Browsing by Author "Amaral, L"
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- Abordagem Cirúrgica da Rigidez do CotoveloPublication . Guerra Pinto, F; Teixeira, F; Sá da Costa, D; Constantino, H; Dantas, P; Amaral, LO cotovelo é a articulação que mais frequentemente perde mobilidade na sequencia de traumatismos. Esta rigidez do cotovelo pode derivar de causas intrínsecas, extrínsecas ou mistas. A abordagem inicial desta patologia deve ser conservadora. A opinião clássica é que a abordagem cirúrgica desta situação tem fracos resultados clínicos e elevadas taxas de recidiva. Nos últimos 10 anos várias publicações contradizem esta impressão e descrevem séries com resultados satisfatórios a bons, principalmente quando a etiologia é extrínseca. À luz dos achados atuais é expectável uma melhoria da mobilidade em 95% dos casos e uma elevada satisfação dos doentes. Os autores apresentam uma revisão da literatura no que diz respeito à anatomia funcional e cirúrgica, indicação operatória, vias de abordagem, abordagem sequencial da rigidez e protocolos de reabilitação. As várias vias de abordagem são pormenorizadamente explicadas, com destaque para as suas vantagens, desvantagens e indicações.
- Complications Relating to Accuracy of Reduction of Intertrochanteric Fractures Treated with a Compressive Hip ScrewPublication . Guerra Pinto, F; Dantas, P; Moreira, R; Mamede, R; Amaral, LIntertrochanteric fracture is the most frequent type of fracture in the proximal femur and the compressive hip screw is one of the most popular methods of treatment. The reduction criteria for this type of fracture are ill-defined. The purpose of this study was to validate 3 reduction criteria: displacement, alignment in the anteroposterior and in the lateral plane. We reviewed a cohort of 430 intertrochanteric fractures treated with a compression hip screw. The type of fracture, quality of reduction and technical complications were noted. We observed a relationship between accuracy of reduction and the incidence of complications, even among fractures of the same severity. A displacement bigger than 4mm and failure to accomplish correct alignment (a neck-shaft angle over 125 masculine and less than 20 degrees angulation on the lateral view) was considered a poor reduction and was associated with more complications.
- Omalizumab for Severe Asthma: Beyond Allergic AsthmaPublication . Loureiro, CC; Amaral, L; Ferreira, JA; Lima, R; Pardal, C; Fernandes, I; Semedo, L; Arrobas, ADifferent subsets of asthma patients may be recognized according to the exposure trigger and the frequency and severity of clinical signs and symptoms. Regarding the exposure trigger, generally asthma can be classified as allergic (or atopic) and nonallergic (or nonatopic). Allergic and nonallergic asthma are distinguished by the presence or absence of clinical allergic reaction and in vitro IgE response to specific aeroallergens. The mechanisms of allergic asthma have been extensively studied with major advances in the last two decades. Nonallergic asthma is characterized by its apparent independence from allergen exposure and sensitization and a higher degree of severity, but little is known regarding the underlying mechanisms. Clinically, allergic and nonallergic asthma are virtually indistinguishable in exacerbations, although exacerbation following allergen exposure is typical of allergic asthma. Although they both show several distinct clinical phenotypes and different biomarkers, there are no ideal biomarkers to stratify asthma phenotypes and guide therapy in clinical practice. Nevertheless, some biomarkers may be helpful to select subsets of atopic patients which might benefit from biologic agents, such as omalizumab. Patients with severe asthma, uncontrolled besides optimal treatment, notwithstanding nonatopic, may also benefit from omalizumab therapy, although currently there are no randomized double-blind placebo controlled clinical trials to support this suggestion. However, omalizumab discontinuation according to each patient's response to therapy and pharmacoeconomical analysis are questions that remain to be answered.