150Acute renal failure is a severe condition that occurs in 2.0% to 7.0% of patients during hospital stay [1][2][3] . In 18.0% to 47.0% of cases, it is related to a surgical event, and acute tubular necrosis is the main type of lesion 1,2,4 . The great variation in the incidence of acute renal failure among the studies presents a multifactor profile, including different diagnostic criteria, such as the study design, inclusion and exclusion criteria, profile of the patients and of the centers involved in the sample, hindering study comparisons 5 .In cardiac surgery, its incidence ranges from 3.5% to 31.0% [5][6][7][8][9][10][11][12] , and the need for dialysis occurs in 0.3% to 15.0% of cases [5][6][7][8][9][10][11][12][13][14][15][16][17][18] . The presence of acute renal failure in these patients increases the mortality rate from 0.4% to 4.4% to 1.3% to 22.3%, and when dialysis is required, these rates reach 25.0% to 88.9% [5][6][7][8][9][10][11][12][13][14][15][16][17][18] , making it an independent risk factor for mortality, according to Chertow et al 16 , and increasing 8-fold the death odds ratio among these patients.The presence of conditions that determine hypoperfusion and renal ischemia are directly related to the development of ARF. Patients who present with reduced renal functional reserve, in whom a reduction occurs in the glomerular filtration rate without serum creatinine elevation above normal values, are more likely to have ARF even with minor renal lesions 16 . Preoperative and intraoperative factors, such as age, previous level of creatinine, diabetes mellitus, cardiac output, the duration of extracorporeal circulation, and the use of the intraaortic balloon, are influencial in the development of ARF [5][6][7][8][10][11][12]19 . The severity of ARF may increase with the occurrence of complications in the postoperative period, such as infections, hemorrhage, and the use of nephrotoxic substances 20 .In Brazil, few studies have reported the incidence of ARF after cardiac surgery, its risk factors, and its outcomes. The great impact of ARF in the outcomes of cardiac surgery demand its study in our population, encouraging to the elaboration of this study, which aims at identifying the incidence, risk factors, duration of ICU stay, and mortality due to ARF after myocardial coronary artery bypass surgery in a university hospital in Brazil. MethodsFrom 10/1/2001 to 9/30/2002, 223 of 247 patients undergoing myocardial coronary artery bypass surgery were prospectively studied. Exclusion criteria were: surgery without extracorporeal circulation (12 patients), death within the first 24h after surgery ConclusionAcute renal failure after myocardial coronary artery bypass surgery is a frequent complication associated with a high mortality rate. The independent risk factors are age, previous renal failure, and the need for inotropic drugs.
The Latarjet-Bristow procedure has been shown to be a safe and reliable method of treating recurrent anterior instability. We proposed using bioabsorbable screws for fixation of the coracoid graft to avoid the potential complications associated with metallic hardware. The aim of this study was to assess the early radiologic healing of the graft using bioabsorbable screws and comment on our initial experience using this method of fixation for the Latarjet-Bristow procedure. Twelve Latarjet-Bristow procedures were performed for recurrent anterior instability using two 4.5-mm bioabsorbable compression screws composed of L-lactic/ co-glycolic acid copolymer (PLGA 85L/15G). All patients had followup imaging including plain radiographs and a computed tomography scan performed at 3 months postoperatively to assess bone healing and graft position. In all cases, there was radiologic evidence of bony graft healing in a satisfactory position. There were no intraoperative or postoperative complications observed. This study confirms that satisfactory bone healing in the Latarjet-Bristow procedure can be obtained with the use of bioabsorbable screws. Although the early radiographic results were encouraging, at this stage, we cannot recommend the use of bioabsorbable screws for use with the Latarjet-Bristow procedure until the long-term clinical and radiologic outcomes are assessed. Level of Evidence:Case series (IV).
Fournier's gangrene is a rare, high-mortality infection that affects the subcutaneous tissue with rapidly progressive necrosis. The objective is to report a case of Fournier's gangrene involving the region of the shoulder girdle after closed fracture of the clavicle, and to discuss this unusual evolution. The patient underwent a series of surgical procedures and was followed up on an outpatient basis for 12 months, at which point she was discharged. Fournier's gangrene is an aggressive lesion and requires early diagnosis (clinical-laboratory correlation) with the appropriate adequate surgical approach and clinical stabilization.
Introdução: As lesões do tendão musculo subescapular (TMSE) do manguito rotador passaram a ter aumento de sua incidência com as avançadas técnicas de diagnostico por imagem e artroscópicas. A Ressonância Nuclear Magnética (RM) apresenta boa sensibilidade e especificidade permitindo adequada acurácia diagnóstico. Objetivo: avaliação da concordância interobservador da RM para Lesões do TMSE comparada à artroscopia. Métodologia: 49 pacientes sintomáticos foram submetidos à RM para diagnóstico de lesão do TMSE e avaliação da Classificação de Lafosse, tendo sua concordância avaliada através da Artroscopia diagnostica. Resultados: A acurácia global foi 68% para concordância diagnóstica da Lesão do TMSE e 57,1% para concordância na classificação de Lafosse. Discussão: obteve-se concordância para o diagnóstico de Lesão ou ausência de Lesão do TMSE de 0,49 e a concordância para a Classificação de Lafosse foi de 0,30. Conclusão: o diagnóstico da lesão do TMSE através da RM é de difícil realização.Descritores: Manguito Rotador; Artroscopia; Imagem por Ressonância Magnética.ReferênciasTicker JB, Warner JJ. Single-tendon tears of the rotator cuff: evaluation and treatment of subscapularis tears and principles of treatment for supraspinatus tears. Orthop Clin North Am. 1997; 28(1):99-116. Codman EA. Rupture of the supraspinatus tendon and other lesions in or about the subacromial bursa. The Shoulder. 2nd Ed. Boston: Thomas Todd; 1934. p. 262-312. Deutsch A, Altchek DW, Veltri DM, Potter HG, Warren RF. Traumatic tears of the subscapularis tendon. Clinical diagnosis, magnetic resonance imaging findings, and operative treatment. Am J Sports Med. 1997;25(1):13-22.Li XX, Schweitzer ME, Bifano JA, Lerman J, Manton GL, El-Noueam KI. MR evaluation of subscapularis tears. J Comput Assist Tomogr. 1999;23(5):713-17. Adams CR, Schoolfield JD, Burkhart SS. Accuracy of preoperative magnetic resonance imaging in predicting a subscapularis tendon tear based on arthroscopy. Arthroscopy. 2010;26(11):1427-33.Adams CR, Brady PC, Koo SS, Narbona P, Arrigoni P, Karnes GJ et al. A systematic approach for diagnosing subscapularis tendon tears with preoperative magnetic resonance imaging scans. Arthroscopy. 2012; 28(11):1592-600.Pfirrmann CWA, Zanetti M, Weishaupt D, Gerber C, Hodler J. Subscapularis tendon tears: Detection and grading at MR ar- thrography. Radiology. 1999; 213:709-714.Yoon JP, Chung SW, Kim SH, Oh JH. Diagnostic value of four clinical tests for the evaluation of subscapularis integrity. J Shoulder Elbow Surg. 2013;22(9):1186-92.Beltran J. The use of magnetic resonance imaging about the shoulder. J Shoulder Elbow Surg. 1992; 1(6):321-33.Houtz CG, Schwartzberg RS, Barry JA, Reuss BL, Papa L. Shoulder MRI accuracy in the community setting. J Shoulder Elbow Surg. 2011; 20(4):537-42.Burks RT, Crim J, Brown N, Fink B, Greis PE. A prospective randomized clinical trial comparing arthroscopic single- and double-row rotator cuff repair: magnetic resonance imaging and early clinical evaluation. Am J Sports Med. 2009;37(4):674-82. Gyftopoulos S, O' Donnell J, Shah NP, Goss J, Babb J, Recht MP. Correlation of MRI with arthroscopy for the evaluation of the subscapularis tendon: a musculoskeletal division’s experience. Skeletal Radiol. 2013;42(9):1269-75.Pfirrmann CW1, Zanetti M, Weishaupt D, Gerber C, Hodler J. Subscapularis tendon tears: detection and grading at MR arthrography. Radiology. 1999;213(3):709-14.Spencer EE Jr, Dunn WR, Wright RW, Wolf BR, Spindler KP, McCarty E et al. Interobserver agreement in the classification of rotator cuff tears using magnetic resonance imaging. Am J Sports Med. 2008;36(1):99-103.Toussaint B, Barth J, Charousset C, Godeneche A, Joudet T, Lefebvre Y et al. New endoscopic classification for subscapularis lesions. Orthop Traumatol Surg Res. 2012;98(8 Suppl):S186-92.Lafosse L, Jost B, Reiland Y, Audebert S, Tousaint B, Gobezie R. Structural integrity and clinical outcomes after arthroscopic repair of isolated subescapularis tears. J Bone Joint Surg Am. 2007;89(6):1184-93.Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159-74.Balich SM, Sheley RC, Brown TR, Sauser DD, Quinn SF. MR imaging of the rotator cuff tendon: interobserver agreement and analysis of interpretive errors. Radiology. 1997; 204(1):191-94.Robertson PL, Schweitzer ME, Mitchell DG, Schlesinger F, Epstein RE, Frieman BG et al. Rotator cuff disor- ders: interobserver and intraobserver variation in diagnosis with MR imaging. Radiology. 1995;194(3):831-35.Singson RD, Hoang T, Dan S, Friedman M. MR evaluation of rotator cuff pathology using T2-weighted fast spin-echo technique with and without fat suppression. AJR Am J Roentgenol. 1996; 166:1061-65.Szymanski C1, Staquet V, Deladerrière JY, Vervoort T, Audebert S, Maynou C. Reproducibility and reliability of subscapularis tendon assessment using CT-arthrography. Orthop Traumatol Surg Res. 2013;99(1):2-9.
A artroplastia total do ombro e a hemiartroplastia do ombro têm sido o método tradicional para tratar uma variedade de condições do ombro, incluindo artrose glenoumeral, artropatia do manguito rotador e alguns tipos de fraturas. No entanto, esses procedimentos não fornecem resultados consistentes quando empregadas no tratamento de pacientes com ruptura do manguito rotador. O desenvolvimento da artroplastia reversa por Grammont no final do século XX revolucionou o tratamento da osteoartrose glenoumeral associada a rupturas do manguito rotador. A principal indicação para a artroplastia reversa é para o paciente portador de artropatia do manguito rotador apresentando dor e perda do arco de movimento do ombro. Devido aos bons resultados obtidos no tratamento desta patologia, as indicações para utilização da artroplastia reversa se expandiram gradualmente incluindo outras condições que anteriormente eram difíceis de tratar com sucesso e de forma previsível. Esta revisão discute e analisa criticamente essas novas indicações para a artroplastia reversa do ombro.
As fraturas do úmero proximal (FUP) representam aproximadamente 5%, quando consideramos todas as fraturas. São lesões frequentes em idosos após trauma de baixa energia, em decorrência da prevalência de osteoporose. Sua incidência tem aumentado nos últimos anos, elevação esta atribuída ao envelhecimento da população. As principais complicações nos idosos são a lesão do manguito rotador (MR) e a osteonecrose da cabeça umeral, possíveis causas de dor e disfunção no ombro, perda da independência e, consequentemente, diminuição da qualidade de vida. Preservar a independência é o principal objetivo do tratamento proposto, considerando também o alívio da dor e a manutenção da função do ombro.
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