Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 63
Filtrar
1.
South Med J ; 117(1): 11-15, 2024 01.
Artigo em Inglês | MEDLINE | ID: mdl-38151245

RESUMO

OBJECTIVES: Thoracic outlet syndrome (TOS) is an uncommon neurovascular disorder that presents as neck and upper extremity pain secondary to brachial plexus trunk or subclavian vasculature compression. The orthopedic literature has correlated patient-reported allergies to postoperative patient-reported outcome (PRO) scores for a variety of surgical procedures. We sought to evaluate patient-reported allergies and PROs following surgical decompression for TOS. METHODS: A chart review was conducted after identifying patients who underwent surgical thoracic outlet decompression by a single surgeon. Patients were contacted and administered five PRO questionnaires via telephone: the QuickDASH Outcome Measure questionnaire (disabilities of the arm, shoulder, and hand [DASH]), the Cervical Brachial Symptom Questionnaire, the Single Assessment Numeric Evaluation, the 12-Item Short Form Survey, and the Numeric Rating Scale (a visual analogue scale). A bivariate analysis of Pearson's correlation coefficient (r) was used to determine the associations of allergies with questionnaires and demographic variables. RESULTS: Of the 393 patients (128 males and 265 females) identified in the study, 75 (24%) responded and completed all of the questionnaires, 18 (24%) males and 57 (76%) females. A significant correlation was found between the number of allergies reported and the QuickDASH Outcome Measure questionnaire (r = 0.375, P < 0.001), the Cervical Brachial Symptom Questionnaire (r = 0.295, P = 0.01), change in the Single Assessment Numeric Evaluation score (r = -0.310, P < 0.01), change in the visual analogue scale (r = 0.244, P = 0.035), sex (r = 0.245, P = 0.034), and the number of medications (r = 0.642, P < 0.001). CONCLUSIONS: The increased frequency of patient-reported allergies is significantly associated with worse PRO scores for women undergoing TOS surgical decompression. Better understanding this association can help physicians counsel patients on expected outcomes.


Assuntos
Hipersensibilidade , Síndrome do Desfiladeiro Torácico , Masculino , Humanos , Feminino , Autorrelato , Resultado do Tratamento , Síndrome do Desfiladeiro Torácico/complicações , Síndrome do Desfiladeiro Torácico/epidemiologia , Síndrome do Desfiladeiro Torácico/cirurgia , Inquéritos e Questionários , Descompressão Cirúrgica/métodos , Hipersensibilidade/complicações , Hipersensibilidade/epidemiologia , Hipersensibilidade/cirurgia , Estudos Retrospectivos
2.
J Arthroplasty ; 39(1): 103-110, 2024 01.
Artigo em Inglês | MEDLINE | ID: mdl-37454947

RESUMO

BACKGROUND: Metal allergy is a rare and controversial cause of implant failure and poor outcomes following total knee arthroplasty (TKA). Few studies have investigated clinical and patient-reported outcome measures (PROMs) in patients treated with hypoallergenic implants. This investigation aimed to compare: (1) health care utilizations (eg, hospital length of stay, 90-day readmission rate, and incidence of nonhome discharge) and (2) 1-year PROMs between patients who received hypoallergenic and standard TKA implants. METHODS: This was a retrospective review of prospectively collected data from patients who underwent primary TKA between 2018 and 2019. Propensity score matching (3:1) was used to compare standard TKA patients with those who received hypoallergenic TKA implants, respectively. Knee injury and Osteoarthritis Outcome Score (KOOS) pain, KOOS Physical function Shortform (PS), and Veterans RAND 12-Item Health Survey Mental Component Score were collected preoperatively and at 1-year. After matching, 190 hypoallergenic and 570 standard TKAs were analyzed. RESULTS: No differences were observed in length of stay (P = .98), 90-day readmission (P = .89), and nonhome discharge (P = .82). Additionally, there was no significant difference in change from preoperative to 1-year PROMs (KOOS pain, P = .97; KOOS PS, P = .88; Veterans RAND 12-Item Health Survey Mental Component Score, P = .28). Patient-reported satisfaction was similar at 1-year (P = .23). Patients achieved similar rates of Patient Acceptable Symptom State (PASS) and minimal clinically important difference (MCID) for KOOS pain (PASS, P = .77; MCID, P = .33) and KOOS PS (PASS, P = .44; MCID, P = .65). CONCLUSION: Patients treated with hypoallergenic TKA implants for suspected metal allergy had similar outcomes compared to patients who had standard implants and no metal allergy.


Assuntos
Artroplastia do Joelho , Hipersensibilidade , Osteoartrite do Joelho , Humanos , Artroplastia do Joelho/efeitos adversos , Osteoartrite do Joelho/cirurgia , Satisfação do Paciente , Aceitação pelo Paciente de Cuidados de Saúde , Dor/cirurgia , Inquéritos Epidemiológicos , Hipersensibilidade/epidemiologia , Hipersensibilidade/etiologia , Hipersensibilidade/cirurgia , Medidas de Resultados Relatados pelo Paciente , Resultado do Tratamento
3.
BMC Musculoskelet Disord ; 24(1): 968, 2023 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-38098024

RESUMO

BACKGROUND: Allergies against implant materials are still not fully understood. Despite controversies about its relevance, some patients need treatment with hypoallergenic implants. This study compared coated and standard total knee arthroplasty (TKA) regarding inflammatory response and patient-reported outcome measures (PROMs). METHODS: 76 patients without self-reported allergies against implant materials were included in a RCT and received a coated or standard TKA of the same cemented posterior-stabilized knee system. 73 patients completed the 3-year follow-up. Two patients died and there was one revision surgery. Serum levels of cytokines with a possible role in implant allergy were measured in patient`s serum (IL-1beta, IL-5, IL-6, IL-8, IL-10, IFN γ, TNF α) prior to, one and three years after surgery. Furthermore, PROMs including knee function (Oxford Knee Score, Knee Society Score) and health-related quality of life (QoL, EuroQuol questionnaire) were assessed. Additionally, 8 patients with patch-test proven skin allergy against implant materials who received the coated implant were assessed similarly and compared to a matched-pair group receiving the same implant. RESULTS: There were no differences in function and QoL between the assessed groups at any follow-up. The majority of patients demonstrated no elevation of the measured blood cytokines. Cytokine patterns showed no differences between study groups at any follow-up. The allergy patients demonstrated slower functional improvement and minor differences in cytokine pattern. Yet these results were not significant. There were no differences in the matched-pair analysis. CONCLUSION: We observed no relevant increase in serum cytokine levels in any group. The inflammatory response measured seems limited, even in allergy patients. Furthermore, there were no differences between coated and standard TKA in non-allergy patients in the 3-year Follow-Up period. TRIAL REGISTRATION: The study protocol was registered in the US National Institutes of Health's database ( http://www. CLINICALTRIALS: gov ) registry under NCT03424174 on 03/17/2016.


Assuntos
Artroplastia do Joelho , Hipersensibilidade , Prótese do Joelho , Osteoartrite do Joelho , Humanos , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Qualidade de Vida , Prótese do Joelho/efeitos adversos , Articulação do Joelho/cirurgia , Hipersensibilidade/etiologia , Hipersensibilidade/cirurgia , Citocinas , Medidas de Resultados Relatados pelo Paciente , Resultado do Tratamento , Osteoartrite do Joelho/cirurgia , Osteoartrite do Joelho/etiologia
4.
J Arthroplasty ; 38(7 Suppl 2): S194-S198, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-37100098

RESUMO

BACKGROUND: The role of metal hypersensitivity reactions in total knee arthroplasty (TKA) failure is debated. There is no consensus on whether use of a more expensive nickel-free implant is indicated for patients who have preoperative nickel allergy. The purpose of this study was to examine the outcome of patients who have preoperative nickel allergy receiving nickel-free or cobalt chromium (CoCr) implants. METHODS: This was a retrospective review of 17,798 patients who underwent 20,324 unilateral primary TKAs between 2016 and 2020. Presence of preoperative nickel allergy was determined (n = 282). Patients were divided into 2 cohorts: those receiving (1) nickel-free or (2) CoCr implants. Clinical outcome scores and revision rates were assessed. RESULTS: 243 received a nickel-free implant and 39 received a CoCr implant. There was no significant difference in revision rate between the cohorts. Survivorship free of revision was 94% in the CoCr implant cohort and 98% in the nickel-free implant cohort (P = .9). When comparing clinical outcome scores between cohorts, there was no difference in preoperative, 6-week or 1-year Knee Osteoarthritis Outcome Score Joint Replacement, Visual Analog Scale (VAS), Lower Extremity Activity Scale, Patient-Reported Outcomes Measurement Information System (PROMIS), and Veterans RAND 12-item scores between cohorts. CONCLUSION: In this retrospective cohort study, there was no difference in revision rates or clinical outcomes in patients who had a nickel allergy undergoing primary TKA with CoCr or nickel-free implants. Further studies are needed to determine if nickel allergy is an independent risk factor for worse TKA outcomes in general.


Assuntos
Artroplastia do Joelho , Hipersensibilidade , Prótese do Joelho , Humanos , Artroplastia do Joelho/efeitos adversos , Articulação do Joelho/cirurgia , Níquel/efeitos adversos , Prótese do Joelho/efeitos adversos , Estudos Retrospectivos , Hipersensibilidade/etiologia , Hipersensibilidade/cirurgia , Cobalto/efeitos adversos , Cromo/efeitos adversos , Reoperação , Resultado do Tratamento
5.
Turk J Ophthalmol ; 53(2): 85-90, 2023 04 20.
Artigo em Inglês | MEDLINE | ID: mdl-37089010

RESUMO

Objectives: The aim of this study was to investigate the incidence of postoperative ptosis after primary trabeculectomy and the possible factors contributing to ptosis. Materials and Methods: A total of 312 patients (339 eyes) who underwent trabeculectomy with mitomycin-C between 2015 and 2020 were retrospectively evaluated. Patients who had regular follow-up for at least 6 months and no history of ptosis or ptosis surgery were included. Age, sex, glaucoma type, preoperative and postoperative intraocular pressure, preoperative and postoperative antiglaucoma medications, number of antiglaucoma drops, duration of antiglaucoma medication use, history of eye itching due to antiglaucoma medication-associated allergy, duration of follow-up, postoperative needling, needling time, and ocular massage were recorded. Ptosis was defined as ≥2 mm reduction in margin-reflex distance 1 from preoperative levels. Ptosis that had not improved for at least 6 months was considered persistent ptosis. Multivariate logistic regression was used to determine potential predictors of ptosis development. Results: Ptosis after trabeculectomy was observed in 35 of 339 eyes (10.3%). Thirty eyes of 30 patients (8.8%) had transient ptosis and 5 eyes of 4 patients (1.5%) had persistent ptosis. Preoperative duration of antiglaucoma medication use, drug(s) used (prostaglandin analogs, beta-blockers, alpha-2 agonists, carbonic anhydrase inhibitors, or combinations of these), needling time, and ocular massage after trabeculectomy did not differ significantly between groups (p>0.05). Needling and eye itching due to antiglaucoma medication-associated allergy were significantly higher in patients with ptosis (p<0.05). Conclusion: Ptosis after trabeculectomy is an important problem for glaucoma patients. It has been observed that needling and a history of eye itching due to antiglaucoma drug-associated allergy may increase the risk of ptosis.


Assuntos
Blefaroptose , Glaucoma , Hipersensibilidade , Trabeculectomia , Humanos , Trabeculectomia/efeitos adversos , Incidência , Estudos Retrospectivos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Glaucoma/cirurgia , Glaucoma/tratamento farmacológico , Blefaroptose/epidemiologia , Blefaroptose/cirurgia , Hipersensibilidade/cirurgia
6.
Musculoskelet Surg ; 107(1): 55-68, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34719773

RESUMO

PURPOSE: Metal ion release may cause local and systemic effects and induce hypersensitivity reactions. The aim of our study is first to determine if implant-related hypersensitivity correlates to patient symptoms or not; second, to assess the rate of hypersensitivity and allergies in shoulder arthroplasty. METHODS: Forty patients with shoulder replacements performed between 2015 and 2017 were studied with minimum 2-year follow-up; no patient had prior metal implants. Each patient underwent radiographic and clinical evaluation using the Constant-Murley Score (CMS), 22 metal and cement haptens patch testing, serum and urine tests to evaluate 12 metals concentration, and a personal occupational medicine interview. RESULTS: At follow-up (average 45 ± 10.7 months), the mean CMS was 76 ± 15.9; no clinical complications or radiographic signs of loosening were detected; two nickel sulfate (5%), 1 benzoyl peroxide (2.5%) and 1 potassium dichromate (2.5%) positive findings were found, but all these patients were asymptomatic. There was an increase in serum aluminum, urinary aluminum and urinary chromium levels of 1.74, 3.40 and 1.83 times the baseline, respectively. No significant difference in metal ion concentrations were found when patients were stratified according to gender, date of surgery, type of surgery, and type of implant. CONCLUSIONS: Shoulder arthroplasty is a source of metal ion release and might act as a sensitizing exposure. However, patch test positivity does not seem to correlate to hypersensitivity cutaneous manifestations or poor clinical results. Laboratory data showed small constant ion release over time, regardless of gender, type of shoulder replacement and implant used. LEVELS OF EVIDENCE: Level II.


Assuntos
Artroplastia de Substituição , Hipersensibilidade , Articulação do Ombro , Humanos , Alumínio , Ombro/cirurgia , Hipersensibilidade/etiologia , Hipersensibilidade/diagnóstico , Hipersensibilidade/cirurgia , Metais/efeitos adversos , Artroplastia de Substituição/efeitos adversos , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia
7.
J Knee Surg ; 36(1): 6-17, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33932947

RESUMO

Lymphocyte transformation testing (LTT) is often used in the workup for possible metal allergy after total knee arthroplasty (TKA) but the correlation of this test with other diagnostic metal-allergy findings in patients undergoing revision TKA for suspected metal allergy has not been established. A single-center, single-surgeon cohort of 19 TKAs in which both components were revised for presumed implant-related metal allergy based on history, physical, and LTT testing, to nonnickel-containing implants were retrospectively identified. Histopathologic samples obtained intraoperatively were semiquantitatively analyzed using both the Hospital for Special Surgery (HSS) synovial pathology score and the Campbell aseptic lymphocyte-dominant vasculitis-associated lesion (ALVAL) score. As histopathology control group, we included in the study an additional cohort of 17 patients who received aseptic revision TKA and had no history of reported or tested metal sensitivity. All preoperative LTT results were highly reactive to nickel. However, this did not correlate with local periarticular tissue response in 18 of 19 cases which demonstrated a low HSS synovial score (mean: 3.8 ± 2.8, of a maximum score of 28) and the low Campbell ALVAL scores (mean: 2.5/10 ± 1.3, of a maximum score of 10). There were not any significant differences between the study group (suspected implant-related metal allergy) and the control group (nonsuspected implant-related metal allergy) in regard to (1) the Campbell score and (2) the HSS synovial inflammatory score. Knee Society Clinical Rating System (KSCRS) function score improved significantly after revision (mean postoperative increase: 34.0 ± 17. 2; p < 0.001), as well as mean visual analog scale (VAS) pain (mean postoperative decrease: 33.3 ± 26.4; p < 0.01) score. The short-term survival rate (at mean follow-up of 26.1 months) of this patient cohort was 100%. In this cohort of revised TKA patients with suspected nickel allergy based on clinical presentation and LTT positive results, intraoperative histopathology was essentially normal. However, all patients with suspected nickel allergy showed a significant clinical and functional improvement with excellent short-term survival rates. The clinical significance of a positive LTT needs further study.


Assuntos
Artroplastia do Joelho , Hipersensibilidade , Prótese do Joelho , Humanos , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Níquel/efeitos adversos , Estudos Retrospectivos , Reoperação , Hipersensibilidade/etiologia , Hipersensibilidade/cirurgia , Prótese do Joelho/efeitos adversos
8.
Br J Neurosurg ; 37(4): 916-920, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32003246

RESUMO

PURPOSE: Cases of allergy to large surgical implants have been reported. However, few studies have reported allergy to small titanium-containing implants (e.g. Zero-P device). METHODS: We reported the case of a 51-year old male patient who underwent the anterior cervical discectomy and fusion (ACDF) procedure using a Zero-P device and exhibited allergic symptoms 1 month after the surgery. RESULTS: The allergic symptoms included intermittent tingling and itches in the throat induced by speaking. Systemic rashes over the skin surface and congestion of the eyeball, and dysphagia were also present. Anti-allergic treatment did not resolve the symptoms. Patch tests revealed negative reactions to the rested reagents including titanium. Radiographic results showed solid bone fusion and no signs of chronic inflammation or hypotoxic infection in the surrounding tissues. Upon the patient's request, we removed the titanium screws and plate of the Zero-P device. No allergic reactions were observed after the surgery and at a 6-month follow-up. CONCLUSIONS: Even with a small implant such as the Zero-P device, allergy to titanium may still occur. This case demonstrated the need to screen for the presence of allergy to metals including titanium before the surgery.


Assuntos
Hipersensibilidade , Fusão Vertebral , Masculino , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento , Titânio/efeitos adversos , Próteses e Implantes , Hipersensibilidade/etiologia , Hipersensibilidade/cirurgia , Discotomia/efeitos adversos , Discotomia/métodos , Fusão Vertebral/métodos , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia
9.
J Arthroplasty ; 37(6S): S250-S257, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35196568

RESUMO

BACKGROUND: Metal and cement allergy affects a small subset of patients, causing severe pain and often systemic reaction after total knee arthroplasty (TKA). Revision with ceramic-surfaced femoral components has been reported to resolve these symptoms of metal allergy, but no solution currently is available for patients with allergies to metal and bone cement. METHODS: Five patients (5 knees) with documented metal allergy were revised with custom porous-coated ceramic femoral components (Magnesia-stabilized Zirconia) from January 2007 to January 2013. An additional 23 patients (23 knees) met inclusion criteria from 2007 to 2015, but because the ceramic implant was unavailable, they underwent different treatment based on their underlying allergy to metal, cement, or both. Inclusion criteria included the history of clinically documented severe metal allergy, severe pain, swelling, and effusion >1 year after TKA, negative workup for infection, loosening, and ligament imbalance. Knee Society scores were compared for each cohort. RESULTS: Mean Knee Society scores for all 5 patients revised with custom cementless ceramic femoral components improved significantly for objective score (preoperative, 39 ± 5; most recent visit, 90 ± 2) and function score (preoperative, 33 ± 8; most recent visit 93 ± 4) (P < .0001). The 12 knees revised with off-the-shelf cemented ceramic-coated femoral components had similar results. The 7 unrevised knees (including 4 knees with allergy to metal and bone cement) and the 4 knees revised with standard CoCr femoral components did not improve and worsened over time. CONCLUSION: Symptoms resolved in the 5 patients revised with custom ceramic implants and in the 12 patients revised with ceramic-coated components, but did not improve in the patients unrevised or revised with CoCr femoral components. Symptoms presumed to be associated with metal or cement allergy improve with the use of ceramic femoral surfaces, but patients who are allergic both to metals and bone cement would be candidates only for porous-coated ceramic implants fixed without bone cement.


Assuntos
Artroplastia do Joelho , Hipersensibilidade , Prótese do Joelho , Artroplastia do Joelho/efeitos adversos , Cimentos Ósseos , Humanos , Hipersensibilidade/etiologia , Hipersensibilidade/cirurgia , Articulação do Joelho/cirurgia , Prótese do Joelho/efeitos adversos , Dor/cirurgia , Desenho de Prótese , Falha de Prótese , Reoperação
10.
J Urol ; 207(6): 1236-1245, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35050703

RESUMO

PURPOSE: Hematuria following post-prostatectomy radiotherapy (PPRT) is inadequately characterized. We performed a consecutive cohort study of patients treated with PPRT at our institution to characterize this complication including impact on patient-reported quality of life. MATERIALS AND METHODS: Patients with potential followup ≥4 years following PPRT were identified. Freedom from ≥grade 2 hematuria (FFG2H; macroscopic blood) was estimated using the Kaplan-Meier method. Predictors of ≥grade 2 hematuria (G2H) were assessed via log-rank tests and the Cox model. Urinary patient-reported quality of life by EPIC-26 (26-question Expanded Prostate Cancer Index Composite) was compared for patients with/without hematuria using mixed-effects regression. RESULTS: A total of 216 men received PPRT (median 68.4 Gy, IQR 68.0-68.4) from 2007 to 2016 at a median of 20 months (IQR 9-45) after prostatectomy. Median followup was 72 months (IQR 54-99). A total of 85 men developed hematuria, of whom 49 (58%) underwent cystoscopy, 13 (15%) required intervention and 26 (31%) experienced recurrent hematuria. Eight-year FFG2H was 55%. G2H was highest in men treated with anticoagulation/antiplatelet therapy (HR 3.24, p <0.001), men with bladder V65 Gy ≥43% (HR 1.97, p=0.004) and men with medication allergies (HR 1.73, p=0.049). Age <65 years (HR 0.81, p=0.374) and diabetes mellitus (HR 0.49, p=0.098) were not associated with G2H. Change in urinary continence (mean -3.5, 95% CI: 10.1, 3.1) and irritation/obstruction (mean -3.0, 95% CI: 5.8, -0.3) domain scores did not exceed the minimally clinically important difference for men with/without hematuria. CONCLUSIONS: Hematuria following PPRT is common, especially among men with medication allergies and those on anticoagulation/antiplatelet therapy; however, PPRT-related hematuria is typically self-limited. Limiting bladder V65 Gy may reduce PPRT-related hematuria.


Assuntos
Hipersensibilidade , Neoplasias da Próstata , Idoso , Anticoagulantes , Estudos de Coortes , Feminino , Seguimentos , Hematúria/epidemiologia , Hematúria/etiologia , Humanos , Hipersensibilidade/complicações , Hipersensibilidade/cirurgia , Incidência , Masculino , Inibidores da Agregação Plaquetária , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Neoplasias da Próstata/complicações , Neoplasias da Próstata/radioterapia , Neoplasias da Próstata/cirurgia , Qualidade de Vida
11.
Br J Ophthalmol ; 106(10): 1363-1367, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-33985961

RESUMO

BACKGROUND: The purpose of this study was to evaluate the incidence, timing and risk factors of corneal neovascularisation (NV) after deep anterior lamellar keratoplasty (DALK) for corneal ectasia. METHODS: This study included 616 eyes who underwent DALK between 2012 and 2020 in two tertiary referral centres. In one centre topical corticosteroids were discontinued after complete suture removal 1 year after surgery, whereas in the other they were discontinued 3-4 months after surgery. The presence and severity of corneal NV was ascertained based on slit lamp photographs. Potential risk factors for corneal NV were evaluated using the Cox proportional hazards model. RESULTS: The cumulative incidence of corneal NV was 8.7% at 1 year after surgery and 13.2% at 5 years. Mean time interval from surgery to development of corneal NV was 12.8±16.2 months, with 68.9% of cases occurring before complete suture removal. Early discontinuation of topical steroids, older age and ocular allergy were associated with an increased risk of developing corneal NV (respectively, HR=2.625, HR=1.019, HR=3.726, all p<0.05). CONCLUSIONS: The risk of corneal NV is higher in the first year following DALK. Early discontinuation of topical steroids, ocular allergy and older age are significant predictors of corneal NV.


Assuntos
Neovascularização da Córnea , Transplante de Córnea , Hipersensibilidade , Ceratocone , Corticosteroides , Córnea/cirurgia , Neovascularização da Córnea/diagnóstico , Neovascularização da Córnea/epidemiologia , Neovascularização da Córnea/etiologia , Transplante de Córnea/efeitos adversos , Dilatação Patológica , Humanos , Hipersensibilidade/etiologia , Hipersensibilidade/cirurgia , Incidência , Ceratocone/cirurgia , Ceratoplastia Penetrante , Estudos Retrospectivos , Fatores de Risco , Esteroides , Acuidade Visual
12.
Clin Podiatr Med Surg ; 38(2): 183-191, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33745650

RESUMO

Postoperative complications can be burdensome on both the patient and the surgeon. Attention in literature is often directed toward different forms of treatment and successful outcomes in surgery. The incentive of this article is to bring insight toward postoperative complications in rearfoot surgery, more specifically, the repair of the Achilles tendon with suture tape and suture anchors. This article directs attention to the recent reports on hypersensitivity reactions seen with the use of suture tape and nonabsorbable suture anchors and may encourage physicians to make patients aware of this potential complication when using these materials.


Assuntos
Tendão do Calcâneo/cirurgia , Complicações Pós-Operatórias , Tendão do Calcâneo/lesões , Idoso , Reação a Corpo Estranho/etiologia , Reação a Corpo Estranho/cirurgia , Humanos , Hipersensibilidade/etiologia , Hipersensibilidade/cirurgia , Masculino , Pessoa de Meia-Idade , Ruptura Espontânea , Fita Cirúrgica/efeitos adversos , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Âncoras de Sutura/efeitos adversos , Tendinopatia/etiologia , Tendinopatia/prevenção & controle , Trombose Venosa/etiologia , Trombose Venosa/prevenção & controle
13.
Front Immunol ; 12: 634313, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33679784

RESUMO

Recently, a novel syndrome of combined immune deficiency, infections, allergy, and inflammation has been attributed to mutations in the gene encoding actin-related protein 2/3 complex subunit 1B (ARPC1B), which is a key molecule driving the dynamics of the cytoskeleton. Homozygous mutations in the ARPC1B gene have been found to result in the disruption of the protein structure and cause an autosomal recessive syndrome of combined immune deficiency, impaired T-cell migration and proliferation, increased levels of immunoglobulin E (IgE) and immunoglobulin A (IgA), and thrombocytopenia. To date, only a few individuals have been diagnosed with the ARPC1B deficiency syndrome worldwide. In this case series, we report the wide spectrum of phenotype in 3 siblings of a consanguineous family from Afghanistan with a novel homozygous synonymous pathogenic variant c.783G>A, p. (Ala261Ala) of the ARPC1B gene that causes a similar syndrome but no thrombocytopenia. Targeted RNA studies demonstrated that the variant affects the splicing process of mRNA, resulting in a marked reduction of the levels of primary (normal) RNA transcript of the ARPC1B gene in the affected patients and likely premature termination from the abnormally spliced mRNA. The next generation sequencing (NGS) studies facilitated the diagnosis of this rare combined immunodeficiency and led to the decision to treat the affected patients with hematopoietic cell transplant (HCT) from an human leukocyte antigen (HLA)-matched healthy sibling.


Assuntos
Complexo 2-3 de Proteínas Relacionadas à Actina/genética , Asma/genética , Hipersensibilidade/genética , Mutação , Doenças da Imunodeficiência Primária/genética , Adolescente , Asma/diagnóstico , Asma/imunologia , Asma/cirurgia , Criança , Feminino , Predisposição Genética para Doença , Transplante de Células-Tronco Hematopoéticas , Hereditariedade , Homozigoto , Humanos , Hipersensibilidade/diagnóstico , Hipersensibilidade/imunologia , Hipersensibilidade/cirurgia , Lactente , Masculino , Linhagem , Fenótipo , Doenças da Imunodeficiência Primária/diagnóstico , Doenças da Imunodeficiência Primária/imunologia , Doenças da Imunodeficiência Primária/cirurgia , Splicing de RNA , Síndrome , Resultado do Tratamento
14.
J Thorac Cardiovasc Surg ; 160(2): 502-509.e1, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31959452

RESUMO

OBJECTIVES: Systemic allergic reactions to nickel alloys in percutaneous atrial septal defect occlusion devices have a poorly defined natural history. We describe our experience of surgical removal of the offending device in a series of patients with nickel allergy and refractory symptoms. METHODS: Patients with atrial septal defect device explants for nickel allergy were reviewed. Administered questionnaires focused on symptoms, quality of life, and satisfaction along with the 36-Item Short Form Health Survey to measure physical and mental health postsurgery. RESULTS: Atrial septal defect devices were removed for nickel allergy in 58 patients during the past 10 years. The median age was 42 years (range, 24-71 years) and 95% were women. Explantation occurred at a median of 8 years (range, 6 months-18 years) after insertion. Symptoms included fatigue (82%), chest pain (78%), headache (73%), and palpitation (58%). Surveys were available for 45 patients: 58% rated their quality of life as poor and 69% were not at all satisfied with their device. Postexplant, all patients reported improvement in their symptoms, with 18 patients (42%) noting complete resolution. In 12 patients prospectively studied, the preoperative scores in physical and mental health domains were lower than the validation group, indicating significant disability. Similarly, there was marked improvement in each domain postremoval. CONCLUSIONS: Patients with nickel allergy and severe refractory symptoms after atrial septal defect device implantation experience profound resolution of symptoms and improved quality of life after removal. Nickel allergy should be considered before device insertion, and a low threshold should exist for surgical removal for refractory symptoms.


Assuntos
Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/instrumentação , Remoção de Dispositivo , Comunicação Interatrial/terapia , Hipersensibilidade/cirurgia , Níquel/efeitos adversos , Dispositivo para Oclusão Septal/efeitos adversos , Adulto , Idoso , Bases de Dados Factuais , Remoção de Dispositivo/efeitos adversos , Feminino , Nível de Saúde , Humanos , Hipersensibilidade/diagnóstico , Hipersensibilidade/etiologia , Masculino , Saúde Mental , Pessoa de Meia-Idade , Satisfação do Paciente , Desenho de Prótese , Qualidade de Vida , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
15.
Int Orthop ; 43(10): 2323-2331, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-30539218

RESUMO

PURPOSE: The contact allergens nickel, cobalt, and chromium are often discussed as possible triggers of allergic reactions to orthopedic implants. Additionally, acrylates and polymerization additives in bone cement (e.g., benzoyl peroxide (BPO)) have been implicated as triggers of eczema, wound healing disorders, and aseptic implant loosening. We report about six patients with aseptic loosening after total knee arthroplasty (TKA), who underwent revision surgery after testing positive for BPO hypersensitivity. METHODS: After clarification of possible other causes of implant failure, epicutaneous testing had been performed and the implants were replaced in a two-stage procedure with cementless, diaphyseal anchoring, hypoallergenic (TiNb-coated) revision endoprostheses. RESULTS: Epicutaneous testing revealed a BPO allergy in all six patients and an additional nickel allergy in three of the six patients. There was no histopathological or microbiological evidence for a periprosthetic infection. The clinical follow-up showed a low level of pain with good function, a stable knee joint, and proper implant position. The Knee Society Score (KSS) with its subscales Knee Score and Functional Score improved post-operatively from 43 to 70 points and from 47.5 to 68.3 points, respectively. Two implant-specific complications occurred: femoral stress shielding two years post-operatively with no further need for action and aseptic loosening of the tibial stem with the need of revision three years post-operatively. CONCLUSIONS: The regression of complaints after replacement with cementless and nickel-free revision implants suggests allergic implant intolerance. Implantation of a cementless, hypoallergenic endoprosthesis might, therefore, be a surgical treatment strategy in patients with evidence of allergies.


Assuntos
Alérgenos/efeitos adversos , Artroplastia do Joelho/métodos , Peróxido de Benzoíla/efeitos adversos , Cimentos Ósseos/efeitos adversos , Hipersensibilidade/cirurgia , Articulação do Joelho/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cimentação , Cromo/efeitos adversos , Cobalto/efeitos adversos , Feminino , Humanos , Hipersensibilidade/etiologia , Prótese do Joelho , Masculino , Pessoa de Meia-Idade , Níquel/efeitos adversos , Próteses e Implantes/efeitos adversos , Reoperação
16.
Medicine (Baltimore) ; 97(38): e12475, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30235744

RESUMO

RATIONALE: Due to the low incidence and lack of effective diagnostic measures for the diagnosis of metal allergy in patients undergoing total joint arthroplasty (TJA), diagnosis relies mainly on the exclusion of other causes, in particular infection. It remains a relatively unpredictable and poorly understood cause of implant failure. At present, skin patch testing, leukocyte migration inhibition test (LMIT) and lymphocyte transformation tests (LTT) are being commonly used to assess metal hypersensitivity.This report presents both a case and literature review. PATIENT CONCERNS: A 61-year-old female patient experienced continuous swelling and pain in the right knee joint for 9 months after a right-side total knee arthroplasty (TKA). DIAGNOSES: We believe this is the case report of metal allergy in TKA. The following were the reasons for this. First, no definite symptoms of infection during revision arthroplasty were observed, but with obvious hyperplasia of synovium. Furthermore, a frozen biopsy revealed an extremely low neutrophil count, which was considered to be caused by chronic inflammation. Second, the results of repeated post-operation reexaminations indicate a clear increase in the number of eosinophils, while no bacteria were found in the tissue bacterial smear performed during the operation. Third, improvements were clearly observed in the patient following synovectomy, revision of the polyethylene insert and anti-anaphylactic treatment. INTERVENTIONS: The patient underwent synovectomy, revision of the polyethylene insert and anti-anaphylactic treatment. OUTCOMES: The patient's right knee remained mildly swollen; however, the pain has been relieved significantly. The range of motion could achieve 0 degrees of extension and 90 degrees of flexion. LESSONS: No consensus has been reached about the best diagnostic criteria for this disease, and most physicians would consider it to be a possibility when other diseases including periprosthetic joint infection (PJI) have been excluded. Although this case followed the same course, the outcome following synovectomy and anti-anaphylactic treatment further confirmed our hypothesis.


Assuntos
Artroplastia do Joelho/efeitos adversos , Hipersensibilidade/etiologia , Prótese do Joelho , Metais/efeitos adversos , Falha de Prótese/etiologia , Feminino , Humanos , Hipersensibilidade/cirurgia , Pessoa de Meia-Idade , Polietileno/efeitos adversos , Sinovectomia , Membrana Sinovial/patologia
17.
Respir Physiol Neurobiol ; 257: 115-121, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29698696

RESUMO

The aim of this study was to determine whether cough sensitivity is changed after adenoidectomy in atopic children with chronic cough. 21 Children having symptoms of chronic cough and adenoid hypertrophy verified by nasal fiberoptic endoscopy were submitted to cough sensitivity measurement before and after adenoidectomy. Their pulmonary function was within normal range. Concentrations of capsaicin causing two (C2) and five coughs (C5) were reported. Children' (14 boys and 7 girls, mean age 6,52 yrs) cough sensitivity (geometric mean, with 95% CI) for C2 was preoperatively (before adenoidectomy) 19.95 (9.95-39.98) micromol/l vs. children' C2 postoperatively 14.04 (7.16-27.55) (P = .083 for Wilcoxon paired two sample test). Children' C5 was preoperatively 86.26 (39.25-189.57) micromol/l vs. C5 postoperatively 95.23 (46.33-195.75) micromol/l (P = .794 for Wilcoxon paired two sample test). We conclude that cough sensitivity for C2 and C5 was not significantly changed after adenoidectomy in atopic children with chronic cough.


Assuntos
Adenoidectomia , Tosse/fisiopatologia , Tosse/cirurgia , Hipersensibilidade/fisiopatologia , Hipersensibilidade/cirurgia , Reflexo , Adolescente , Capsaicina , Criança , Pré-Escolar , Endoscopia , Feminino , Humanos , Masculino
18.
Ann Thorac Surg ; 105(4): e177-e178, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29274313

RESUMO

The incidence of allergic reactions due to mechanical prosthesis or rings is not well established. We report the case of a 56-year-old man who presented a persistent urticarial rash and anaphylactic shock after a mitral valve repair operation. Prick skin tests were positive for nickel. After the nucleus from the mitral annulus was removed, the urticarial rash disappeared.


Assuntos
Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas/efeitos adversos , Hipersensibilidade/etiologia , Insuficiência da Valva Mitral/cirurgia , Níquel , Complicações Pós-Operatórias/etiologia , Remoção de Dispositivo , Humanos , Hipersensibilidade/diagnóstico , Hipersensibilidade/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia
19.
Curr Probl Dermatol ; 52: 82-93, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28288468

RESUMO

With a continuing increase in the number of tattoos performed worldwide, the need to treat tattoo complications is growing. Earlier treatments of chronic inflammatory tattoo reactions were dominated by a medical approach, or with no active intervention. In this chapter, we will address modern surgical approaches applied to situations when medical treatment is inefficient and lasers are not applicable. Dermatome shaving is positioned as first-line treatment of allergic tattoo reactions and also indicated in a number of other tattoo reactions, supplemented with excision in selected cases. The methods allow fundamental treatment with removal of the culprit pigment from the dermis. The different instruments, surgical methods, and treatment schedules are reviewed, and a guide to surgeons is presented. Postoperative treatments and the long-term outcomes are described in detail. An algorithm on specialist treatment and follow-up of tattoo reactions, which can be practiced in other countries, is presented.


Assuntos
Procedimentos Cirúrgicos Dermatológicos/métodos , Dermatopatias/etiologia , Dermatopatias/cirurgia , Tatuagem/efeitos adversos , Algoritmos , Dinamarca , Dermatite/etiologia , Dermatite/cirurgia , Procedimentos Cirúrgicos Dermatológicos/instrumentação , Granuloma de Corpo Estranho/etiologia , Granuloma de Corpo Estranho/cirurgia , Humanos , Hipersensibilidade/etiologia , Hipersensibilidade/cirurgia , Neoplasias Cutâneas/etiologia , Neoplasias Cutâneas/cirurgia
20.
Am J Rhinol Allergy ; 31(1): 3-6, 2017 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-28234140

RESUMO

BACKGROUND: Chronic rhinosinusitis (CRS) has a multifactorial etiology, with a debate about the role of inhalant allergy in the pathogenesis of CRS. OBJECTIVE: This study assessed the impact of allergy status on externalized paranasal sinuses after tumor resection to determine if a predisposition to inhalant allergy brought about additional inflammation after sinus surgery. METHODOLOGY: A case-control study was performed on patients who had no history of CRS who underwent paranasal sinus tumor resection. Allergic sensitization was defined by a positive serum ImmunoCAP test result. Outcomes were measured at least 6 months after surgery by using the modified Lund-MacKay endoscopic score and the 22-item Sino-Nasal Outcome test, with rhinitis, sleep, psychological, ear and/or facial, and sinus subscores to assess the impact of allergy status on mucosal inflammation. RESULTS: A total of 103 patients (53.44 ± 17.46 years; 46% women) were assessed. Of these, 61.17% were allergically sensitized at the time of surgery. Postsurgery endoscopic assessment was similar [the modified Lund-Mackay endoscopic score allergic sensitized 0.5 (1.7) versus nonallergic sensitized 0.0 (0.9); p = 0.15]. Sinonasal symptoms were also similar between the groups' 22-item Sino-Nasal Outcome test scores, allergic sensitized versus allergic nonsensitized, (allergic 28.9 ± 20.8 versus nonallergic 33.5 ± 19.7; p = 0.31), rhinitis score (5.9 ± 5.5 versus 6.4 ± 4.7; p = 0.66), sleep score (6.9 ± 5.9 versus 7.7 ± 4.8; p = 0.50), ear and/or facial symptom score (3.4 ± 3.6 versus 4.3 ± 3.3; p = 0.22), psychological score (6.9 ± 6.0 versus 8.3 ± 6.7; p = 0.29), and of nasal symptom score (6.4 ± 5.2 versus 7.0 ± 5.3; p = 0.61). CONCLUSIONS: Externalization of the sinuses in patients with inhalant allergy did not bring about significant additional inflammation in patients after tumor surgery.


Assuntos
Hipersensibilidade/epidemiologia , Inflamação/epidemiologia , Neoplasias Nasais/epidemiologia , Seios Paranasais/imunologia , Complicações Pós-Operatórias/epidemiologia , Rinite/epidemiologia , Sinusite/epidemiologia , Adulto , Idoso , Estudos de Casos e Controles , Doença Crônica , Comorbidade , Endoscopia , Feminino , Humanos , Hipersensibilidade/cirurgia , Masculino , Pessoa de Meia-Idade , Neoplasias Nasais/cirurgia , Seios Paranasais/cirurgia , Estudos Retrospectivos , Rinite/cirurgia , Sinusite/cirurgia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...