The incidence of fractures at the proximal end of the femur has increased significantly in recent decades. It is believed that this increase is closely related to the increasing geriatric population in our society, since this disease occurs predominantly in elderly patients and its incidence progressively increases with advanced age (1-6) .
Objective: The primary aim of this study was to analyze the possible association between delay in receiving surgical treatment and mortality among elderly patients with fractures at the proximal end of the femur. Methods: 269 patients with fractures at the proximal end of the femur (femur neck and intertrochanteric fractures) who were treated surgically at Hospital São Paulo, UNIFESP, São Paulo, between January 2003 and December 2007, were studied. The following attributes were analyzed and compared with the literature relating to this subject: sex, age, type of fracture, classification of the fracture, affected side, synthesis used, trauma mechanism, length of hospitalization, waiting time for surgery, associated comorbidities, hemogram on admission, type of anesthesia, need for blood transfusion, day of the week and season of the year of the fracture. Results: The study showed that higher mortality correlated with higher numbers of clinical comorbidities, longer hospitalization and use of general anesthesia during the surgery. Conclusion: There was no association between the time spent waiting for surgery and mortality.
Purpose:To evaluate tissue lesions, especially those of the intestinal innervation, in an excluded jejunal loop subjected to ischemia and reperfusion in rats. Methods: To evaluate the role of ischemia and reperfusion lesions in an excluded intestinal loop, four groups of 20 rats were set up: control group (GCEI7) and three experimental groups (GIREI7, GIREI14 and GIREI28). They were all subjected to exclusion of an intestinal segment of six centimeters in length, at a distance of 10 centimeters from the Treitz angle. The 60 animals in the three experimental groups were additionally subjected to ischemia of the vascular pedicle for 30 minutes. The control group and the experimental group GIREI7 were evaluated on the 7 th day after the operation. The groups GIREI14 and GIREI28 (which also underwent ischemia) were utilized to evaluate the evolution of the lesion over time, on the 14 th and 28 th days after the operation, respectively. From the intestinal excluded loop, we take one ring of 0,5 cm distal and proximal, that were fixed in formaline 10% solution in order to do histological (HE) and immuno-hystochemial (PS-100) evaluation (enteric nervous system.) The distal loop was exteriorized in stoma and the proximal part closed with polipropilene 6-0. Results: It was observed a decrease in the number of ganglionic cells in the myenteric plexus in the group subjected to ischemia and reperfusion (GIREI7), in relation to the control group (GCEI7) at the 7 th post-operative day (Mann-Whitney test: p = 0.0173 *. Comparing the numbers of ganglionic cells in the myenteric plexus before and after jejunal loop exclusion GCEI7 -(Wilcoxon test: p = 0.0577). GIREI7 -Comparing the numbers of ganglionic cells in the myenteric plexus before and after ischemia (*p = 0.0399). Comparing the percentage variations in ganglionic cells in the myenteric plexus on the 7 th , 14 th and 28 th days after the procedure, in the groups GIREI7, GIREI14 and GIREI28, it was observed that there were no significant alterations. Kruskal-Wallis test: p = 0.6501. Conclusion: There was a decrease in the number of ganglionic cells in the myenteric plexus due to ischemia and reperfusion that did not recover in the late post-operative period. Key words: Intestine, small. Ischemia. Reperfusion. Enteric nervous system. RESUMO Objetivo: Avaliar lesões teciduais, especialmente aquelas da inervação intestinal em alça jejunal excluída submetida à isquemia e reperfusão em ratos. Métodos: Para avaliar o papel da isquemia e reperfusão nas lesões em uma alça intestinal exclusa, quatro grupos de 20 ratos foram criados: Grupo controle (GCE17) e 3 Grupos experimentais (GIRE!7, GIREI14) e GIREI28) Todos foram submetidos à exclusão de um segmento intestinal de seis centímetros de extensão, a 10 centímetros do ângulo de Treitz . Os 60 animais dos 3 grupos experimentais foram também submetidos a isquemia do pedículo vascular por 30 minutos.O grupo controle e o grupo experimental GIREI7 foram avaliados no 7º. Dia após a operação. Os grupos GIREI14 e GIREI28 também ...
Objective – To compare the head/neck ratio on the contralateral side of patients with a unilateral slipped capital femoral epiphysis (SCFE) with control individuals. Methods – Seventeen patients who were followed up at the Department of Orthopedics and Traumatology, Federal University of São Paulo, Brazil, between 1985 and 2007, were assessed. The control group consisted of 34 individuals from the same place who were matched for gender and age, with a history of trauma that necessitated pelvic radiography. The femoral head height and femoral neck measurements were made using simple pelvic radiography in accordance with the criteria of Bleck (1983), on both sides in the control group and on the contralateral hip in the patients. Nonparametric statistics were used, with a p-value ≤ 0.05. Results – There was no difference in the distribution of age, gender, body mass index and bone age between the groups. The head/neck ratio on the right and left side in the controls did not differ (p = 0.64). However, the head/neck ratio from the contralateral hip of the patients with SCFE was significantly lower than that of the control group (p = 0.00). Conclusion – The significantly lower head/neck ratio in the patients with epiphysiolysis could be indicative of a risk of SCFE.
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