectar más material biosintético por persistencia del RVU. En este estudio hemos querido evaluar la utilidad de esta prueba como predictor de éxito deltratamiento. Material y métodos: Estudio analítico retrospectivo mediante la revisión de historias clínicas de pacientes, medidos en unidades ureterales, intervenidos de RVU de forma endoscópica entre los años 2000 y2019. Se comparó la persistencia de RVU en la CUMS intraoperatoria tras el tratamiento con el resultado de la CUMS a los 3 meses. Resultados: De un total de 167 unidades ureterales intervenidas, se observó persistencia del reflujo inmediatamente tras la intervención en 17 casos (10% de la muestra). Solo 3 asociaban otras malformacionesurológicas. En la CUMS a los 3 meses se observó reflujo en el 38% de la muestra (64 casos). Al comparar los resultados, obtenemos para la CUMS intraoperatoria una especificidad del 92,6% y una sensibilidad del 15,6%. Conclusiones: Dada la baja sensibilidad (15,6%) de la CUMS intraoperatoria para detectar los casos en los que persiste el reflujo a medio plazo y, teniendo en cuenta los riesgos asociados a la radiación que supone en una población especialmente sensible como es la pediátrica, se desestima su utilidad como indicador de éxito del tratamientoendoscópico.(AU)
Objective: Up until now, serial voiding cystourethrogram (SVCU) has been regarded as the gold standard technique in the diagnosis ofvesicoureteral reflux (VUR). The aim of intraoperative SVCU during endoscopic treatment is to detect those patients eligible to receive morebiosynthetic material as a result of persistent VUR. The objective of this study was to assess the usefulness of SVCU as a predictor of treatment success. Materials and methods: An analytical, retrospective study of patient medical records was carried out. Patients included had undergoneendoscopic VUR surgery from 2000 to 2019, and they were measured in ureteral units. VUR persistence at intraoperative SVCU followingtreatment was compared with SVCU results after 3 months. Results: Of a total of 167 ureteral units undergoing surgery, persistent reflux immediately after surgery was observed in 17 cases (10%of the sample). Only 3 cases had other urological malformations. In the SVCU carried out after 3 months, reflux was found in 38% of thesample (64 cases). When comparing the results, intraoperative SVCU demonstrated a specificity of 92.6%, and a sensitivity of 15.6%. Conclusions: Given the low sensitivity (15.6%) of intraoperative SVCU to detect cases of persistent reflux in the midterm, and considering the risks associated with radiation in the pediatric population which is extremely sensitive to it, intraoperative SVCU should be ruled outas a useful indicator of endoscopic treatment success.(AU)
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Endoscopia , Endoscopia Gastrointestinal/métodos , Refluxo Vesicoureteral/diagnóstico por imagem , Refluxo Vesicoureteral/cirurgia , Doenças Ureterais , Resultado do Tratamento , Dimetilpolisiloxanos , Ácido Hialurônico , Estudos Retrospectivos , 28599 , PediatriaRESUMO
Paciente de 78 años que sufre fractura de ramas ilio e isquipubiana derechas tras caída casual. A las pocas horas presenta un cuadro de dolor abdominal brusco e hipotensión, siendo diagnosticada de hemorragia extraperitoneal con sangrado activo y repercusión hemodinámica. Ante el progresivo empeoramiento, con anemización e inestabilidad hemodinámica, es remitido al hospital de referencia, donde se realiza embolización selectiva del vaso sangrante. Tras la embolización, la paciente se estabiliza y permanece ingresada, comenzando sedestación una semana más tarde y con consolidación de las fracturas a los 3 meses. Las fracturas pélvicas de baja energía por compresión lateral suelen presentar escasas complicaciones, aunque precisan un control exhaustivo por el riesgo potencial de lesiones vasculares. Es estos casos suponen un riesgo vital, siendo la embolización selectiva del punto sangrante un método de control eficaz, que tampoco está exento de complicaciones graves (AU)
The case is presented of a 78 year-old patient who suffered a right ileo- and ischiopubic rami fracture after a casual fall. A few hours later, she presented with sudden abdominal pain and hypotension. Imaging test showed extraperitoneal hemorrhage with active bleeding and hemodynamic compromise. The progressive worsening, with anemia and hemodynamic instability, required her being sent to the reference hospital for selective embolization of the bleeding point. After embolization, the patient́s situation stabilized, and she was then able to sit down one week later. The fracture consolidated 3 months later. Although low-energy pelvic fractures by lateral compression do not usually present with complications, sometimes they require a strict control due to the potential risk of vascular injuries (AU)
Assuntos
Humanos , Masculino , Idoso , Pelve/lesões , Pelve/cirurgia , Pelve , Choque/complicações , Dor Abdominal/complicações , Dor Abdominal/etiologia , Embolia/complicações , Fatores de Risco , Embolização Terapêutica/métodos , Imageamento por Ressonância Magnética , Tomografia Computadorizada de Emissão/métodos , Tomografia Computadorizada de Emissão , Angiografia/métodos , Angiografia/tendênciasRESUMO
The case is presented of a 78 year-old patient who suffered a right ileo- and ischiopubic rami fracture after a casual fall. A few hours later, she presented with sudden abdominal pain and hypotension. Imaging test showed extraperitoneal hemorrhage with active bleeding and hemodynamic compromise. The progressive worsening, with anemia and hemodynamic instability, required her being sent to the reference hospital for selective embolization of the bleeding point. After embolization, the patientÌs situation stabilized, and she was then able to sit down one week later. The fracture consolidated 3 months later. Although low-energy pelvic fractures by lateral compression do not usually present with complications, sometimes they require a strict control due to the potential risk of vascular injuries.
Assuntos
Artérias Epigástricas/lesões , Fraturas Ósseas/complicações , Ossos Pélvicos/lesões , Choque Hemorrágico/etiologia , Lesões do Sistema Vascular/etiologia , Idoso , Feminino , Humanos , Choque Hemorrágico/diagnóstico , Lesões do Sistema Vascular/diagnósticoRESUMO
Objetivo: Determinar, mediante simulación con elementos finitos (MEF), la adecuación de la fijación con tornillo biocompatible del fascículo posterolateral (PL) en las reparaciones de ligamento cruzado anterior (LCA) con técnica bifascicular y único túnel tibial. Material y método: Se realizó un estudio mediante MEF de las tensiones sufridas del material de fijación (Endobutton ® y Biosure HA®) y del componente óseo en reparaciones del LCA mediante la técnica bifascicular y único túnel tibial. Resultados: Las fuerzas ejercidas sobre las fijaciones sobre el componente óseo están dentro de los límites admisibles por el hueso y por los materiales de fabricación de las fijaciones, tanto en la zona de anclaje como en fémur distal. Conclusión: La fijación del fascículo PL con un tornillo biocompatible en la reconstrucción del LCA con técnica bifascicular y único túnel tibial asegura un comportamiento mecánico adecuado para cuando la rodilla del paciente va a ser intensivamente rehabilitada (AU)
Objective: To determine, through finite element simulation (FEM), the adaptation of the posterolateral (PL) fascicle fixation by means of a biocompatible screw for anterior cruciate ligament (ACL) repairs when using the bifascicular technique with a single tibial tunnel. Material and method: It has been performed a finite element study in order to analyse the stress suffered by both material fixation (Endobutton® and Biosure HA®), and the bone component in ACL repairs using the bifascicular technique with a single tibial tunnel. Results: The simulation carried out shows that the forces exerted over the fixations and the bone are within the allowable limits for the bone and the manufacture material of the fixing devices, both at the anchorage area and at distal femur. Conclusion: The fixation of the PL fascicle by means of a biocompatible screw Biosure HA® in ACL repairs, when using the bifascicular technique with a single tibial tunnel, allows ensuring a proper mechanical behaviour when patient's knee is going to be intensively rehabilitated (AU)
Assuntos
Humanos , Masculino , Feminino , Ligamento Cruzado Anterior/lesões , Ligamento Cruzado Anterior/cirurgia , Fixação Intramedular de Fraturas/métodos , Fixação Intramedular de Fraturas/tendências , Fixação Intramedular de Fraturas , Fixadores Internos , /métodosRESUMO
PURPOSE: To determine whether polymorphisms (SNPs) in the genes encoding cytokines and nitric oxide synthase (NOS) might play some role in lumbar disc herniation (LDH). PATIENTS AND METHODS: Case-control study in which 179 patients were retrospectively reviewed. The case group was made of 50 patients with symptomatic LDH diagnosed by MRI while the control group was made of 129 individuals undergoing routine hip or knee arthroplasty with a lifetime lack of low back pain. SNPs in the cytokine genes of IL-1 [IL-1α (-889 C/T), IL-1ß (+3953 T/C)], TNF-α (-308 G/A and -238 G/A) and NOS genes [eNOS (r 27 bp, intron 4 and -786 T/C) and iNOS (22 G/A)]. RESULTS: The CC genotype and C allele of the IL-1ß (+3953 T/C) SNP were significantly more frequent among LDH patients compared to controls. On the other hand, eNOS (-768 T/C) and iNOS (22 G/A) SNPs were significantly more common in the control group. CONCLUSIONS: Carriers of the CC genotype of the IL-1ß (+3953 T/C) SNP were more frequent among LDH patients suggesting some potential role of the IL-1ß SNP on LDH pathogenesis. The eNOS (-786 T/C) and iNOS (22 G/A) SNPs were more frequent among the control subjects, suggesting their possible protective role against LDH. Genotyping these SNPs could be useful to identify persons with an increased lifetime risk of disc herniation in whom measures to avoid LDH could be implemented.
Assuntos
Interleucina-1beta/genética , Deslocamento do Disco Intervertebral/genética , Deslocamento do Disco Intervertebral/patologia , Vértebras Lombares/patologia , Polimorfismo de Nucleotídeo Único/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Frequência do Gene/genética , Triagem de Portadores Genéticos , Humanos , Interleucina-1alfa/genética , Masculino , Pessoa de Meia-Idade , Fator de Necrose Tumoral alfa/genética , Adulto JovemRESUMO
Objetivo: determinar, mediante la simulación con elementos finitos, las diferencias mecánicas del túnel femoral en las reparaciones del ligamento cruzado anterior (LCA), con técnicas mono y bifasciculares con un único túnel tibial. Material y Método: se realizó un estudio mediante elementos finitos de las tensiones sufridas en el material de fijación (Endobutton® y Endobutton direct®), como del componente óseo, en las reparaciones del LCA mediante la técnica monofascicular y bifascicular con un único túnel tibial. Se simuló la resistencia a la compresión del extremo distal del fémur tras la realización de los túneles. Resultados: las fuerzas sufridas tanto por el material de fijación como por el componente óseo estaban dentro de los límites de tolerancia de ambos materiales en todos los supuestos estudiados, tanto en la zona de anclaje como en el fémur distal. Conclusiones: la realización de mayor número de túneles en la reconstrucción del LCA no supone un riesgo de rotura del material ni de fractura ósea (AU)
Objetive: To use finite elements simulation to determine the mechanical differences of the femoral tunnel in monofascicular and bifascicular anterior cruciate ligament (ACL) repair with a single tibial tunnel. Material and method: A finite elements study was made of the tension experienced in the fixation material (Endobutton® and Endobutton direct®) and bone component in monofascicular and bifascicular ACL repair with a single tibial tunnel. Resistance to compression of the distal extremity of the femur was simulated aftercreating the tunnels. Results: The forces experienced by the fixation material and bone component were within the limits of tolerance of both materials in all the studied scenarios, in both the anchoring zone and in the distal femur. Conclusions: The creation of an increased number of tunnels in ACL reconstruction does not imply a risk of material rupture or bone fracture (AU)