Browsing by Issue Date, starting with "2019-07"
Now showing 1 - 5 of 5
Results Per Page
Sort Options
- Intra- and Interreader Variability of Orbital Volume Quantification Using 3D Computed Tomography for Reconstructed Orbital FracturesPublication . Gomes de Oliveira, P; Perry da Câmara, C; Valejo Coelho, PPurpose: Management of orbital fractures continues to present some difficulties, particularly regarding the prediction of late complications. Radiographic assessment provides a detailed evaluation, but the results lack consistency to be considered a standard factor in the decision-making process. Studies focusing on reliability of post-operative imaging are lacking. Materials and methods: We performed a retrospective study using patients from a major trauma center with unilateral orbital floor fracture who underwent surgery. Using three-dimensional volume assessment software, we performed a volume calculation and determined the intra- and interreader variation by intraclass correlation coefficient analysis. Results: Twenty-four orbits were assessed. Mean orbital volume (SD) was 24.02 (2,43) cm3 for reader 1 and 24.08 (2,51) cm3 for reader 2. The intraclass correlation coefficient (95% CI) was 0.95 (0.91-0.98) between readers and 0.96 (0.91-0.98) for intra-reader variability. Normal and reconstructed orbits assessed separately also showed very high correlation coefficient for both intra- and inter-subject variability. Conclusion: Results show an almost perfect agreement of volume assessment between readers. The presence of reconstruction material does not seem to add variability. Although reproducible and reliable, radiological volume assessments have not yet shown a clear correlation with clinical outcomes and post-operative management decisions should be based mainly on clinical findings.
- Sacroileítis Piógena: Lecciones Aprendidas de una Serie de Casos AtípicosPublication . Arcângelo, J; Norte Ramos, S; Alves, P; Tavares, D; Gouveia, CPyogenic sacroiliitis (PSI) is a rare condition that amounts to 1% to 2% of all joint infections in the paediatric age group. Its diagnosis is often difficult and delayed due to its nonspecific signs, symptoms and physical findings. Also, the identification of the causative microorganism is frequently challenging due to a high proportion of negative blood cultures and the risks involved in joint aspiration in this site.
- Short- and Long-Term Outcome After Alcohol Septal Ablation in Obstructive Hypertrophic Cardiomyopathy: Experience of a Reference CenterPublication . Aguiar Rosa, S; Fiarresga, A; Galrinho, A; Cacela, D; Ramos, R; de Sousa, L; Gonçalves, A; Bernardes, L; Patrício, L; Branco, LM; Cruz Ferreira, RIntroduction: In obstructive hypertrophic cardiomyopathy (HCM), alcohol septal ablation (ASA) can lead to gradient reduction and symptom improvement. We aimed to assess the efficacy and safety of ASA in a long-term outcome study. Methods: We analyzed patients who underwent ASA over a seven-year period in a tertiary center. The primary echocardiographic endpoint was >50% reduction in left ventricular outflow tract (LVOT) gradient within a year of the procedure. The primary clinical endpoints were improvement in functional capacity and a combined endpoint of cardiac death and rehospitalization for cardiac cause. The follow-up period was 4.17±2.13 years. Results: A total of 80 patients, mean age 63.9±12.3 years, 30.0% male, were analyzed. Baseline LVOT gradient was 96.3±34.6 mmHg and interventricular septal thickness was 21.6±3.1 mm. Minor complications were observed in 6.3% and major complications in 2.5%, and 8.8% received a permanent pacemaker. The primary echocardiographic endpoint was achieved by 85.7%. At three-month follow-up, LVOT gradient was 25.8±26.0 mmHg in the successful procedure group, compared to 69.2±35.6 mmHg in the other patients (p=0.001). At six months, LVOT gradient was 27.1±27.4 vs. 58.2±16.6 mmHg (p=0.024). Among 74 patients in NYHA class III/IV before the procedure, 57 (77%) improved to NHYA class I/II. The combined primary clinical endpoint (cardiac death and rehospitalization for cardiac cause) was observed in 27.5% (n=22). In the unsuccessful group, the combined endpoint was observed in 54.5%, compared to only 22.7% in the successful group. Only two patients died of cardiac causes. Conclusion: ASA is a safe procedure with a high success rate. Patients who achieved significant reductions in LVOT gradient suffered less cardiac death and rehospitalization for cardiac cause.
- Adjacent Bi-Level Bilateral Pedicle Stress Fractures After Instrumented Posterolateral Lumbar Fusion - a Case Report and Review of the LiteraturePublication . Jorge, JP; Carvalho, NIsolated bilateral pedicle stress fractures of the lumbar spine are rare events, and few cases are reported in the literature. Their occurrence is commonly related to post-operative complications of spine instrumentation but can also be associated with stress-related activities, degenerative spine conditions, trauma and other miscellaneous causes. The authors report a case of adjacent bi-level bilateral pedicle fracture that developed 5 years after an instrumented posterolateral lumbar fusion. We believe that this has never been described before, and we reviewed the current literature pertaining this subject.
- Rehabilitation of Neonatal Brachial Plexus Palsy: Integrative Literature ReviewPublication . Frade, F; Gómez-Salgado, J; Jacobsohn, L; Florindo-Silva, FThis integrative literature review has been carried out with the aim of analyzing the scientific literature aimed at identifying and describing existing rehabilitation treatments/therapies for neonatal brachial plexus palsy (NBPP). NBPP is a frequent consequence of difficult birthing, and it impairs the function of the brachial plexus in newborns. This is why knowledge on rehabilitation strategies deserves special attention. The data collection was carried out in January 2019, in the EBSCOhost and BVS (Biblioteca Virtual em Saúde) platforms, in the CINAHL Complete, MEDLINE Complete, LILACS and PubMed databases. Thirteen articles were included in this integrative literature review, based on a literature search spanning title, abstract and full text, and considering the inclusion criteria. Two main treatments/therapies for NBPP rehabilitation were identified: conservative treatment and surgical treatment. Conservative treatment includes teamwork done by physiatrists, physiotherapists and occupational therapists. These professionals use rehabilitation techniques and resources in a complementary way, such as electrostimulation, botulinum toxin injection, immobilizing splints, and constraint induced movement therapy of the non-injured limb. Professionals and family members work jointly. Surgical treatment includes primary surgeries, indicated for children who do not present any type of spontaneous rehabilitation in the first three months of life; and secondary surgeries, recommended in children who after primary surgery have some limitation of injured limb function, or in children who have had some spontaneous recovery, yet still have significant functional deficits. Treatment options for NBPP are defined by clinical evaluation/type of injury, but regardless of the type of injury, it is unanimous that conservative treatment is always started as early as possible. It should be noted that there was no evidence in the literature of other types of rehabilitation and techniques used in clinical practice, such as preventive positioning of contractures and deformities, hydrotherapy/aquatic therapy, among others, so we consider there is a need for further studies at this level in this area.