Amendola L.,Maggiore Hospital |
Simonetti L.,Bellaria and Maggiore Hospital |
Simoes C.E.,Hospital Felicio Rocho |
Bandiera S.,Rizzoli Orthopaedic Institute |
And 2 more authors.
European Spine Journal | Year: 2013
Purpose: Our aim is to define the role of embolization in the treatment of aneurysmal bone cyst of the spine in order to include this option in the decision making process. Methods: From April 2004 to November 2009, seven patients with primary aneurysmal bone cyst of the mobile spine treated by embolization have been prospectively followed-up. All clinical presentations and imagings were recorded. There are many options of embolic agent and techniques used, but all aim to devascularize the tumor. The therapeutic protocol includes: embolization repeated every 8 weeks until the appearance of radiographic signs of healing. Complications, rate of healing and clinical outcome were analyzed. Results The number of embolizations varied from one to a maximum of seven without related intra- or post-operative complications. One patient, after four selective arterial embolizations, underwent direct percutaneous injection of embolic agents into the cyst.Aclinical and radiographical response was achieved in all patients who were found alive and completely free of disease at mean follow-up of 46 months after last treatment and nobody crossed to surgical option. Conclusion: Embolization seems to be the first option for spinal aneurysmal bone cyst treatment because of the best cost-to-benefit ratio. It is indicated in intact aneurysmal bone cyst, when diagnosis is certain, when technically feasible and safe and when no pathologic fracture or neurologic involvements are found. If embolization fails, other options for treatment would still be available. © Springer-Verlag Berlin Heidelberg 2012.
Boriani S.,Rizzoli Orthopaedic Institute |
Amendola L.,Ospedale Maggiore C.A. Pizzardi |
Bandiera S.,Rizzoli Orthopaedic Institute |
Simoes C.E.,Hospital Felicio Rocho |
And 3 more authors.
European Spine Journal | Year: 2012
Purpose To define the role of Enneking staging system and of the consequent different treatment options on the outcome of osteoblastoma (OBL) of the spine. Methods A retrospective review of 51 patients with OBL of the mobile spine conducted to compare the outcomes among the different types of treatments at long term follow-up (25-229 months, av.90). These 51 patients were previously staged according to Enneking staging system and treatment selected accordingly. 10 stage two (st.2) OBLs were treated with intralesional excision and 41 stage three (st.3) OBLs were treated either by intralesional excision or en bloc resection. The intralesional excision group was divided considering the use or not of radiation therapy after surgery. The recurrence rate was compared among these groups and also considering previous open surgery ('non intact' vs. 'intact'). The statistical significance was defined using the Fisher Exact test. Results No local recurrence occurred in the st.2 patients treated by intralesional excision. Considering the st.3 patients, 2 local recurrences out of 13 patients occurred in the en bloc resection (15.4 %) group. All occurred in 'non intact' cases (67 %). In the intralesional group, 5 local recurrences out of 27 patients occurred (18 %) being none in the group that received radiation therapy after surgery. Two occurred in the 'intact' (7 %) and three in the 'non intact' group (75 %). Considering all patients, the difference between the recurrence rate between 'intact' and 'non intact' groups was statistically significant (p< 0.002). Conclusions Intralesional excision proved to be effective in st.2 lesions and en bloc resection in st.3. Radiotherapy seems to be an effective adjuvant treatment when en bloc resection is not feasible or requires unacceptable functional sacrifices. The first treatment significantly affects the prognosis as previously treated patients have worse prognosis. © Springer-Verlag 2012.
Belisario Falchetto E.,Hospital Felicio Rocho |
Costa S.C.S.,Hospital Felicio Rocho |
Rochitte C.E.,University of Sao Paulo
Global Heart | Year: 2015
Chagas disease comprises a poorly understood and studied clinical scenario, and the Chagas cardiomyopathy is the more representative field of these difficulties. Different from other cardiomyopathies, there is a discrepancy between its severity and poor prognosis and the low efficiency specific diagnostic and therapeutic available tools. Recently, cardiac magnetic resonance has evolved as an important cardiologic method of detailed and accurate myocardial evaluation. It has already been proved as a valuable test for cardiac functional and structural analysis. Considering the vast area that must be studied and researched regarding this cardiomyopathy, cardiac magnetic resonance is being considered an important recent tool for this purpose. The current use of this imaging method for Chagas cardiomyopathy is reviewed. For the proper image interpretation, the relevant pathophysiological aspects are remembered and the natural history of the Chagas disease is briefly reviewed. © 2015 World Heart Federation (Geneva). Published by Elsevier Ltd. All rights reserved.
PubMed | University of Sao Paulo and Hospital Felicio Rocho
Type: | Journal: Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery | Year: 2017
Traumatic intracranial aneurysms in children are rare and may occur as the result of closed or penetrating head trauma. Their natural history seems to be more aggressive. Most traumatic aneurysms have complex shape, tending to have a large neck or even a fusiform morphology.We present a case of a traumatic carotid artery aneurysm in a 9-year-old girl that was successfully treated with pipeline embolization device.Due to its dissecting nature, wall friability and lack of a substantial neck can make surgical clipping and selective coiling difficult and risky. Although endovascular parent artery occlusion is the best approach in the acute phase, in some situations it is not possible or very risky. In such scenario the use of flow diverter devices would be an alternative approach. Additionally, we discuss the potential advantages and risks of flow diverter deployment inside a developing vessel.
Nery C.,Foot and Ankle Clinic |
Coughlin M.J.,St Alphonsus Foot and Ankle Clinic |
Baumfeld D.,Hospital Felicio Rocho |
Ballerini F.J.,Foot and Ankle Clinic |
Kobata S.,Foot and Ankle Clinic
Foot and Ankle International | Year: 2013
Background: The high frequency of hallux valgus deformities in females is well known and has been widely reported in the literature. This finding tends to obscure the importance and the characteristic details of hallux valgus deformities in males. The severity of the deformity, its onset at an earlier age, and its inheritability seem to be more frequent in males, but there are no reports in the literature to substantiate these concepts. The purpose of this study was to analyze these questions in regard to males with hallux valgus. Methods: The records and plain radiographs of 31 males (53 feet) with a diagnosis of hallux valgus that were treated over a 20-year period (1985-2005) were analyzed. During that same period, the senior author (CN) performed 812 procedures for the correction of hallux valgus deformities in women. In order to compare gender-related differences associated with this deformity, 31 women's charts-paired by age and affected side-were randomly selected and both clinical and radiological data were statistically compared. Results: The onset of the complaints of first ray pain in males was equally distributed by decades, indicating that the deformity begins earlier in this group. Among males, we found 68% of the subjects had a familial history of bunion deformities-58% were maternal and 10% were fraternal. In the control group of females, only 35% of the women reported inheritance of the deformity. No correlation with footwear was found among males. The radiographic measurements were significantly higher in the male group, which included the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), and the tarsal metatarsal angle (TMA). The main gender difference was found to be the DMAA with first metatarsophalangeal (MTP) joint congruence being much more common in males (males = 57%, females = 30%). No correlations were found for metatarsus primus varus or pes planus. Conclusion: Based on our observations, we conclude that hallux valgus in males is commonly hereditary in nature and is mainly transmitted by the mother, with early onset and higher severity when compared to women. We report a female/male ratio of 15:1. The main intrinsic factor associated with a hallux valgus deformity in males is a high DMAA. Level of Evidence: Level III, retrospective comparative series. © The Author(s) 2013.
[Single cardiac troponin T measurement predicts risk for adverse outcome in decompensated heart failure]. [Dosagem única de troponina cardíaca T prediz risco adverso na insuficiência cardíaca descompensada.]
Oliveira M.D.,Hospital Felicio Rocho
Arquivos brasileiros de cardiologia | Year: 2010
The slight increase in cardiac troponin in the blood of patients with heart failure (HF) suggests that myofibrils are degraded in the myocardium and released in the circulation, reflecting a continuous and progressive injury process in the contractile system. To correlate the serum levels of cardiac troponin T (TnT) at the hospital admission of patients with decompensated HF and prognosis. A total of 79 consecutive patients, hospitalized due to decompensated HF, with LVEF < 45%, were included in the study. Patients were followed for 8 months. We excluded patients using intravenous inotropic agents, as well as those with acute coronary syndrome, pulmonary thromboembolism, creatinine levels > 2.5 mg%, liver failure, or neuromuscular diseases. High levels of TnTc (>0.02 ng/ml) were detected in 37 patients (46.84%). The global mortality was 35.4%. In the groups with high TnT and low TnT levels (<0.02 ng/ml) there were, respectively, 19 versus 9 deaths (RR=2.4; 95%CI 1.24-4.63; p=0.011), 5 versus 4 heart transplants (RR=1,42; 95%CI 0.41-4.89; p=0.73), 11 versus 7 patients needed IV inotropic agents (RR=1.78; 95%CI 0.77-4.12; p=0.26) and 14 versus 10 patients were re-hospitalized (RR=1.85; 95%CI 0.95-3.6; p=0.10). Mean troponin levels were significantly higher in those individuals who died (0.071+/-0,119 vs 0.032+/-0.046; p=0.004). At the multivariate analysis, the persistence of the third sound and the need for IV inotropic agents showed to be independent predictors of death; however, we observed a higher tendency towards mortality for patients presenting high TnT when compared to those with low troponin levels (HR=2.64; 95%CI 0.91-7.63; p=0.07). The single troponin measurement at hospital admission in patients with decompensated HF predicts adverse outcomes and should be considered at the early stratification of long-term morbimortality.
Sternick M.B.,Hospital Felicio Rocho |
Formentini P.K.I.,Hospital Felicio Rocho |
de Souza G.M.C.,Hospital Felicio Rocho |
Teixeira E.C.,Hospital Felicio Rocho |
And 2 more authors.
International Orthopaedics | Year: 2016
Background: Inherited epidermolysis bullosa is a rare disease characterised by mechanical fragility of the skin when under insignificant stress. The main consequences of epidermolysis bullosa, mainly the dystrophic type, despite pseudosyndactyly, are joint contractures and deformities in hands and feet. In this study, we describe our experience treating patients suffering from epidermolysis bullosa, as far as feet deformities are concerned. Methods: This is a retrospective analysis of a consecutive series of patients presenting feet deformities related to epidermolysis bullosa. Extension contractures of the toes, equinus and cavus deformities were treated with soft tissues surgery. Results: Thirteen surgical procedures were done in six patients with feet deformities caused by epidermolysis bullosa. Of the feet operated 85.7 % extension contracture of the toes was asymptomatic at follow-up. However, 42.9 % developed hammertoe deformities. There were no recurrence or complications for other deformities. Subjectively, all patients declared themselves very satisfied with the results. Conclusion: Foot deformities must be treated as early as possible, due to progressive disability for walking and pain symptoms. We considered that, despite long term complications, treatment was adequate and we recommend it. Level of Evidence Level IV. © 2016, SICOT aisbl.
Pena G.P.,Hospital Felicio Rocho |
de Souza Andrade-Filho J.,Hospital Felicio Rocho
Advances in Health Sciences Education | Year: 2010
Analogies are important tools in human reasoning and learning, for resolving problems and providing arguments, and are extensively used in medicine. Analogy and similarity involve a structural alignment or mapping between domains. This cognitive mechanism can be used to make inferences and learn new abstractions. Through analogies, we try to explain a knowledge to be achieved (the target), with pieces of information already familiar to the learner (the source), keeping in mind the constraints of similarity, structure and purpose. The purpose of this essay is to examine the use of analogies in medicine. We provide a brief review of the theoretical basis of analogical reasoning. This theoretical background is discussed in the light of actual examples of analogies retrieved from medical literature. In medicine, analogies have long been used to explain several physiologic and pathologic processes. Besides deeper structural relations, superficial attribute similarity is extensively used in many medical specialties. These attribute similarities are important in naming, categorizing and classifying, and play a role as learning and memorizing tools. Analogies also serve as basis for medical nomenclature. The choice of the source of analogies is highly dependent on cultural background, and may derive from ancient or diverse cultures. Learning by analogies may thus require research on culture diversity in order to establish an adequate justification and to comprehend the purpose of an analogy. © 2008 Springer Science+Business Media B.V.
Pena G.P.,Hospital Felicio Rocho
American Journal of Transplantation | Year: 2011
Ludwik Fleck was a polish physician and bacteriologist with major interest in epistemology. In 1935, he published, in German, a monograph entitled 'Genesis and development of a scientific fact'. His concepts of 'thought collective', 'thought style' and 'active and passive associations' have been materialized in Banff classification of renal allograft pathology. The dynamics and evolution of the classification of renal allograft pathology, generated within Banff community, reflect perfectly Fleck's conceptions. In this essay, the Banff community of thought is characterized as a thought collective, according to Fleck's epistemology. Since its inception, the classification has been evolving in a continuum of active and passive connections, preserving its initial thought style, based on morphology. Whether the emergence of nonmorphological, molecular techniques will result in the end of morphological thought style is a question the community is presently facing. © 2011 The American Society of Transplantation and the American Society of Transplant Surgeons.
Fontes D.,Hospital Felicio Rocho |
Generoso S.D.V.,Federal University of Minas Gerais |
Toulson Davisson Correia M.I.,Federal University of Minas Gerais
Clinical Nutrition | Year: 2014
Background & aims: Nutritional assessment of critically ill patients has created controversy. However, it is well established that malnourished patients who are severely ill have worse outcomes than well-nourished patients. Therefore, assessing patients' nutritional status may be useful in predicting which patients may experience increased morbidity and mortality. Method: One hundred eighty-five consecutively admitted patients were followed until discharge or death, and their nutritional status was evaluated using Subjective Global Assessment (SGA) as well as anthropometric and laboratory methods. Agreement between the methods was measured using the Kappa coefficient. Results: Malnutrition was highly prevalent (54%), according to SGA. Malnourished patients had significantly higher rates of readmission to the intensive care unit (ICU) (OR 2.27; CI 1.08-4.80) and mortality (OR 8.12; CI 2.94-22.42). The comparison of SGA with other tests used to assess nutritional status showed that the correlation between the methods ranged from poor to superficial. Conclusion: SGA, an inexpensive and quick nutritional assessment method conducted at the bedside, is a reliable tool for predicting outcomes in critically ill patients. © 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism.