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Iamaguchi RB, Dias GM, Iwase FDOC, Rezende MRDE, Mattar R. CAN TEMPORARY ARTERY CATHETERIZATION EXTEND LIMITS OF ISCHEMIA TIME FOR MACROREPLANTATION? Acta Ortop Bras 2023; 31:e267476. [PMID: 38115877 PMCID: PMC10726705 DOI: 10.1590/1413-785220233105e267476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 05/19/2023] [Indexed: 12/21/2023]
Abstract
We observe delayed referrals to appropriate Microsurgery Unit and definitive treatment of traumatic limb amputations. Cases with wrist proximal amputations have a deadline for surgical replantation as these configure life-threatening injuries. Objective To analyze patients with traumatic proximal wrist upper limb amputations with prolonged ischemic time who underwent temporary artery catheterization to assess stump viability and results. Methods A case-series study including all patients with a proximal wrist upper limb amputation and a cold ischemic time equal to or above six hours from 2017 to 2021. Results In total, two surgeons operated eight patients who had experienced forearm amputation injuries. Median ischemia time totaled eight hours. All patients required additional surgeries, most commonly split-thickness skin graft or fixation revision (three patients). This study obtained five successful macroreimplantations. The mean cold ischemia time was longer in the group with successful macroreimplantations (7.4 hours) than of the unsuccessful group (9 hours). Conclusion Macroreplantations require immediate referral to microsurgery and, although temporary artery catheterization helps surgical decision making, the technique seems to fail to influence outcomes. Level of Evidence IV, Retrospective Case Series.
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Affiliation(s)
- Raquel Bernardelli Iamaguchi
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas, Instituto de Ortopedia e Traumatologia IOT HCFMUSP, Grupo de Cirurgia da Mao e Microcirurgia Reconstrutiva, Sao Paulo, SP, Brazil
| | - Guilherme Moreira Dias
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas, Instituto de Ortopedia e Traumatologia IOT HCFMUSP, Grupo de Cirurgia da Mao e Microcirurgia Reconstrutiva, Sao Paulo, SP, Brazil
| | - Fernanda DO Carmo Iwase
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas, Instituto de Ortopedia e Traumatologia IOT HCFMUSP, Grupo de Cirurgia da Mao e Microcirurgia Reconstrutiva, Sao Paulo, SP, Brazil
| | - Marcelo Rosa DE Rezende
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas, Instituto de Ortopedia e Traumatologia IOT HCFMUSP, Grupo de Cirurgia da Mao e Microcirurgia Reconstrutiva, Sao Paulo, SP, Brazil
| | - Rames Mattar
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas, Instituto de Ortopedia e Traumatologia IOT HCFMUSP, Grupo de Cirurgia da Mao e Microcirurgia Reconstrutiva, Sao Paulo, SP, Brazil
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2
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Iamaguchi RB, Macedo LS, Cho AB, Rezende MRD, Mattar R, Wei TH. Reconstrução microcirúrgica em um hospital ortopédico: Indicações e desfechos em adultos. Rev Bras Ortop 2022; 57:772-780. [PMID: 36226202 PMCID: PMC9550366 DOI: 10.1055/s-0041-1735946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/18/2021] [Indexed: 11/05/2022] Open
Abstract
Objective
Advances in reconstructive microsurgery in orthopedic surgery provided better functional and aesthetic results and avoided many indications for amputation. In high-volume trauma and orthopedic hospitals, microsurgical reconstruction is essential to reduce costs and complications for these complex orthopedic defects. We describe a microsurgical approach to traumatic wounds, tumor resection, bone defects, and free muscle transfer, performed by an orthopedic microsurgery unit. The objective of the present study was to evaluate predictor factors for outcomes of microsurgical flaps for limb reconstruction, and to provide a descriptive analysis of microsurgical flaps for orthopedic indications.
Methods
Cross-sectional prospective study that included all consecutive cases of microsurgical flaps for orthopedic indications from 2014 to 2020. Data were collected from personal medical history, intraoperative microsurgical procedure, and laboratory blood tests. Complications and free-flap outcomes were studied in a descriptive and statistical analysis.
Results
We evaluated 171 flaps in 168 patients; the indications were traumatic in 66% of the patients. Type III complications of the Clavien-Dindo Classification were observed in 51 flaps. The overall success rate of the microsurgical flaps was 88.3%. In the multivariate analysis, the risk factors for complications were ischemia time ≥ 2 hours (
p
= 0.032) and obesity (
p
= 0.007). Partial flap loss was more common in patients with thrombocytosis in the preoperative platelet count (
p
= 0.001).
Conclusion
The independent risk factors for complications of microsurgical flaps for limb reconstruction are obesity and flap ischemia time ≥ 2 hours, and presence of thrombocytosis is a risk factor for partial flap loss.
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Affiliation(s)
- Raquel Bernardelli Iamaguchi
- Grupo de Cirurgia da Mão e Microcirurgia Reconstrutiva, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Lucas Sousa Macedo
- Grupo de Cirurgia da Mão e Microcirurgia Reconstrutiva, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Alvaro Baik Cho
- Grupo de Cirurgia da Mão e Microcirurgia Reconstrutiva, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Marcelo Rosa de Rezende
- Grupo de Cirurgia da Mão e Microcirurgia Reconstrutiva, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Rames Mattar
- Grupo de Cirurgia da Mão e Microcirurgia Reconstrutiva, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Teng Hsiang Wei
- Grupo de Cirurgia da Mão e Microcirurgia Reconstrutiva, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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3
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Iamaguchi RB, Cartolano R, Silva GB, Torres LR, Cho AB, Wei TH, de Rezende MR, Mattar R. Orthoplastic reconstruction in children: are the risk factors similar to those observed in adults? J Pediatr Orthop B 2022; 31:e227-e235. [PMID: 34285161 DOI: 10.1097/bpb.0000000000000900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Free flaps in the pediatric population are less common and when indicated the expectations to avoid amputation are high. The objective of this study is to describe indications and results of free flaps for limb reconstruction. Patients undergoing microsurgical free flaps in an orthopedic hospital were consecutively included in this cross-sectional study, from 2014 to 2020. Data regarding personal medical history, intraoperative microsurgical procedure and laboratory tests were collected. Patients under 18 years of age were included. Complications and free flap outcomes were observed during follow-up. This study included 23 free flaps in 23 patients with orthoplastic reconstruction. The free flap was performed as a reconstructive elevator concept. The most common indications were skin or bone defects caused by trauma (nine patients), tumor (six patients) and congenital pseudarthrosis of the tibia (four patients). The most indicated flap was a vascularized fibular flap in 10 patients, followed by an anterolateral thigh flap in 5 patients. Complications were observed in five patients. In total 93% of patients with inferior limb reconstruction walked at the final evaluation. Among risk factors studied, cases had a higher incidence of complications (P = 0.03) when only the superficial venous system was used. Free flaps in children are well-tolerated and indications are restricted to precise indications to provide alternatives to amputations and improve patient's function. We observed an increase in the incidence of complications when only superficial veins were used for free flap outflow in children.
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Affiliation(s)
- Raquel Bernardelli Iamaguchi
- Department of Hand Surgery and Reconstructive Microsurgery Group of the Institute of Orthopedics and Traumathology, University of Sao Paulo, São Paulo, Brazil
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4
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Martins-Filho FVF, do Carmo Iwase F, Silva GB, Cho AB, Wei TH, de Rezende MR, Mattar R, Iamaguchi RB. Do technical components of microanastomoses influence the functional outcome of free gracilis muscle transfer for elbow flexion in traumatic brachial plexus injury? Orthop Traumatol Surg Res 2021; 107:102827. [PMID: 33516891 DOI: 10.1016/j.otsr.2021.102827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/27/2020] [Accepted: 02/28/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The traumatic lesions of the brachial plexus in adults are devastating injuries causing continuous severe functional impairment for both work and daily living activities. The restoration of elbow flexion is one of the most important movements for patient recovery to previous activities. Free gracilis muscle transfer has good outcomes for cases with late presentation or as a rescue surgery to regain elbow flexion, however, bad results are present in all cohorts with insufficient recovery of muscle strength for elbow flexion. A number of hypotheses can be postulate to explain the fair results observed in some cases of free gracilis muscle transfer for elbow flexion. Most studies in the current literature compare the choice of the donor nerve used in neurotization and nerve grafts. The aim of this study is to evaluate if technical components of microvascular anastomosis could influence the functional outcome of free functional muscle transfer for elbow flexion in adult patients with traumatic brachial plexus injury. MATERIAL AND METHODS Included all adult patients with traumatic brachial plexus injury submitted to free functional gracilis muscle transfer for elbow flexion. The complications and functional results according to British Medical Research Council (BMRC) score were recorded. RESULTS We assessed 26 patients with mean age of 32.8 years. The most common donor nerve for gracilis muscle was the accessory nerve in 18 patients. Eighteen patients presented with good result (M3/M4). The mean ischemia time was higher for patients with bad results (132 minutes) comparing with patients with good results (122 minutes). Patients with only one venous anastomosis had 41% of poor functional outcome compared with 22% of cases with two venous anastomoses. No statistically significant difference in the ischemia time of the cases with good or poor functional outcome was observed (p=0.657), as for the number of venous anastomoses (p=0.418). CONCLUSION Our study observes that patients with only one venous anastomoses for drainage of free gracilis and those with longer intraoperative ischemia time had higher incidence of poor functional outcome of free gracilis muscle transfer for elbow flexion, but not statistically significant. LEVEL OF PROOF II; prospective cross-sectional study.
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Affiliation(s)
- Francisco Vilmar Felix Martins-Filho
- Hand Surgery and Reconstructive Microsurgery Group of the Institute of Orthopedics and Traumathology, Clinics Hospital of University of Sao Paulo, São Paulo, Brazil
| | - Fernanda do Carmo Iwase
- Hand Surgery and Reconstructive Microsurgery Group of the Institute of Orthopedics and Traumathology, Clinics Hospital of University of Sao Paulo, São Paulo, Brazil
| | - Gustavo Bersani Silva
- Hand Surgery and Reconstructive Microsurgery Group of the Institute of Orthopedics and Traumathology, Clinics Hospital of University of Sao Paulo, São Paulo, Brazil
| | - Alvaro Baik Cho
- Hand Surgery and Reconstructive Microsurgery Group of the Institute of Orthopedics and Traumathology, Clinics Hospital of University of Sao Paulo, São Paulo, Brazil
| | - Teng Hsiang Wei
- Hand Surgery and Reconstructive Microsurgery Group of the Institute of Orthopedics and Traumathology, Clinics Hospital of University of Sao Paulo, São Paulo, Brazil
| | - Marcelo Rosa de Rezende
- Hand Surgery and Reconstructive Microsurgery Group of the Institute of Orthopedics and Traumathology, Clinics Hospital of University of Sao Paulo, São Paulo, Brazil
| | - Rames Mattar
- Hand Surgery and Reconstructive Microsurgery Group of the Institute of Orthopedics and Traumathology, Clinics Hospital of University of Sao Paulo, São Paulo, Brazil
| | - Raquel Bernardelli Iamaguchi
- Hand Surgery and Reconstructive Microsurgery Group of the Institute of Orthopedics and Traumathology, Clinics Hospital of University of Sao Paulo, São Paulo, Brazil.
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5
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Mattar TGDM, dos Santos GB, Telles JPM, de Rezende MR, Wei TH, Mattar R. Structured evaluation of a comprehensive microsurgical training program. Clinics (Sao Paulo) 2021; 76:e3194. [PMID: 34669876 PMCID: PMC8491592 DOI: 10.6061/clinics/2021/e3194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/09/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This study proposed a structured microsurgical training program and evaluated it with the assistance of a large sample of surgeons. METHODS The practical course comprised 16 sessions of approximately 4 hours each. This included two sessions for suturing rubber gloves and two sessions for suturing arteries, veins, and nerves in chicken thighs. The other sessions were performed on the femoral vessels of rats: 5 sessions for end-to-end arterial anastomosis, 5 for end-to-end venous anastomosis, 1 for arterial grafting, and 1 for end-to-side anastomosis. We conducted a structured assessment of the microsurgical skills in each training session. RESULTS In this study, 89 surgeons were evaluated. The mean scores for the different procedures were as follows: glove suturing, 33.3±0.59; chicken nerve end-to-end anastomosis, 40.3±0.49; chicken artery suturing, 40.9±0.36; chicken vein suturing, 42.3±0.36; graft interposition, 44.8±0.7; and end-to-side anastomosis, 43.7±0.63 (p<0.05 for all). The chicken thigh suturing scores were significantly higher than the rubber gloves suturing scores (p<0.01). There were no differences between scores of the rat artery and chicken thigh suturing procedures (p=0.24). The rat venous anastomosis scores were higher than the rat arterial anastomosis scores (p=0.02), as were graft interposition scores when compared with end-to-end venous anastomosis scores. The end-to-side anastomosis scores did not differ significantly from the grafting scores (p=0.85). The most common errors were inadequate knotting technique and suture rupture due to inadequate technique (both n=88 [98.9%]). CONCLUSION We propose a 16-step, progressive microsurgical training program to learn the basic microsurgical techniques comprehensively and reliably. The program was evaluated in a large sample of trainees, and it demonstrated the adequacy of the training sequence and results.
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Affiliation(s)
- Tiago Guedes da Motta Mattar
- Divisao de Cirurgia da Mao e Microcirurgia Reconstrutiva, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, SP, BR
| | - Gustavo Bispo dos Santos
- Divisao de Cirurgia da Mao e Microcirurgia Reconstrutiva, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, SP, BR
| | | | - Marcelo Rosa de Rezende
- Divisao de Cirurgia da Mao e Microcirurgia Reconstrutiva, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, SP, BR
| | - Teng Hsiang Wei
- Divisao de Cirurgia da Mao e Microcirurgia Reconstrutiva, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, SP, BR
| | - Rames Mattar
- Divisao de Cirurgia da Mao e Microcirurgia Reconstrutiva, Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Sao Paulo, SP, BR
- Corresponding author. E-mail:
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6
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Soczewski E, Gori S, Paparini D, Grasso E, Fernández L, Gallino L, Schafir A, Irigoyen M, Lobo TF, Salamone G, Mattar R, Daher S, Pérez Leirós C, Ramhorst R. VIP conditions human endometrial receptivity by privileging endoplasmic reticulum stress through ATF6α pathway. Mol Cell Endocrinol 2020; 516:110948. [PMID: 32693008 DOI: 10.1016/j.mce.2020.110948] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/10/2020] [Accepted: 07/10/2020] [Indexed: 12/17/2022]
Abstract
Endometrial stromal cells undergo endoplasmic reticulum (ER) stress and unfolded protein response (UPR) during the decidualization linked with the inflammation and angiogenesis processes. Considering VIP (vasoactive intestinal peptide) induces the decidualization program, we studied whether modulates the ER/UPR pathways to condition both processes for embryo implantation. When Human Endometrial Stromal Cell line (HESC) were decidualized by VIP we observed an increased expression of ATF6α, an ER stress-sensor, and UPR markers, associated with an increase in IL-1β production. Moreover, AEBSF (ATF6α -inhibitor pathway) prevented this effect and decreased the expansion index in the in vitro model of implantation. VIP-decidualized cells also favor angiogenesis accompanied by a strong downregulation in thrombospondin-1. Finally, ATF6α, VIP and VPAC2-receptor expression were reduced in endometrial biopsies from women with recurrent implantation failures in comparison with fertile. In conclusion, VIP privileged ATF6α-pathway associated with a sterile inflammatory response and angiogenesis that might condition endometrial receptivity.
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Affiliation(s)
- E Soczewski
- CONICET, Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales IQUIBICEN, Buenos Aires, Argentina
| | - S Gori
- CONICET, Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales IQUIBICEN, Buenos Aires, Argentina
| | - D Paparini
- CONICET, Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales IQUIBICEN, Buenos Aires, Argentina
| | - E Grasso
- CONICET, Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales IQUIBICEN, Buenos Aires, Argentina
| | - L Fernández
- CONICET, Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales IQUIBICEN, Buenos Aires, Argentina
| | - L Gallino
- CONICET, Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales IQUIBICEN, Buenos Aires, Argentina
| | - A Schafir
- CONICET, Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales IQUIBICEN, Buenos Aires, Argentina
| | - M Irigoyen
- Fertilis Medicina Reproductiva, San Isidro, Buenos Aires, Argentina
| | - T F Lobo
- Departamento de Obstetrícia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - G Salamone
- Instituto de Medicina Experimental, IMEX-CONICET, Academia Nacional de Medicina, Buenos Aires, Argentina
| | - R Mattar
- Departamento de Obstetrícia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - S Daher
- Departamento de Obstetrícia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - C Pérez Leirós
- CONICET, Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales IQUIBICEN, Buenos Aires, Argentina
| | - R Ramhorst
- CONICET, Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales IQUIBICEN, Buenos Aires, Argentina.
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Abstract
Arthroscopy is a surgical technique whose indication for wrist injuries has grown in recent years. Athletes are subject to traumatic injury to the wrist due to training overload or the intensity of the activity during competition. The need of a quick return to sports practice makes arthroscopy a very useful minimally invasive technique in these situations. The authors present indications of sports-related injuries to the wrist that can be treated by arthroscopy. A literature review is also presented.
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Affiliation(s)
- Edgard Novaes França Bisneto
- Departamento de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Emygdio José Leomil de Paula
- Departamento de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Rames Mattar
- Departamento de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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Iamaguchi R, Burgos F, Silva G, Cho A, Nakamoto H, Takemura R, Wei T, de Rezende M, Mattar R. Do two venous anastomoses decrease venous thrombosis during limb reconstruction? Clin Hemorheol Microcirc 2019; 72:269-277. [DOI: 10.3233/ch-180467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Raquel Iamaguchi
- Hand Surgery and Reconstructive Microsurgery Group of the Institute of Orthopedics and Traumathology, Clinics Hospital of University of Sao Paulo, São Paulo, Brazil
| | - Felipe Burgos
- Hand Surgery and Reconstructive Microsurgery Group of the Institute of Orthopedics and Traumathology, Clinics Hospital of University of Sao Paulo, São Paulo, Brazil
| | - Gustavo Silva
- Hand Surgery and Reconstructive Microsurgery Group of the Institute of Orthopedics and Traumathology, Clinics Hospital of University of Sao Paulo, São Paulo, Brazil
| | - Alvaro Cho
- Hand Surgery and Reconstructive Microsurgery Group of the Institute of Orthopedics and Traumathology, Clinics Hospital of University of Sao Paulo, São Paulo, Brazil
| | - Hugo Nakamoto
- Hand Surgery and Reconstructive Microsurgery Group of the Institute of Orthopedics and Traumathology, Clinics Hospital of University of Sao Paulo, São Paulo, Brazil
| | - Renan Takemura
- Hand Surgery and Reconstructive Microsurgery Group of the Institute of Orthopedics and Traumathology, Clinics Hospital of University of Sao Paulo, São Paulo, Brazil
| | - Teng Wei
- Hand Surgery and Reconstructive Microsurgery Group of the Institute of Orthopedics and Traumathology, Clinics Hospital of University of Sao Paulo, São Paulo, Brazil
| | - Marcelo de Rezende
- Hand Surgery and Reconstructive Microsurgery Group of the Institute of Orthopedics and Traumathology, Clinics Hospital of University of Sao Paulo, São Paulo, Brazil
| | - Rames Mattar
- Hand Surgery and Reconstructive Microsurgery Group of the Institute of Orthopedics and Traumathology, Clinics Hospital of University of Sao Paulo, São Paulo, Brazil
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9
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Lobo TF, Torloni MR, Mattar R, Nakamura MU, Alexandre SM, Daher S. Adipokine levels in overweight women with early-onset gestational diabetes mellitus. J Endocrinol Invest 2019; 42:149-156. [PMID: 29696612 DOI: 10.1007/s40618-018-0894-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 04/19/2018] [Indexed: 01/07/2023]
Abstract
PURPOSE The study of adipokines in overweight women with early-onset (diagnosed before 20 weeks) gestational diabetes mellitus (GDM) could help to understand the ethiopathological mechanisms of this disorder. Our aim was to assess adipokine levels in overweight pregnant women with early-onset GDM compared to patients with standard-onset (diagnosed at 24-28 weeks) GDM and to glucose-tolerant women at the same gestational ages. METHODS This nested case-control study included 133 overweight pregnant women: 33 with early-onset (diagnosed < 20 weeks) GDM; 40 with standard-onset (diagnosed ≥ 24 weeks) GDM and 60 glucose-tolerant (normal oral glucose tolerance tests < 20 and ≥ 24 weeks). Adiponectin, leptin, resistin, visfatin and ghrelin serum levels were measured by ELISA. RESULTS Adiponectin serum levels were significantly lower in early-onset GDM women than in standard-onset GDM patients or controls matched for gestational age. Leptin serum levels were significantly higher in women with early-onset GDM than in controls. Women with early-onset GDM had lower adiponectin/leptin ratio than those with standard-onset GDM. There were no significant differences in resistin, ghrelin and visfatin serum levels among the participants. CONCLUSIONS Our results suggest that, compared to overweight glucose-tolerant women and patients with standard-onset GDM, overweight women with early-onset GDM have unbalanced adipokine levels, suggesting that they have a more inflammatory profile.
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Affiliation(s)
- T F Lobo
- Department of Obstetrics, Universidade Federal de São Paulo, São Paulo, Brazil
| | - M R Torloni
- Department of Obstetrics, Universidade Federal de São Paulo, São Paulo, Brazil
| | - R Mattar
- Department of Obstetrics, Universidade Federal de São Paulo, São Paulo, Brazil
| | - M U Nakamura
- Department of Obstetrics, Universidade Federal de São Paulo, São Paulo, Brazil
| | - S M Alexandre
- Department of Obstetrics, Universidade Federal de São Paulo, São Paulo, Brazil
| | - S Daher
- Department of Obstetrics, Universidade Federal de São Paulo, São Paulo, Brazil.
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10
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de Rezende MR, Saito M, Paulos RG, Ribak S, Abarca Herrera AK, Cho ÁB, Mattar R. Reduction of Morbidity With a Reverse-Flow Sural Flap: A Two-Stage Technique. J Foot Ankle Surg 2018; 57:821-825. [PMID: 29503140 DOI: 10.1053/j.jfas.2017.11.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Indexed: 02/03/2023]
Abstract
The reverse sural flap has often been used for cutaneous coverage of the distal region of the leg and ankle. When the flap is performed in 2 stages, the vascular pedicle is exteriorized and later resected. Our goal was to assess the reverse sural flap performed in 2 stages regarding its viability and low morbidity along the flap-donor area. Eleven patients with cutaneous coverage loss found in the area between the distal third of the leg and ankle underwent cutaneous coverage surgery with a reverse-flow sural flap with an exteriorized pedicle, without violation of the skin between the base of the flap pedicle to the margin of the wound. After a minimum period of 15 days with flap autonomy, the pedicle was resected. The flap dimensions, its viability before and after the pedicle ligature, and the distance from the intact skin between the flap base and the margin of the wound were evaluated. Any losses were measured as a percentage of the total flap size. The respective length and width of the flap were a mean average of 7.45 cm × 4.18 cm. All the flaps survived. Partial loss of the flap occurred in 3 patients, ranging from 20% to 30%. The mean average distance of the intact skin between the pedicle base and the margin of the wound was 5.59 (range 4 to 8) cm. Our results showed that the 2-stage reverse sural flap ensures good flap survival and low morbidity.
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Affiliation(s)
- Marcelo Rosa de Rezende
- Professor, Department of Hand and Microsurgery, Hospital das Clinicas, Faculty of Medicine, São Paulo University, São Paulo, Brazil.
| | - Mateus Saito
- Orthopedist, Department of Hand and Microsurgery, Hospital das Clinicas, Faculty of Medicine, São Paulo University, São Paulo, Brazil
| | - Renata Gregorio Paulos
- Orthopedist, Department of Hand and Microsurgery, Hospital das Clinicas, Faculty of Medicine, São Paulo University, São Paulo, Brazil
| | - Samuel Ribak
- Professor, Department of Hand and Microsurgery, Pontifical Catholic University of Campinas, São Paulo, Brazil
| | - Ana Katherina Abarca Herrera
- Resident, Department of Hand and Microsurgery, Hospital das Clinicas, Faculty of Medicine, São Paulo University, São Paulo, Brazil
| | - Álvaro Baik Cho
- Orthopedist, Department of Hand and Microsurgery, Hospital das Clinicas, Faculty of Medicine, São Paulo University, São Paulo, Brazil
| | - Rames Mattar
- Professor, Department of Hand and Microsurgery, Hospital das Clinicas, Faculty of Medicine, São Paulo University, São Paulo, Brazil
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Grasso E, Gori S, Soczewski E, Fernández L, Gallino L, Vota D, Martínez G, Irigoyen M, Ruhlmann C, Lobo TF, Salamone G, Mattar R, Daher S, Leirós CP, Ramhorst R. Impact of the Reticular Stress and Unfolded Protein Response on the inflammatory response in endometrial stromal cells. Sci Rep 2018; 8:12274. [PMID: 30116009 PMCID: PMC6095878 DOI: 10.1038/s41598-018-29779-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 07/18/2018] [Indexed: 11/15/2022] Open
Abstract
During decidualization, endometrial stromal cells undergo reticular stress (RS) and unfolded protein response (UPR), allowing the endoplasmic reticulum-expansion and immunomodulators production. Physiological RS generates the activation of sensing proteins, inflammasome activation and mature-IL-1β secretion, associated with pro-implantatory effects. We focus on the impact of RS and UPR on decidualized cells and whether they induce a physiological sterile inflammatory response through IL-1β production. Human endometrial stromal cell line (HESC) after decidualization treatment with MPA + dibutyryl-cAMP (Dec) increased the expression of RS-sensors (ATF6, PERK and IRE1α) and UPR markers (sXBP1 and CHOP) in comparison with Non-dec cells. Then we found increased NLRP3 expression in Dec cells compared with Non-dec cells. In fact STF-083010 (an IRE1α inhibitor) prevented this increase. Downstream, increased levels of active caspase-1 on Dec cells were detected by FAM-Flica Caspase-1 associated with an increase in IL-1β production. Moreover, the treatment with STF-083010 decreased the invasion index observed in Dec cells, evaluated by an in vitro model of implantation. In endometrial biopsies from recurrent spontaneous abortion patients an increased expression of IRE1α was found in comparison with fertile women; while recurrent implantation failure samples showed a lower expression of sXBP1, TXNIP and NLRP3 than fertile women, suggesting that RS/UPR tenors might condition endometrial receptivity.
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Grants
- PICT 2013-1632 Ministry of Science, Technology and Productive Innovation, Argentina | Agencia Nacional de Promoción Científica y Tecnológica (National Agency for Science and Technology, Argentina)
- PICT 2014-0657 Ministry of Science, Technology and Productive Innovation, Argentina | Agencia Nacional de Promoción Científica y Tecnológica (National Agency for Science and Technology, Argentina)
- PICT 2016-464 Ministry of Science, Technology and Productive Innovation, Argentina | Agencia Nacional de Promoción Científica y Tecnológica (National Agency for Science and Technology, Argentina)
- 20020130100040 and 20020090200034 Universidad de Buenos Aires (University of Buenos Aires)
- Ministry of Science, Technology and Productive Innovation, Argentina | Agencia Nacional de Promoci&#x00F3;n Cient&#x00ED;fica y Tecnol&#x00F3;gica (National Agency for Science and Technology, Argentina)
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Affiliation(s)
- E Grasso
- CONICET, Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales IQUIBICEN, Buenos Aires, Argentina
| | - S Gori
- CONICET, Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales IQUIBICEN, Buenos Aires, Argentina
- Institute of Experimental Medicine IMEX-CONICET, National Academy of Sciences, Buenos Aires, Argentina
| | - E Soczewski
- CONICET, Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales IQUIBICEN, Buenos Aires, Argentina
| | - L Fernández
- CONICET, Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales IQUIBICEN, Buenos Aires, Argentina
| | - L Gallino
- CONICET, Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales IQUIBICEN, Buenos Aires, Argentina
| | - D Vota
- CONICET, Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales IQUIBICEN, Buenos Aires, Argentina
| | - G Martínez
- Instituto de Fertilidad San Isidro, Buenos Aires, Argentina
| | - M Irigoyen
- Instituto de Fertilidad San Isidro, Buenos Aires, Argentina
| | - C Ruhlmann
- Instituto de Fertilidad San Isidro, Buenos Aires, Argentina
| | - T F Lobo
- Department of Obstetrics, Universidade Federal de São Paulo, São Paulo, Brazil
| | - G Salamone
- Institute of Experimental Medicine IMEX-CONICET, National Academy of Sciences, Buenos Aires, Argentina
| | - R Mattar
- Department of Obstetrics, Universidade Federal de São Paulo, São Paulo, Brazil
| | - S Daher
- Department of Obstetrics, Universidade Federal de São Paulo, São Paulo, Brazil
| | - C Pérez Leirós
- CONICET, Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales IQUIBICEN, Buenos Aires, Argentina
| | - R Ramhorst
- CONICET, Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales IQUIBICEN, Buenos Aires, Argentina.
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Herbst SSR, Peixoto AB, Araujo Júnior E, Moron AF, Mattar R. Effects of cervical cerclage on cervical length and the impact of changes in cervical length on pregnancy prognosis. Ceska Gynekol 2018; 83:341-347. [PMID: 30848137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To identify any cervix-related morphological and functional marker that can be correlated with pregnancy prognosis in patients who have undergone cerclage for cervical incompetence. DESIGN An observational and prospective study. SETTING Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (UNIFESP-EPM). METHODS Patients with cervical incompetence who underwent cervical cerclage using a modified version of the McDonald procedure during or before the 22nd week of pregnancy. The patients were examined by transvaginal ultrasound in the preoperative period, the immediate postoperative period, and between 20 and 24 weeks, 24 weeks + 1 day and 28 weeks, and 28 weeks + 1 day and 32 weeks. Cervical length and the presence of funneling were evaluated during all examinations. Changes in cervical length, presence or absence of funneling, percent increase or decrease in cervical length, and cervical length of less than established values (.
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13
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Almeida MA, Araujo Júnior E, Camano L, Peixoto AB, Martins WP, Mattar R. Impact of cesarean section in a private health service in Brazil: indications and neonatal morbidity and mortality rates. Ceska Gynekol 2018; 83:4-10. [PMID: 29510632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To evaluate the incidence of, indications of, and maternal and neonatal morbidity and mortality rates in cesarean sections in a private health service in Brazil. DESIGN Retrospective and observational study. SETTING Private health service in Vitória, Espírito Santo, Brazil. METHODS The patients were interviewed using a structured questionnaire to determine maternal age, gestational age at the time of delivery, number of previous deliveries, type of delivery performed, duration of labor, indications for cesarean delivery, point at which cesarean section was performed, physician responsible for delivery, and maternal morbidity, fetal morbidity, and fetal mortality rates. A descriptive analysis of the data was conducted. Students t-test was performed to compare quantitative variables, and Fishers exact test was performed for categorical variables. RESULTS A total of 584 patients were evaluated. Of these, 91.8% (536/584) had cesarean sections, while only 8.2% (48/584) had vaginal deliveries. There were no reports of forceps-assisted vaginal deliveries. In 87.49% of the deliveries, the number of gestational weeks was more than 37. In terms of indications for performing cesarean section, 48.5% were for maternal causes, 30.41% were for fetal causes, and 17.17% were elective. Maternal re-hospitalization due to puerperal complications was necessary in 10.42% of the vaginal deliveries and in 0.93% of the cesarean deliveries (p<0.001). Complications were observed in 18.75% of the vaginally delivered newborns and in 17.16% of those delivered by cesarean section. Of the newborns with complications at birth, 40.59% (41/101) had to be admitted to the neonatal intensive care unit. There were no cases of maternal death. There were seven cases of fetal/neonatal death. CONCLUSION We observed that the vast majority of deliveries in the private sector are performed by cesarean section, without labor, and by the patients obstetrician. We found no serious maternal complications or increased neonatal morbidity rates associated with cesarean section.
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14
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Dos Anjos KC, de Rezende MR, Mattar R. Social and hospital costs of patients admitted to a university hospital in Brazil due to motorcycle crashes. Traffic Inj Prev 2017; 18:585-592. [PMID: 28436733 DOI: 10.1080/15389588.2017.1293823] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 02/07/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This study aimed to investigate the social and hospital costs of patients treated at a public hospital who were motorcycle crash victims. METHOD This prospective study was on 68 motorcycle riders (drivers or passengers), who were followed up from hospital admission to 6 months after the crash. A questionnaire covering quantitative and qualitative questions was administered. RESULTS Motorcycle crash victims were responsible for 12% of the institution's hospital admissions; 54.4% were young (18-28 years of age); 92.6% were the drivers; 91.2% were male; and 50% used their motorcycles as daily means of transportation. Six months afterward, 94.1% needed help from someone; 83.8% had changed their family dynamics; and 73.5% had not returned to their professional activities. Among the injuries, 94.7% had some type of fracture, of which 53.5% were exposed fractures; 35.3% presented temporary sequelae; and 32.4% presented permanent sequelae. They used the surgical center 2.53 times on average, with a mean hospital stay of 18 days. The per capita hospital cost of these victims' treatment was US$17,481.50. CONCLUSION The social and hospital costs were high, relative to the characteristics of a public institution. Temporary or permanent disability caused changes to family dynamics, as shown by the high numbers of patients who were still away from their professional activities more than 6 months afterward.
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Affiliation(s)
- Katia Campos Dos Anjos
- a Hospital das Clínicas , Institute of Orthopedics and Traumatology , São Paulo , Brazil
| | | | - Rames Mattar
- a Hospital das Clínicas , Institute of Orthopedics and Traumatology , São Paulo , Brazil
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15
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Lobo T, Borges C, Angelo A, Godoy R, Pendeloski K, Mattar R, Daher S. Evaluation of Treg, NK cells and their subsets in healthy pregnant women: Preliminary results. Placenta 2017. [DOI: 10.1016/j.placenta.2017.01.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Amed FG, Campanharo FF, Araujo Júnior E, Souza RT, Akiba RT, Mattar R, Moron AF. Sigmoid volvulus during pregnancy with endoscopic treatment. J OBSTET GYNAECOL 2015; 36:287-8. [PMID: 26457644 DOI: 10.3109/01443615.2015.1060208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- F G Amed
- a Paulista School of Medicine-Federal University of São Paulo (EPM-UNIFESP), Obstetrics , São Paulo , Brazil
| | - F F Campanharo
- a Paulista School of Medicine-Federal University of São Paulo (EPM-UNIFESP), Obstetrics , São Paulo , Brazil
| | - E Araujo Júnior
- a Paulista School of Medicine-Federal University of São Paulo (EPM-UNIFESP), Obstetrics , São Paulo , Brazil
| | - R T Souza
- a Paulista School of Medicine-Federal University of São Paulo (EPM-UNIFESP), Obstetrics , São Paulo , Brazil
| | - R T Akiba
- b Paulista School of Medicine-Federal University of São Paulo (EPM-UNIFESP), Surgery , São Paulo , Brazil
| | - R Mattar
- a Paulista School of Medicine-Federal University of São Paulo (EPM-UNIFESP), Obstetrics , São Paulo , Brazil
| | - A F Moron
- a Paulista School of Medicine-Federal University of São Paulo (EPM-UNIFESP), Obstetrics , São Paulo , Brazil
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17
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Cho AB, Iamaguchi RB, Bersani Silva G, Paulos RG, Kiyohara LY, Sorrenti L, de Oliveira Costa Riker Teles de Me K, Rosa de Rezende M, Wei TH, Mattar R. Intercostal nerve transfer to the biceps motor branch in complete traumatic brachial plexus injuries. Microsurgery 2015. [DOI: 10.1002/micr.22453] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Alvaro Baik Cho
- Instituto De Ortopedia E Traumatologia Do Hospital Das Clínicas, Da Faculdade De Medicina - University of São Paulo; São Paulo, SP Brazil
- Hospital Estadual Mario Covas, Faculdade De Medicina Do ABC; Santo André, SP Brazil
| | - Raquel Bernardelli Iamaguchi
- Instituto De Ortopedia E Traumatologia Do Hospital Das Clínicas, Da Faculdade De Medicina - University of São Paulo; São Paulo, SP Brazil
| | - Gustavo Bersani Silva
- Instituto De Ortopedia E Traumatologia Do Hospital Das Clínicas, Da Faculdade De Medicina - University of São Paulo; São Paulo, SP Brazil
| | - Renata Gregorio Paulos
- Instituto De Ortopedia E Traumatologia Do Hospital Das Clínicas, Da Faculdade De Medicina - University of São Paulo; São Paulo, SP Brazil
| | - Leandro Yoshinobu Kiyohara
- Instituto De Ortopedia E Traumatologia Do Hospital Das Clínicas, Da Faculdade De Medicina - University of São Paulo; São Paulo, SP Brazil
- Hospital Estadual Mario Covas, Faculdade De Medicina Do ABC; Santo André, SP Brazil
| | - Luiz Sorrenti
- Instituto De Ortopedia E Traumatologia Do Hospital Das Clínicas, Da Faculdade De Medicina - University of São Paulo; São Paulo, SP Brazil
- Hospital Estadual Mario Covas, Faculdade De Medicina Do ABC; Santo André, SP Brazil
| | | | - Marcelo Rosa de Rezende
- Instituto De Ortopedia E Traumatologia Do Hospital Das Clínicas, Da Faculdade De Medicina - University of São Paulo; São Paulo, SP Brazil
| | - Teng Hsiang Wei
- Instituto De Ortopedia E Traumatologia Do Hospital Das Clínicas, Da Faculdade De Medicina - University of São Paulo; São Paulo, SP Brazil
| | - Rames Mattar
- Instituto De Ortopedia E Traumatologia Do Hospital Das Clínicas, Da Faculdade De Medicina - University of São Paulo; São Paulo, SP Brazil
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18
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Andrade-Silva FB, Kojima KE, Joeris A, Santos Silva J, Mattar R. Single, superiorly placed reconstruction plate compared with flexible intramedullary nailing for midshaft clavicular fractures: a prospective, randomized controlled trial. J Bone Joint Surg Am 2015; 97:620-6. [PMID: 25878305 DOI: 10.2106/jbjs.n.00497] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Previous studies have shown good clinical results in patients with midshaft clavicular fractures treated with reconstruction plate fixation or elastic stable intramedullary nailing. The objective of this study was to compare these methods in terms of clinical and radiographic results. METHODS In this prospective, randomized controlled trial, fifty-nine patients with displaced midshaft clavicular fractures were randomly assigned to receive fixation with either a reconstruction plate (thirty-three patients), known as the plate group, or elastic stable intramedullary nailing (twenty-six patients), known as the nail group. The primary outcome was the six-month Disabilities of the Arm, Shoulder and Hand (DASH) score. The secondary outcomes included the Constant-Murley score, time to fracture union, residual shortening, level of postoperative pain, percentage of satisfied patients, and complication rates. RESULTS The mean six-month DASH score was 9.9 points in the plate group and 8.5 points in the nail group (p = 0.329). Similarly, there were no differences in the twelve-month DASH and Constant-Murley scores. Time to union was equivalent (p = 0.352) between the groups at 16.8 weeks for the plate group and 15.9 weeks for the nail group, whereas the residual shortening was 0.4 cm greater in the plate group (p = 0.032). The visual analog scale pain score and the satisfaction rate were similar between the groups. Implant-related pain was more frequent in the nail group (p = 0.035). There were no differences in terms of major complications. CONCLUSIONS Reconstruction plates and elastic stable intramedullary nailing yielded similar functional results, time to union, level of postoperative pain, and patient satisfaction rates. Both methods were safe in terms of major complications.
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Affiliation(s)
- Fernando Brandao Andrade-Silva
- Institute of Orthopedics and Traumatology, University of São Paulo, Brazil, Rua Ovidio Pires de Campos 333, 05403-010 São Paulo, Brazil. E-mail address for F.B. Andrade-Silva:
| | - Kodi Edson Kojima
- Institute of Orthopedics and Traumatology, University of São Paulo, Brazil, Rua Ovidio Pires de Campos 333, 05403-010 São Paulo, Brazil. E-mail address for F.B. Andrade-Silva:
| | - Alexander Joeris
- AO Clinical Investigation and Documentation, Stettbachstrasse 6, 8600 Dübendorf, Switzerland
| | - Jorge Santos Silva
- Institute of Orthopedics and Traumatology, University of São Paulo, Brazil, Rua Ovidio Pires de Campos 333, 05403-010 São Paulo, Brazil. E-mail address for F.B. Andrade-Silva:
| | - Rames Mattar
- Institute of Orthopedics and Traumatology, University of São Paulo, Brazil, Rua Ovidio Pires de Campos 333, 05403-010 São Paulo, Brazil. E-mail address for F.B. Andrade-Silva:
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Santos J, Daher S, Mattar R, Sun S, Knöfler M, Oliveira S, Bevilacqua E, Borbely A. Immunolocalization of fibronectin-1 and versican in healthy and accreta placentas. Placenta 2015. [DOI: 10.1016/j.placenta.2015.01.485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lobo T, Pendeloski K, Mattar R, Torloni M, Souza B, S D. Influence of glucose on the in vitro production of IL-6 from peripheral blood cells of patients with and without gestational diabetes mellitus. Placenta 2015. [DOI: 10.1016/j.placenta.2015.01.446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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21
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Pendeloski K, Lobo T, Ohki C, Siqueira T, Fantasia J, Torloni M, Mattar R, Daher S. Vitamin D and gestational diabetes mellitus: Phenotype and genotype analysis. Placenta 2015. [DOI: 10.1016/j.placenta.2015.01.548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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22
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Campanharo FF, Santana EFM, Araujo Júnior E, Sarmento SGP, Fernandes FC, Sun SY, Mattar R, Moron AF. Amniotic embolism with complement activation in a lupic pregnant woman. J OBSTET GYNAECOL 2014; 35:416. [PMID: 25356886 DOI: 10.3109/01443615.2014.969206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- F F Campanharo
- Department of Obstetrics, Paulista School of Medicine - Federal University of São Paulo (EPM-UNIFESP) , São Paulo , Brazil
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23
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Benegas E, Ferreira Neto AA, Gracitelli MEC, Malavolta EA, Assunção JH, Prada FDS, Bolliger Neto R, Mattar R. Shoulder function after surgical treatment of displaced fractures of the humeral shaft: a randomized trial comparing antegrade intramedullary nailing with minimally invasive plate osteosynthesis. J Shoulder Elbow Surg 2014; 23:767-74. [PMID: 24768221 DOI: 10.1016/j.jse.2014.02.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 02/04/2014] [Accepted: 02/10/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Minimally invasive plate osteosynthesis for humeral shaft fractures has been described recently, but there are no randomized studies comparing the clinical results for shoulder function between this technique and locking intramedullary nailing. METHODS A prospective randomized study was performed. Forty-one humeral shaft fractures (40 patients) were randomized to be treated with a minimally invasive plate (n = 21) or a locking intramedullary nail (n = 19). Clinical and radiographic outcome assessments were conducted at 1 year postoperatively. Shoulder function was the primary outcome, as measured by the University of California, Los Angeles Shoulder Scale. Elbow function was measured by the Broberg-Morrey score, and fracture consolidation and complications were the main secondary outcomes. RESULTS At 1 year postoperatively, no significant difference was found with regard to shoulder function according to the University of California, Los Angeles scale between the minimally invasive plate and locking intramedullary nail (31.4 points vs 31.2 points, P = .98). There was also no difference in elbow function (94.8 points vs 94.1 points, P = .96). Complications were similar between the groups, without significant differences regarding infection (P > .99), symptomatic shoulder stiffness (P = .488), and neurapraxia of the lateral cutaneous nerve of the forearm (P = .475). Fracture union was achieved in all but 1 patient (2.4%) in the intramedullary nail group within 1 year after the surgical procedure. CONCLUSION There is no significant difference in shoulder function between antegrade intramedullary nailing and minimally invasive plate osteosynthesis for the treatment of displaced humeral shaft fractures, despite the limited power of our study.
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Affiliation(s)
- Eduardo Benegas
- Shoulder and Elbow Group, Orthopedic and Traumatology Department, Medical School, University of São Paulo, São Paulo, Brazil
| | - Arnaldo Amado Ferreira Neto
- Shoulder and Elbow Group, Orthopedic and Traumatology Department, Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Eduardo Angeli Malavolta
- Shoulder and Elbow Group, Orthopedic and Traumatology Department, Medical School, University of São Paulo, São Paulo, Brazil
| | - Jorge Henrique Assunção
- Shoulder and Elbow Group, Orthopedic and Traumatology Department, Medical School, University of São Paulo, São Paulo, Brazil
| | - Flávia De Santis Prada
- Shoulder and Elbow Group, Orthopedic and Traumatology Department, Medical School, University of São Paulo, São Paulo, Brazil
| | - Raul Bolliger Neto
- Shoulder and Elbow Group, Orthopedic and Traumatology Department, Medical School, University of São Paulo, São Paulo, Brazil
| | - Rames Mattar
- Hand, Microsurgery, and Trauma Group, Orthopedic and Traumatology Department, Medical School, University of São Paulo, São Paulo, Brazil
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Cho AB, Paulos RG, de Resende MR, Kiyohara LY, Sorrenti L, Wei TH, Bolliger Neto R, Mattar R. Median nerve fascicle transfer versus ULNAR nerve fascicle transfer to the biceps motor branch in C5-C6 and C5-C7 brachial plexus injuries: Nonrandomized prospective study of 23 consecutive patients. Microsurgery 2014; 34:511-5. [DOI: 10.1002/micr.22263] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 03/31/2014] [Accepted: 04/03/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Alvaro Baik Cho
- Instituto de Ortopedia e Traumatologia do Hospital das Clínicas, da Faculdade de Medicina - University of São Paulo; São Paulo SP Brazil
- Hospital Estadual Mario Covas, Faculdade de Medicina do ABC; Santo André SP Brazil
| | - Renata Gregorio Paulos
- Instituto de Ortopedia e Traumatologia do Hospital das Clínicas, da Faculdade de Medicina - University of São Paulo; São Paulo SP Brazil
| | - Marcelo Rosa de Resende
- Instituto de Ortopedia e Traumatologia do Hospital das Clínicas, da Faculdade de Medicina - University of São Paulo; São Paulo SP Brazil
| | | | - Luiz Sorrenti
- Hospital Estadual Mario Covas, Faculdade de Medicina do ABC; Santo André SP Brazil
| | - Teng Hsiang Wei
- Instituto de Ortopedia e Traumatologia do Hospital das Clínicas, da Faculdade de Medicina - University of São Paulo; São Paulo SP Brazil
| | - Raul Bolliger Neto
- Instituto de Ortopedia e Traumatologia do Hospital das Clínicas, da Faculdade de Medicina - University of São Paulo; São Paulo SP Brazil
| | - Rames Mattar
- Instituto de Ortopedia e Traumatologia do Hospital das Clínicas, da Faculdade de Medicina - University of São Paulo; São Paulo SP Brazil
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Hamaji A, Rezende MRD, Mattar R, Vieira JE, Auler JOC. Comparative study related to cardiovascular safety between bupivacaine (S75-R25) and ropivacaine in brachial plexus block. Braz J Anesthesiol 2014; 63:322-6. [PMID: 24565238 DOI: 10.1016/j.bjane.2012.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 06/14/2012] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Bupivacaine is a first choice for regional anesthesia considering its effectiveness, long duration and less motor blockade. Bupivacaine (S75-R25) is a mixture of optical isomers containing 75% levobupivacaine (S-) and 25% dextrobupivacaine (R+) created by a Brazilian pharmaceutical company. This investigation compared cardiac safety and efficacy of bupivacaine S75-R25 with vasoconstrictor and ropivacaine for brachial plexus blockade. METHODS Patients were randomized to receive brachial plexus anesthesia with either bupivacaine S75-R25 with epinephrine 1:200,000 (bupi) or ropivacaine (ropi), both at 0.50%, in 30 mL solution. We registered a continuous Holter ECG throughout the procedure, as well as the Lovett scale of force in addition to monitoring (heart rate, pulse oximetry and non-invasive blood pressure). The incidence of adverse events was compared with the chi-square or Fisher test. RESULTS We allocated forty-four patients into two groups. They did not show any difference related to age, weight or height, gender, as well as for surgical duration. Supraventricular arrhythmias were not different before or after the plexus blockade, independent of the local anesthetic chosen. Loss of sensitivity was faster for the bupivacaine group (23.1 ± 11.7 min) compared to the ropivacaine one (26.8 ± 11.5 min), though not significant (p = 0.205, Student t). There was a reduction in the cardiac rate, observed during the twenty-four-hour Holter monitoring. CONCLUSIONS This study showed similar efficacy between bupivacaine S75-R25 for brachial plexus blockade and ropivacaine, with similar incidences of supraventricular arrhythmias.
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Affiliation(s)
- Adilson Hamaji
- MD, PhD, Anesthesiologist, Instituto de Ortopedia of Hospital das Clínicas of Universidade de São Paulo (USP) Medical School, SP, Brazil
| | - Marcelo Rosa de Rezende
- MD, PhD, Orthopedic Surgeon, Instituto de Ortopedia of Hospital das Clínicas of USP Medical School, SP, Brazil
| | - Rames Mattar
- MD, PhD, Associate Professor, Orthopedics and Traumatology Department, USP Medical School, SP, Brazil
| | - Joaquim Edson Vieira
- MD, PhD, Associate Professor of Anesthesiology, Surgery Department, USP Medical School; Anesthesiologist, Instituto de Ortopedia of Hospital das Clínicas, USP Medical School, SP, Brazil.
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Peçanha D, Capelozza M, Sun S, Mattar R. EPA-1348 – Pregnancy and cancer: a qualitative analysis. Eur Psychiatry 2014. [DOI: 10.1016/s0924-9338(14)78563-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Iamaguchi RB, Villani W, Rezende MR, Wei TH, Cho AB, Santos GBD, Mattar R. Biomechanical comparison of the four-strand cruciate and Strickland techniques in animal tendons. Clinics (Sao Paulo) 2013; 68:1543-7. [PMID: 24473513 PMCID: PMC3840376 DOI: 10.6061/clinics/2013(12)11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 06/20/2013] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The objective of this study was to compare two four-strand techniques: the traditional Strickland and cruciate techniques. METHODS Thirty-eight Achilles tendons were removed from 19 rabbits and were assigned to two groups based on suture technique (Group 1, Strickland suture; Group 2, cruciate repair). The sutured tendons were subjected to constant progressive distraction using a universal testing machine (Kratos®). Based on data from the instrument, which were synchronized with the visualized gap at the suture site and at the time of suture rupture, the following data were obtained: maximum load to rupture, maximum deformation or gap, time elapsed until failure, and stiffness. RESULTS In the statistical analysis, the data were parametric and unpaired, and by Kolmogorov-Smirnov test, the sample distribution was normal. By Student's t-test, there was no significant difference in any of the data: the cruciate repair sutures had slightly better mean stiffness, and the Strickland sutures had longer time-elapsed suture ruptures and higher average maximum deformation. CONCLUSIONS The cruciate and Strickland techniques for flexor tendon sutures have similar mechanical characteristics in vitro.
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Affiliation(s)
- Raquel Bernardelli Iamaguchi
- Institute of Orthopedics and Traumatology, Faculdade de Medicina, Universidade de São Paulo, São PauloSP, Brazil
| | - William Villani
- Institute of Orthopedics and Traumatology, Faculdade de Medicina, Universidade de São Paulo, São PauloSP, Brazil
| | - Marcelo Rosa Rezende
- Institute of Orthopedics and Traumatology, Faculdade de Medicina, Universidade de São Paulo, São PauloSP, Brazil
| | - Teng Hsiang Wei
- Institute of Orthopedics and Traumatology, Faculdade de Medicina, Universidade de São Paulo, São PauloSP, Brazil
| | - Alvaro B Cho
- Institute of Orthopedics and Traumatology, Faculdade de Medicina, Universidade de São Paulo, São PauloSP, Brazil
| | - Gustavo Bispo dos Santos
- Institute of Orthopedics and Traumatology, Faculdade de Medicina, Universidade de São Paulo, São PauloSP, Brazil
| | - Rames Mattar
- Institute of Orthopedics and Traumatology, Faculdade de Medicina, Universidade de São Paulo, São PauloSP, Brazil
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Hamaji A, de Rezende MR, Mattar R, Vieira JE, Auler JOC. Comparative study related to cardiovascular safety between bupivacaine (S75-R25) and ropivacaine in brachial plexus block. Rev Bras Anestesiol 2013; 63:322-6. [PMID: 23931245 DOI: 10.1016/j.bjan.2012.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 06/14/2012] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Bupivacaine is a fi rst choice for regional anesthesia considering its effectiveness, long duration and less motor blockade. Bupivacaine (S75-R25) is a mixture of optical isomers containing 75% levobupivacaine (S-) and 25% dextrobupivacaine (R+) created by a Brazilian pharmaceutical company. This investigation compared cardiac safety and efficacy of bupivacaine S75-R25 with vasoconstrictor and ropivacaine for brachial plexus blockade. METHODS Patients were randomized to receive brachial plexus anesthesia with either bupivacaine S75-R25 with epinephrine 1:200,000 (bupi) or ropivacaine (ropi), both at 0.50%, in 30 mL solution.We registered a continuous Holter ECG throughout the procedure, as well as the Lovett scale of force in addition to monitoring (heart rate, pulse oximetry and non-invasive blood pressure). The incidence of adverse events was compared with the chi-square or Fisher test. RESULTS We allocated forty-four patients into two groups. They did not show any difference related to age, weight or height, gender, as well as for surgical duration. Supraventricular arrhythmias were not different before or after the plexus blockade, independent of the local anestheticchosen. Loss of sensitivity was faster for the bupivacaine group (23.1 ± 11.7 min) compared to the ropivacaine one (26.8 ± 11.5 min), though not significant (p = 0.205, Student t). There was a reduction in the cardiac rate, observed during the twenty-four-hour Holter monitoring. CONCLUSIONS This study showed similar efficacy between bupivacaine S75-R25 for brachial plexus blockade and ropivacaine, with similar incidences of supraventricular arrhythmias.
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Affiliation(s)
- Adilson Hamaji
- Instituto de Ortopedia of Hospital das Clínicas of Universidade de São Paulo, Medical School, SP, Brazil
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Godoy-Santos A, Cunha MV, Ortiz RT, Fernandes TD, Mattar R, dos Santos MCLG. MMP-1 promoter polymorphism is associated with primary tendinopathy of the posterior tibial tendon. J Orthop Res 2013; 31:1103-7. [PMID: 23389922 DOI: 10.1002/jor.22321] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 01/10/2013] [Indexed: 02/04/2023]
Abstract
Posterior tibial tendon (PTT) dysfunction is recognized as an etiology leading to acquired flatfoot in adults, causing significant functional loss. Many risk factors and systemic conditions have been proposed in literature. However, many patients present PTT dysfunction without any of these characteristics. This suggests that there could be a genetic influence associated with posterior tibial tendinopathy. The purpose of the present study is to investigate the association of the -1607 polymorphism in the promoter gene of MMP-1 and posterior tibial tendinopathy. The test group included 50 women, who presented PTT dysfunction grade 2 or 3, and who were submitted to surgical treatment, with histopathological examination of the tendon and magnetic resonance image (MRI) confirming tendinopathy, while the control group was 100 asymptomatic women who presented intact PTT at MRI. The results were analyzed using the chi-square test. The data showed a 75% incidence of the allele 1G and 62% of the genotype 1G/1G at the control group while, at the test group, they showed a 78% incidence of the allele 2G and 72% of the genotype 2G/2G (p < 0.001). The -1607 polymorphism of promoter gene of MMP-1 is associated with the posterior tibial tendinopathy in the studied population.
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Affiliation(s)
- Alexandre Godoy-Santos
- Department of Orthopedics and Traumatology, University of São Paulo, Rua Ovídio Pires de Campos, 333, Cerqueira Cesar, São Paulo, SP 05403-010, Brazil.
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Bambicini J, Soares V, Zanetti M, Torloni M, Ribeiro M, Mattar R. M221 EFFECTS OF AEROBIC AND RESISTANCE EXERCISES ON GLYCEMIC LEVELS OF PATIENTS WITH GESTATIONAL DIABETES: PILOT STUDY. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)61413-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ribeiro M, Torloni M, de T. Scanavino M, Nakamura M, Mattar R. M187 SEXUAL FUNCTION OF PREGNANT DIABETICS. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)61381-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Pereira FA, Mattar R, Facincani I, Defino HLA, Ramalho LNZ, Jorgetti V, Volpon JB, de Paula FJA. Pamidronate for the treatment of osteoporosis secondary to chronic cholestatic liver disease in Wistar rats. Braz J Med Biol Res 2012; 45:1255-61. [PMID: 22983176 PMCID: PMC3854229 DOI: 10.1590/s0100-879x2012007500143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Accepted: 08/31/2012] [Indexed: 11/22/2022] Open
Abstract
Osteoporosis is a major complication of chronic cholestatic liver disease (CCLD). We evaluated the efficacy of using disodium pamidronate (1.0 mg/kg body weight) for the prevention (Pr) or treatment (Tr) of cholestasis-induced osteoporosis in male Wistar rats: sham-operated (Sham = 12); bile duct-ligated (Bi = 15); bile duct-ligated animals previously treated with pamidronate before and 1 month after surgery (Pr = 9); bile duct-ligated animals treated with pamidronate 1 month after surgery (Tr = 9). Rats were sacrificed 8 weeks after surgery. Immunohistochemical expression of IGF-I and GH receptor was determined in the proximal growth plate cartilage of the left tibia. Histomorphometric analysis was performed in the right tibia and the right femur was used for biomechanical analysis. Bone material volume over tissue volume (BV/TV) was significantly affected by CCLD (Sham = 18.1 ± 3.2 vs Bi = 10.6 ± 2.2%) and pamidronate successfully increased bone volume. However, pamidronate administered in a preventive regimen presented no additional benefit on bone volume compared to secondary treatment (BV/TV: Pr = 39.4 ± 12.0; Tr = 41.2 ± 12.7%). Moreover, the force on the momentum of fracture was significantly reduced in Pr rats (Sham = 116.6 ± 23.0; Bi = 94.6 ± 33.8; Pr = 82.9 ± 22.8; Tr = 92.5 ± 29.5 N; P < 0.05, Sham vs Pr). Thus, CCLD had a significant impact on bone histomorphometric parameters and pamidronate was highly effective in increasing bone mass in CCLD; however, preventive therapy with pamidronate has no advantage regarding bone fragility.
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Affiliation(s)
- F A Pereira
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Araujo Júnior E, Sun SY, Campanharo FF, Nacaratto DC, Nardozza LMM, Mattar R, Habib VV, Moron AF. Diagnosis of ovarian metastasis from gestational trophoblastic neoplasia by 3D power Doppler ultrasound and dynamic contrast-enhanced magnetic resonance imaging: case report. Case Rep Oncol 2012; 5:359-66. [PMID: 22807905 PMCID: PMC3398080 DOI: 10.1159/000341256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Choriocarcinoma is a highly malignant disease of trophoblastic cells, which affects young women in the reproductive years. The main sites of metastasis from choriocarcinoma are lung, vagina, liver, gastrointestinal tract and kidneys, and the involvement of the ovaries is extremely rare. The diagnosis of ovarian metastasis is made mainly by two-dimensional ultrasonography (2DUS) with color Doppler, which shows a large vessel in the center of the mass. The three-dimensional power Doppler ultrasound (3D power Doppler) and dynamic contrast-enhanced magnetic resonance imaging (MRI) are new diagnostic modalities not yet published in literature. We report a case of metastatic choriocarcinoma with left ovary involvement in a 48-year-old woman with history of molar pregnancy and irregular follow-up of this disease. We emphasize the main findings by 2DUS with color Doppler, 3D power Doppler and dynamic contrast-enhanced MRI. 3D power Doppler is able to improve the assessment of anatomical relationships of vessels with the ovarian mass, while the resonance angiography allows us to evaluate the anatomic relations of the mass and adjacent structures, as well as the iliac vessels. The 3D power Doppler and dynamic contrast-enhanced MRI are promising methods in the evaluation of metastasis arising from gestational trophoblastic tumors.
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Affiliation(s)
- E Araujo Júnior
- Department of Obstetrics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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de Morais Filho MC, Kawamura CM, dos Santos CA, Mattar R. Outcomes of correction of internal hip rotation in patients with spastic cerebral palsy using proximal femoral osteotomy. Gait Posture 2012; 36:201-4. [PMID: 22425638 DOI: 10.1016/j.gaitpost.2012.02.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 01/15/2012] [Accepted: 02/19/2012] [Indexed: 02/02/2023]
Abstract
Internal hip rotation (IHR) is the major cause of intoeing gait in patients with cerebral palsy (CP). Femoral derotation osteotomy (FDO) is the preferred treatment to correct excessive anteversion, however the condition may persist or recur postoperatively. Retrospective clinical and kinematic evaluation of 75 spastic diplegic CP patients was conducted for a mean duration of 22 months following proximal FDO. The patients were divided into two groups depending on the correction or persistence of IHR evident at kinematics after surgery. If corrected, mean patient follow-up was extended to 53 months. Outcomes were analyzed using Two Proportions Equality, Mann-Whitney and Wilcoxon tests. IHR persisted in 33.3% of cases at mean follow-up of 22 months and subtrochanteric femur osteotomy was more frequent in this group (p=0.033). Thirty-five of the fifty-four patients with first-round gait correction were monitored during the extended follow-up. Those for whom IHR recurred (9.5%) had undergone FDO at a comparatively younger age. Patient gender, operations prior to or at the time of femoral osteotomy, topographic classification, GMFCS level, or the extent of preoperative clinical and kinematic abnormalities had no apparent influence on persistence or recurrence of abnormal gait.
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Lobo TF, Gomes CP, Torloni MR, Mattar R, Wang JHJ, Gueuvoghlanian-Silva BY, Daher S. Inflammatory gene polymorphisms in overweight pregnant women and pregnancy outcomes: preliminary results. J Reprod Immunol 2012. [DOI: 10.1016/j.jri.2012.03.344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Hatanaka AR, Moron AF, Auxiliadora de Aquino MM, de Souza E, de Silva Bussamra LC, Araujo Júnior E, Mattar R. Interruption of a study of cervical ripening with isosorbide mononitrate due to adverse effects. CLIN EXP OBSTET GYN 2012; 39:175-180. [PMID: 22905458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE OF INVESTIGATION The objective of this study was to evaluate cervix length and the presence of cervical gland area (CGA) in ultrasounds performed before and after the administration of vaginal isosorbide mononitrate (IMN) for cervical ripening. METHODS We performed an observational, descriptive, and longitudinal study of pregnant patients indicated for labor induction and with a Modified Bishop Score (MBS) lower than six. For cervical ripening, 40 mg of vaginal IMN was administered at 0, 16, and 24 hours after the initiation of cervix preparation. RESULTS After enrolling 11 patients, the study had to be discontinued due to adverse effects. Three patients requested that they be withdrawn. Headaches were reported by all patients. Nausea, dizziness, dyspnea, and vomiting were also reported. The average cervical lengths at 0, 16, 24 and 36 hours were 27.6, 27.7, 25.9, and 23.0 mm, respectively. CGA disappeared in one of seven patients. CONCLUSIONS The use of IMN appears to increase the MBS, slightly reducing cervical length without altering the appearance of CGA. Considering the importance of maternal wellbeing during labor, the routine use of IMN cannot be recommended for cervical ripening in the third trimester due to the frequency and intensity of side-effects.
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Affiliation(s)
- A R Hatanaka
- Department of Obstetrics, Federal University of São Paulo, São Paulo, SP, Brazil.
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Kimura LK, do Nascimento AT, Capócio R, Mattar R, Rezende MR, Wei TH, Torres LR, Moya FM. MICROSURGICAL TRANSFER OF THE GRACILIS MUSCLE FOR ELBOW FLEXION IN BRACHIAL PLEXUS INJURY IN ADULTS: RETROSPECTIVE STUDY OF EIGHT CASES. Rev Bras Ortop 2011; 46:534-9. [PMID: 27027050 PMCID: PMC4799279 DOI: 10.1016/s2255-4971(15)30408-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Accepted: 09/16/2010] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Treating brachial plexus injuries is a major challenge, especially lesions that are presented late, with more than 12 months of evolution. We retrospectively analyzed patients who underwent one of the possibilities for attempting to restore the function of upper limbs affected under such conditions: microsurgical transfer of the gracilis muscle for elbow flexion. METHODS Eight patients were included, divided into two groups: one in which the procedure consisted of neurorrhaphy of the muscle flap with sural nerve grafting and anastomosis more distally; and the other, in which the neurorrhaphy was performed directly on the spinal accessory nerve, with anastomosis in thoracoacromial vessels. RESULTS We found a significant difference between the groups. A greater number of satisfactory results (75% M4) were found among patients who underwent direct neurorrhaphy, whereas the procedure using grafts for neurorrhaphy was less successful (25% M4). CONCLUSION Patients who underwent microsurgical functional transfer of the gracilis muscle in which vascular anastomoses were performed in thoracoacromial vessels presented better functional outcomes than shown by those whose anastomoses were in the brachial artery with subsequent use of a nerve graft.
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Affiliation(s)
- Luiz Koiti Kimura
- Attending Physician in the Hand Group, Institute of Orthopedics and Traumatology, HC/FMUSP, São Paulo, SP, Brazil
| | | | - Roberto Capócio
- Resident Physician, Institute of Orthopedics and Traumatology, HC/FMUSP, São Paulo, SP, Brazil
| | - Rames Mattar
- Associate Professor in the School of Medicine, USP; Head of the Hand Group, Institute of Orthopedics and Traumatology, HC/FMUSP, São Paulo, SP, Brazil
| | - Marcelo Rosa Rezende
- Attending Physician in the Hand Group, Institute of Orthopedics and Traumatology, HC/FMUSP, São Paulo, SP, Brazil
| | - Teng Hsiang Wei
- Attending Physician in the Hand Group, Institute of Orthopedics and Traumatology, HC/FMUSP, São Paulo, SP, Brazil
| | - Luciano Ruiz Torres
- Attending Physician in the Hand Group, Institute of Orthopedics and Traumatology, HC/FMUSP, São Paulo, SP, Brazil
| | - Fernando Munhoz Moya
- Collaborating Physician in the Hand Group, Institute of Orthopedics and Traumatology, HC/FMUSP, São Paulo, SP, Brazil
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Fornazari AA, Rezende MRD, Mattar R, Taira RI, Santos GBD, Paulos RG. Effect of neurotrophic factor, MDP, on rats' nerve regeneration. Braz J Med Biol Res 2011; 44:327-31. [PMID: 21344131 DOI: 10.1590/s0100-879x2011007500021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Accepted: 02/03/2011] [Indexed: 11/22/2022] Open
Abstract
Our objective was to determine the immune-modulating effects of the neurotrophic factor N-acetylmuramyl-L-alanyl-D-isoglutamine (MDP) on median nerve regeneration in rats. We used male Wistar rats (120-140 days of age, weighing 250-332 g) and compared the results of three different techniques of nerve repair: 1) epineural neurorrhaphy using sutures alone (group S - 10 rats), 2) epineural neurorrhaphy using sutures plus fibrin tissue adhesive (FTA; group SF - 20 rats), and 3) sutures plus FTA, with MDP added to the FTA (group SFM - 20 rats). Functional assessments using the grasp test were performed weekly for 12 weeks to identify recovery of flexor muscle function in the fingers secondary to median nerve regeneration. Histological analysis was also utilized. The total number and diameter of myelinated fibers were determined in each proximal and distal nerve segment. Two indices, reported as percentage, were calculated from these parameters, namely, the regeneration index and the diameter change index. By the 8th week, superiority of group SFM over group S became apparent in the grasping test (P = 0.005). By the 12th week, rats that had received MDP were superior in the grasping test compared to both group S (P < 0.001) and group SF (P = 0.001). Moreover, group SF was better in the grasping test than group S (P = 0.014). However, no significant differences between groups were identified by histological analysis. In the present study, rats that had received MDP obtained better function, in the absence of any significant histological differences.
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Affiliation(s)
- A A Fornazari
- Laboratório de Microcirurgia, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Universidade de São Paulo, SP, Brasil.
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Fontes TMP, Nakamura MU, Mattar R, Simões RS, Wagner A, de Carvalho AM, Espiridião S, Kulay L. Effects of the association zidovudine plus ritonavir on the liver and kidneys of pregnant rats. Morphological and biochemical aspects. CLIN EXP OBSTET GYN 2011; 38:126-130. [PMID: 21793271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE To evaluate biochemical and morphological effects on rats submitted to three different doses of the association zidovudine and ritonavir administered throughout pregnancy. METHODS Forty pregnant EPM-1 Wistar rats weighing about 200 g were randomly divided into the control group (Ctr = drug vehicle control, n = 10) and three experimental ones which were treated with an oral solution of zidovudine/ritonavir (Exp1 = 10/20 mg/kg bw, n = 10; Exp2 = 30/60 mg/kg bw, n = 10; Exp3 = 90/180 mg/kg bw, n = 10) from 'day 0' up to the 20th day of pregnancy. At term (20th day) the rats were anesthetized. Blood and fetal and maternal organ samples (livers and kidneys) were taken for morphological and biochemical analyses. RESULTS Upon histological examinations fetal livers and kidneys appeared normal. In contrast the maternal samples revealed structural alterations. Maternal kidneys of the three experimental groups exhibited progressive and dose-dependent histological alterations; liver alterations were detected only in Exp3. Blood levels of AST and ALT were not significantly different from the control group but urea and creatinine levels were lower in groups Exp3 and Exp1. CONCLUSIONS The administration of zidovudine plus ritonavir throughout rat pregnancy can cause morphological as well as functional changes in maternal kidneys.
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Affiliation(s)
- T M Pereira Fontes
- Department of Obstetrics and Gynecology, Federal University of São Paulo School of Medicine (UNIFESP-EPM), São Paulo, SP, Brazil.
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Bisneto ENF, Freitas MC, Paula EJLD, Mattar R, Zumiotti AV. Comparison between proximal row carpectomy and four-corner fusion for treating osteoarthrosis following carpal trauma: a prospective randomized study. Clinics (Sao Paulo) 2011; 66:51-5. [PMID: 21437436 PMCID: PMC3044580 DOI: 10.1590/s1807-59322011000100010] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 10/13/2010] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To compare the functional results of carpectomy and four-corner fusion surgical procedures for treating osteoarthrosis following carpal trauma. METHODS In this prospective randomized study, 20 patients underwent proximal row carpectomy or four-corner fusion to treat wrist arthritis and their functional results were compared. The midcarpal joint was free of lesions in all patients. RESULTS Both proximal row carpectomy and four-corner fusion reduced the pain. All patients had a decreased range of motion after surgery. The differences between groups were not statistically significant. CONCLUSIONS Functional results of the two procedures were similar as both reduced pain in patients with scapholunate advanced collapse/scaphoid non-union advanced collapse (SLAC/SNAC) wrist without degenerative changes in the midcarpal joint.
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Affiliation(s)
- Edgard Novaes França Bisneto
- Department of Orthopedics and Traumatology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
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Mattar R, Banzato P, Torloni M, Trainá E, Pendeloski K, Puccini R, Daher S. Analysis of FAS and FAS-L gene polymorphisms in Brazilian women with normal pregnancies. J Reprod Immunol 2010. [DOI: 10.1016/j.jri.2010.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Gueuvoghlanian-Silva B, Torloni M, Mattar R, Sanchez V, Alexandre S, Daher S. Inflammatory mediators genotype and phenotype in pregnant women with pre-existing diabetes mellitus: Preliminary results. J Reprod Immunol 2010. [DOI: 10.1016/j.jri.2010.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Malizos KN, Dailiana ZH, Innocenti M, Mathoulin CL, Mattar R, Sauerbier M. Vascularized bone grafts for upper limb reconstruction: defects at the distal radius, wrist, and hand. J Hand Surg Am 2010; 35:1710-8. [PMID: 20888511 DOI: 10.1016/j.jhsa.2010.08.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Accepted: 08/03/2010] [Indexed: 02/02/2023]
Abstract
Vascularized bone grafts have been successfully applied for the reconstruction of bone defects at the forearm, distal radius, carpus, and hand. Vascularized bone grafts are most commonly used in revision cases in which other approaches have failed. Vascularized bone grafts can be obtained from a variety of donor sites, including the fibula, the iliac crest, the distal radius (corticocancellous segments and vascularized periosteum), the metacarpals and metatarsals, and the medial femoral condyle (corticoperiosteal flaps). Their vascularity is preserved as either pedicled autografts or free flaps to carry the optimum biological potential to enhance union. The grafts can also be transferred as composite tissue flaps to reconstruct compound tissue defects. Selection of the most appropriate donor flap site is multifactorial. Considerations include size matching between donor and defect, the structural characteristics of the graft, the mechanical demands of the defect, proximity to the donor area, the need for an anastomosis, the duration of the procedure, and the donor site morbidity. This article focuses on defects of the distal radius, the wrist, and the hand.
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Affiliation(s)
- Konstantinos N Malizos
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessalia, Larissa, Greece.
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Daher S, Pendeloski K, Dalboni M, Mattar R, Sass N, Torloni M. Analysis of CD28 molecule in preeclamptic patients: preliminary report. J Reprod Immunol 2010. [DOI: 10.1016/j.jri.2010.06.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Daher S, Gueuvoghlanian-Silva B, Oliveira L, Sanchez V, Torloni M, Mattar R. Adiponectin in women with gestational diabetes: relationship with obesity. J Reprod Immunol 2010. [DOI: 10.1016/j.jri.2010.06.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Daher S, Gueuvoghlanian-Silva B, Scomparini F, Alexandre S, Torloni M, Mattar R. Gestational diabetes versus inflammatory mediators. J Reprod Immunol 2010. [DOI: 10.1016/j.jri.2010.06.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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de Amorim Cabrita HAB, Malavolta EA, Teixeira OVR, Montenegro NB, Duarte FA, Mattar R. Anterograde removal of broken femoral nails without opening the nonunion site: a new technique. Clinics (Sao Paulo) 2010; 65:279-83. [PMID: 20360918 PMCID: PMC2845768 DOI: 10.1590/s1807-59322010000300007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Accepted: 12/17/2009] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE We describe a new technique for removing the distal fragments of broken intramedullary femoral nails without disturbing the nonunion site. METHODS This technique involves the application of an AO distractor prior to the removal of the nail fragments, with subsequent removal of the proximal nail fragment in an anterograde fashion and removal of the distal fragment through a medial parapatellar approach. Impaction of the fracture site is then performed with a nail that is broader than the remaining fragmented material. RESULTS Nails were removed from five patients using the technique described above without any complications. After a mean follow-up period of 61.8 months, none of these patients showed worsened knee osteoarthritis. CONCLUSION The original technique described in this article allows surgeons to remove the distal fragment of fractured femoral intramedullary nails without opening the nonunion focus or using special surgical instruments.
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Campanharo F, Caetano A, Lopes C, Cavalcante R, Lopes M, Mattar R, Sun S. P313 Organophosphates and carbamates intoxication in pregnancy: A case-report. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)61805-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Zamarian A, Torloni M, Caetano A, Lopes C, Fernandes F, Nardozza L, Moron A, Mattar R. P140 Cesarean section in women with systemic lupus erythematosus: experience from a Brazilian university hospital. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)61631-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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