Objectives: To assess the results from open or arthroscopic surgical treatment on patients with symptomatic recurrence of rotator cuff injuries. Methods: Between December 1990 and July 2007, 30 patients were assessed and underwent reoperation performed by the Shoulder and Elbow Surgery Group of the Department of Orthopedics and Traumatology, Fernandinho Simonsen Wing, Santa Casa de São Paulo, because of dehiscence of the rotator cuff suture. The study included patients with symptomatic recurrence of the injury and with at least 24 months of postoperative follow-up. Results: According to the UCLA evaluation criteria, 21 patients (70%) showed excellent or good outcomes; and nine patients (30%) showed fair or poor outcomes. Conclusion: Open or arthroscopic surgical treatment of recurrent rotator cuff injuries tended to present worse results than from the primary repair. In this study, we found that 70% of the results were excellent and good. The presence of extensive injuries in the reoperation tended to evolve with larger numbers of unsatisfactory results. In our study, we obtained better results from arthroscopic surgery than from open surgery.
Objective: To assess the results from arthroscopic surgical treatment of rotator cuff injuries among patients under 50 years of age. Methods: Sixty-three patients with rotator cuff injuries who underwent arthroscopic surgical treatment performed by the Shoulder and Elbow Group of the Department of Orthopedics and Traumatology, in the Fernandinho Simonsen wing of Santa Casa Medical School, São Paulo, between August 1998 and December 2007, were reassessed. The study included all patients with rotator cuff injuries who were under 50 years of age and had been followed up postoperatively for at least 24 months. Results: According to the UCLA evaluation criteria, 59 patients (92%) showed excellent and good results; five (8%) showed fair results; and none showed poor results. The postoperative evaluation showed that the mean range of motion was 145° for elevation, 47° for lateral rotation and T10 for medial rotation. Unsatisfactory results were associated with prolonged duration of the injury, with a statistically significant relationship. Conclusion: Arthroscopic repair of rotator cuff injuries in young patients produces excellent or good results for most patients.
Objective: Radiographic evaluation of the evolution of hips that underwent soft-tissue release. Methods: This was a retrospective evaluation on 101 spastic cerebral palsy patients who underwent soft-tissue release between 1991 and 2006. Forty-four patients met the inclusion criteria: 23 boys and 21 girls; 34 diparetic and 10 quadriparetic. Functionally, 29 were non-walkers, five were able to walk at home and 10 were able to walk within the community. Reimers' index (RI) and the acetabular index (AI) were measured on pre and postoperative radiographs, with a minimum follow-up of three years. The mean age at the time of surgery was 6.4 years. Results: The results were considered good if the RI had reduced, or had increased by less than 10%. This was found in 52% of this study. We observed a clear improvement in IR, along with worse results in patients with more than five years of postoperative follow-up. Conclusion: Soft-tissue release should be performed as early as possible, regardless of age, walking condition, clinical type, RI, AI or sex, and as soon as the patient clinically presents less than 30° abduction, because of the benefits relating to walking, prevention and treatment of subluxation, hygiene and pain relief.
RESUMENSLING BULBOURETRAL -EXPERIENCIA DEL SERVICIO Objetivos: En el artículo los autores presentan los resultados clínicos verificados en los pacientes portadores de incontinencia urinaria de stress, tras el uso del sling bulbouretral de fijación en el hueso púbico (Invance ® ).Material y métodos: Entre Junio de 2003 y Diciembre de 2003, fueron implantados 10 slings en hombres con edades comprendidas entre los 60 y los 83 años (media 72,6 años), los cuales presentaban incontinencia tras cirugía prostática (prostatectomía radical retropúbica, prostatectomía radical perineal, cistoprostatectomía radical con neovejiga Camey II, resección transuretral o adenomectomía prostática transvesical).Resultados: Tras seguimiento de 9 meses (7 a 13 meses), 8 pacientes (80 %) están continentes (no necesitando utilizar compresas) y 2 (20%) presentan pérdidas mínimas al realizar algún esfuerzo (con la necesidad de una a dos compresas diarias). Todos ellos están satisfechos con el resultado de la cirugía realizada. Dos pacientes presentaron dolor perinanal que respondió con el uso de paracetamol. No se verificó ningún caso de hematoma perinanal, infección, rechazo o erosión uretral.Conclusión: El sling bulbouretral con fijación ósea, es un procedimiento quirúrgico poco invasivo, de fácil ejecución técnica, con tasas de continencia elevadas y asociado a baja morbilidad. A pesar de los resultados positivos presentados por nuestro equipo, que pueden resultar un estímulo para la continuación de la técnica, consideramos que será necesario un mayor seguimiento y una mayor experiencia global para que esta técnica quirúrgica se afirme y se transforme en una alternativa a la utilización del esfínter artificial.Palabras clave: Cáncer de próstata. Incontinencia. Cabestrillo masculino. ABSTRACT BULBOURETHRAL SLING. THE EXPERIENCE OF OUR SERVICEObjectives: The authors present the clinic results obtained with the bulbourethral sling application with pubic bone anchorage (Invance ® ) in patients with stress urinary incontinence.Material and methods: From July to December 2003, 10 slings were implanted in men between the 60's and the 83 years old (average 72,6 years), whose incontinence appeared after prostatic surgery (retro pubic radical prostatectomy, perineal radical prostatectomy, radical cystoprostatectomy with Camey II neobladder, transurethral resection, transvesical prostate adenomectomy).Results: After 9 months follow-up (3 to 7 months), 8 patients (80%) are continent (without need of using any pad) and 2 (20%) show minimum leakage with effort (need of 1 to 2 daily pads). All are satisfied with the surgery result. Two patients referred perineal pain, which was solved with Paracetamol. There was no case of perineal haematoma, infection, rejection or urethral erosion.Conclusion: The bulbourethral sling with bone anchorage is a rather invasive procedure, of easy technical execution, with high continence rates and associated to low morbidity. Although the presented results been an incentive to the technique prolongation, it would be neces...
Ao se deparar com o diagnóstico de câncer no contexto pediátrico, pais ou responsáveis pela criança, podem se sentir desestabilizados para enfrentar tal condição. Sonhos, projetos, rotina, cotidiano, tomam um novo curso, relacionado ao vínculo do tratamento e/ou sob a ideia de finitude da vida da criança. Diante do contexto utilizar de alternativas para não tornar ainda mais doloroso todo o processo que a criança oncológica enfrentará no decorrer do tratamento, em virtude de propor medidas de alívio e conforto, e na oferta do suporte necessário, a implementação de práticas assistenciais que atendam o paciente como um todo, permitindo uma finitude mais digna é fundamental. Os cuidados paliativos, em tal contexto constituem-se como sendo uma alternativa viável para lidar e enfrentar a situação, no que tange ao paciente e a família. Trata-se de uma pesquisa do tipo revisão bibliográfica, onde foi utilizada como base de dados o Google acadêmico. O período escolhido para a busca dos artigos foi o ano de 2021. A seleção dos artigos se deu através do estabelecimento de critérios de inclusão e exclusão. O estudo teve como objetivo: analisar como os cuidados paliativos auxiliam no tratamento da criança oncológica, sua abrangência na família, e as contribuições da enfermagem. Espera-se com esse trabalho, ressaltar a importância da aplicabilidade dos cuidados paliativos, e os seus benefícios tanto para o paciente oncológico pediátrico quanto para os seus familiares, a fim de vincular desta forma maior visibilidade e conhecimento sobre o tema, no que se refere a existência e prática do cuidado, tornando-o mais difundido no meio acadêmico, social e principalmente visto como uma alternativa benéfica e eficaz pela enfermagem e no que concerne a área da saúde.
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