OBJETIVO: Avaliação funcional e oncológica do tratamento do TCG do segmento distal do rádio (estadio B3) mediante ressecção ampla e reconstrução com enxerto autólogo avascular da extremidade proximal da fíbula. MÉTODOS: A função residual foi avaliada mediante escore ISOLS, medida do arco residual global do punho operado, do percentual residual da força de preensão da mão e da preensão entre o polegar e o indicador. O controle oncológico foi avaliado mediante exame clínico do membro operado e avaliação por imagens do punho e do tórax. RESULTADOS: 17 pacientes avaliados, dez do sexo feminino (58,8%) e sete do sexo masculino (41,2%) com idades entre 16 e 61 anos (média de 32,3 anos), todos destros. Na avaliação funcional (ISOLS) observamos 11 resultados excelentes, dois bons e um ruim; os três casos que demandaram artrodese evoluíram com escore excelente. O arco residual global foi de 196,2 ± 116,6º. O arco residual do punho operada correspondeu a 58,9% do controle. A força de preensão da mão correspondeu a 55,4 ± 17,4% do controle. O percentual de "pinça" foi de 80,6 ± 14,8% do controle. Não constatamos recidiva ou metástases nesta casuística. CONCLUSÃO: A técnica propiciou resultados funcionais alentadores, assegurando o retorno dos pacientes às suas atividades. A ausência de recidiva local e/ou metástases, observada inclusive nos pacientes com seguimento mais longo, permite sugerir que a técnica parece ser segura no controle oncológico do tumor.
ObjectivesTo determine the role of immunohistochemistry in identifying the primary site of tumors, and in establishing which bones are most frequently involved, their relationship with the primary tumor site, and the rate of pathologic bone fracture as the first symptom of a malignant tumor.MethodsA retrospective analysis of all medical records on bone metastases the cases treated between January 2006 and December 2011 at the Department of Orthopedics and Traumatology was performed.ResultsImmunohistochemistry correctly determined the primary tumor site in 61.2% of cases analyzed. Regarding the metastatic site, the most affected bone was the femur, accounting for 49.6% of the sample. Bone metastasis was the first symptom of the tumor in only 20.2% of patients, and of these, 95% were admitted for pathologic bone fracture.ConclusionThe study showed that the primary sites and their incidence rate are consistent with the literature reviewed. It was noted that in this sample, most patients did not present with pathologic bone fracture as the first clinical symptom of neoplastic disease. However, analysis of those patients that had a metastasis as the first clinical symptom revealed that it manifested itself as a pathologic fracture in almost all cases. The immunohistochemical study was consistent with the primary tumor site in most cases, indicating the value of the method in the detection of the primary site.
Here we describe the development of a modular program of histology e‐classes and evaluate the effectiveness of an integrative system that articulates e‐learning with traditional onsite education. We produced a set of short e‐classes designed to first‐year medical students. Each e‐class included an online multiple‐choice test, with due date set for the day before the onsite lecture. Scores and statistics guided the onsite approach as they identified the essential information to be reviewed, emphasized and/or detailed in a particular topic. We compared student's grades in the main exams considering the equivalent group of students from the previous year as controls. Students were also required to answer a questionnaire on their learning experience with the program. We observed a general improvement and a positive overall acceptance. To translate the contents of traditional classes into short online videos has technically challenging pitfalls, requiring flexibility and improvement in our communication skills. The integrative learning system allowed for time optimization, since lectures could focus students’ needs and/or interests. Although interactivity and technology support are issues to be improved, the program brought good results, standing as another example e‐technology as a learning enhancer, when used as a facilitating feature, integrated to the traditional paradigm in medical education.
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