No / We retrospectively reviewed the hospital records of 68 patients who had been referred with an injury to the posterolateral corner of the knee to a specialist knee surgeon between 2005 and 2009. These injuries were diagnosed based on a combination of clinical testing and imaging and arthroscopy when available. In all, 51 patients (75%) presented within 24 hours of their injury with a mean presentation at eight days (0 to 20) after the injury. A total of 63 patients (93%) had instability of the knee at presentation. There was a mean delay to the diagnosis of injury to the posterolateral corner of 30 months (0 to 420) from the time of injury. In all, the injuries in 49 patients (72%) were not identified at the time of the initial presentation, with the injury to the posterolateral corner only recognised in those patients who had severe multiple ligamentous injuries. The correct diagnosis, including injury to the posterolateral corner, had only been made in 34 patients (50%) at time of referral to a specialist knee clinic. MRI correctly identified 14 of 15 injuries when performed acutely (within 12 weeks of injury), but this was the case in only four of 15 patients in whom it was performed more than 12 weeks after the injury. Our study highlights a need for greater diligence in the examination and investigation of acute ligamentous injuries at the knee with symptoms of instability, in order to avoid failure to identify the true extent of the injury at the time when anatomical repair is most straightforward.

No / To assess clinical outcomes and cost-effectiveness of using a two-layer cohesive compression bandage (TLCCB; Coban 2) compared with a two-layer compression system (TLCS; Ktwo) and a four-layer compression system (FLCS; Profore) in treating venous leg ulcers (VLUs) in clinical practice in the UK, from the perspective of the National Health Service (NHS). METHOD: This was a retrospective analysis of the case records of VLU patients, randomly extracted from The Health Improvement Network (THIN) database (a nationally representative database of clinical practice among patients registered with general practitioners in the UK), who were treated with either TLCCB (n=250), TLCS (n=250) or FLCS (n=175). Clinical outcomes and health-care resource use (and costs) over six months after starting treatment with each compression system were estimated. Differences in outcomes and resource use between treatments were adjusted for differences in baseline covariates. RESULTS: Patients' mean age was 75 years old and 57% were female. The mean time with a VLU was 6-7 months and the mean initial wound size was 77-85 cm2. The overall VLU healing rate, irrespective of bandage type, was 44% over the six months' study period. In the TLCCB group, 51% of wounds had healed by six months compared with 40% (p=0.03) and 28% (p=0.001) in the TLCS and FLCS groups, respectively. The mean time to healing was 2.5 months. Patients in the TLCCB group experienced better health-related quality of life (HRQoL) over six months (0.374 quality-adjusted life years (QALYs) per patient), compared with the TLCS (0.368 QALYs per patient) and FLCS (0.353 QALYs per patient). The mean six-monthly NHS management cost was pound2,413, pound2,707 and pound2,648 per patient in the TLCCB, TLCS and FLCS groups, respectively. CONCLUSION: Despite the systems studied reporting similar compression levels when tested in controlled studies, real-world evidence demonstrates that initiating treatment with TLCCB, compared with the other two compression systems, affords a more cost-effective use of NHS-funded resources in clinical practice, since it resulted in an increased healing rate, better HRQoL and a reduction in NHS management cost. The evidence also highlighted the lack of continuity between clinicians managing a wound, the inconsistent nature of the administered treatments and the lack of specialist involvement, all of which may impact on healing. DECLARATION OF INTEREST: This study was supported by an unrestricted research grant from 3M Health Care, UK. 3M Health Care had no influence on the study design, the collection, analysis, and interpretation of data, or on the writing of, and decision to submit for publication, the manuscript.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / PURPOSE: To assess the long-term effect of a 2% aqueous chlorhexidine (CHX) solution on bond strength to artificially eroded dentin compared to sound dentin. MATERIALS AND METHODS: Flat mid-coronal dentin surfaces of extracted third molars (n = 28) were subjected only to grinding with a 600-grit SiC paper for 1 min (sound dentin S, n = 14) or additionally to erosive pH cycling with a cola-based soft-drink (eroded dentin E, n = 14). After acid etching, rinsing, and air drying, S and E were rehydrated with 1.5 μl of 2% CHX (S2%, n = 7; E2%, n = 7) or of distilled water (control SC, n = 7; EC, n = 7). Composite buildups were incrementally constructed with Filtek Z350 following Adper Single Bond 2 application. Specimens were sectioned into beams, which were subjected to microtensile testing immediately or after 6 or 12 months of aging. Fractured surfaces were observed under a digital microscope (50X magnification). Microtensile bond strength (μTBS) (MPa) was analyzed by three-way ANOVA and Tukey's tests (α = 0.05) and failure mode by the Kruskal-Wallis test (α = 0.05). RESULTS: Compared to sound dentin, eroded dentin was consistently related to lower μTBS. Immediately and after 12-month aging, the effect of CHX was insignificant, but it was significant after 6-month aging, when it conserved the bond strength to both eroded and sound dentin. The percentage of adhesive and mixed failures were equivalent, and significantly more frequent than cohesive failures, whether in dentin or in composite. CONCLUSION: The 2% CHX effect on bond strength conservation to both eroded and sound dentin was not found to be persistent. / Revisión por pares

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / PURPOSE: To evaluate the effect of aqueous solutions of chlorhexidine digluconate (CHX) in different concentrations on bond strength to eroded dentin up to 6 months, using normal dentin as a control. METHODS: Exposed flat dentin of extracted third molars was only ground with 600-grit SiC paper/1 minute (normal dentin - N), or subsequently eroded by a regular-cola soft-drink (eroded dentin - E). N and E were acid-etched, washed, dried and rehydrated with 1.5 μL, respectively, of distillated water (control - NC / EC); of 0.004% CHX (N0.004% / E0.004%); or of 2% CHX (N2% / E2%). Adper Single Bond 2 was applied in all specimens and resin composite buildups were constructed with Filtek Z350. Specimens were sectioned in beams, which were tested (μTBS) immediately or after 6 months of aging. RESULTS: Microtensile bond strength to eroded dentin was always significantly lower than that to normal dentin. Application of tested CHX solutions did not exert a significant effect immediately; however, after aging, the 2% CHX prevented abrupt bond strength loss both to eroded and normal dentin. / Revisión por pares

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / PURPOSE: To assess the influence of simulated oral erosive/abrasive challenges on the bond strength of an etch-and-rinse two-step bonding system to enamel using an in situ/ex vivo protocol. METHODS: Bovine enamel blocks were prepared and randomly assigned to four groups: CONT - control (no challenge), ABR - 3x/day-1 minute toothbrushing; ERO - 3x/day - 5 minutes extraoral immersion into regular Coca Cola; and ERO+ABR - erosive protocol followed by a 1-minute toothbrushing. Eight blocks were placed into an acrylic palatal appliance for each volunteer (n = 13), who wore the appliance for 5 days. Two blocks were subjected to each of the four challenges. Subsequently, all the blocks were washed with tap water and Adper Single Bond 2/Filtek Z350 were placed. After 24 hours, 1 mm2 beams were obtained from each block to be tested with the microtensile bond strength test (50 N load at 0.5 mm/minute). The data were statistically analyzed by one-way RM-ANOVA and Tukey's tests (alpha = 0.05). RESULTS: No difference was detected among the ABR, ERO, and CONT groups (P > 0.05). ERO+ABR group yielded lower bond strengths than either the ABR and ERO groups (P < 0.0113). / Revisión por pares

Com o objetivo de avaliar o atendimento dos pacientes submetidos à intervenção cirúrgica cardiovascular no protocolo de atendimento na via rápida (fast track recovery) em relação ao protocolo convencional, foi comparada a movimentação dos pacientes atendidos em ambos os protocolos nas diferentes unidades hospitalares. O estudo foi realizado em hospital público universitário especializado em cardiologia de 400 leitos, de referência terciária para o Sistema Único de Saúde. Foram estudados 175 pacientes, 107 (61%) homens e 68 (39%) mulheres, de idades entre 2 meses a 81 anos, dos quais 107 operados no protocolo da via rápida e 68 no protocolo convencional. Foram avaliadas variáveis demográficas, clínicas e, para avaliar a movimentação dos pacientes nas diferentes unidades hospitalares, as taxas de alta por unidade de tempo em cada unidade. A análise estatística foi feita por meio de análise exploratória, método de Kaplan Meier e modelo de riscos proporcionais de Cox. A análise de variância foi empregada para comparar o faturamento das despesas. A taxa de alta das diferentes unidades hospitalares por unidade de tempo dos portadores de cardiopatia congênita atendidos no protocolo da via rápida em relação ao protocolo da via convencional foi: a) 11,3 vezes a taxa de alta quando assistidos no protocolo na via convencional quanto ao tempo de permanência no centro cirúrgico; b) 6,3 vezes quanto à duração da intervenção cirúrgica; c) 6,8 vezes quanto à duração da anestesia; d) 1,5 vezes quanto à duração da perfusão; e) 2,8 vezes quanto à permanência na unidade de recuperação pós-operatória I; f) 6,7 vezes quanto à duração da hospitalização; g) 2,8 vezes quanto à permanência na unidade de internação pré-operatória; h) 2,1 vezes quanto à permanência na unidade de internação após a alta da unidade de terapia intensiva de recuperação pós-operatória. Para os portadores de cardiopatia isquêmica, as taxas de alta das unidades hospitalares para os protocolos de atendimento no protocolo da via rápida e no protocolo convencional não demonstraram diferença estatisticamente significante. Os valores de faturamento das despesas de internação dos portadores de cardiopatia congênita decorrentes de exames e procedimentos realizados nas fases pré- e pós-operatória e dos exames da fase trans-operatória foram menores quando os pacientes foram assistidos no protocolo da via rápida. Portanto, os portadores de cardiopatias congênita apresentaram menor permanência hospitalar nos recursos médicos hospitalares instalados, quando assistidos no protocolo de atendimento na via rápida, bem como menores despesas nas fases pré- e pós- operatória da internação. / Objective - To evaluate patient assistance in pre, per and postoperative phases of cardiac surgical intervention under fast track recovering protocol compared to the conventional way. Patients - 175 patients were studied, 107 (61%) men and 68 (39%) women. Ages 2 months to 81 years old. Patients included: first surgical intervention, congenital and ischemic cardiopathy without complexity, normal ventricular function and with at least 2 preoperative ambulatory consultations. Patients submitted to emergency surgeries were excluded. Interventions - assistance submitted by fast track and conventional protocol. Statistical analysis (measures) - exploratory, uni-varied (Kaplan Meier) and multi-varied (Cox) of the time in each admission unit. Hospital installations were classified in ambulatory, preoperative admission unit, surgical center, postoperative recovery unit and postoperative admission unit; the expression of this use was the discharge rate by unit of time from the significant interaction observed between assistance protocol and the kind of cardiopathy for the stay in the surgical center, surgical intervention time, stay in postoperative recovery unit, anesthesia time and time between admission and surgery dates. Results - the patients of congenital cardiopathy who underwent the protocol of conventional way recovery in relation to the fast track protocol, in the reliability range of 95% allows one to state that discharge rate by unit of time of the congenital cardiopathy patients assisted by the fast track protocol was: 11.3 times the discharge rate when assisted by the conventional way protocol as to the time of staying in the surgical center; 6.3 times as to the duration of the surgical intervention; 6.8 times as to duration of the anesthesia; 1.5 times as to the duration of the perfusion; 2.8 times as to the stay in the postoperative recovery unit; 6.7 times as to the stay in the hospital (period of time between the admission and the discharge date); 2.8 times as to the stay in the preoperative admission unit ( period of time between the admission date and the surgery date); 2.1 times as to the stay in the postoperative unit (period of time between the date of leaving the postoperative recovery unit and the date of discharge from the hospital). For the ischemia cardiopathy patients the risks concerning the protocols of recovery by the traditional way and the fast track were the same. CONCLUSIONS - The data concerning this study allows one to suggest that the assistance can be more efficient if one takes into consideration some variables studied in the protocol of fast track recovery. The congenital and ischemic cardiopathy patients presented shorter interval of time (concerning hospital stay in doctor-hospital installed facilities) when assisted in the fast track recovery protocol as well as fewer expenses with medical and hospital assistance.

A perda da permeabilidade seletiva de membrana celular causada pela isquemia leva ao acúmulo de sódio e edema miocárdico. Este fenômeno tem implicações importantes na estrutura e função do ventrículo esquerdo, nas primeiras horas após infarto do miocárdio. Objetivou-se investigar a hipótese de que, durante as primeiras horas após oclusão coronária prolongada e restabelecimento de fluxo completo, a taxa de acúmulo de sódio miocárdico é determinado pela integridade da microvasculatura. Utilizou-se imagem de ressonância magnética do sódio-23 em 3 dimensões, para monitorizar as alterações do conteúdo de sódio miocárdico no tempo, em um modelo canino in vivo e com tórax fechado (n = 19) de infarto do miocárdio e reperfusão. Seis animais apresentaram fibrilação ventricular durante a oclusão ou imediatamente após reperfusão coronária, não completando o protocolo. Em quatro experimentos não se detectou nenhuma área de infarto, por nenhum dos métodos utilizados. Um animal foi submetido a oclusão coronária permanente. Os oito animais restantes constituíram o grupo de infartos reperfundidos. Destes, infartos com obstrução microvascular (n = 4), detectados por microesfera radioativa e por imagem por ressonância magnética do hidrogênio realçada com contraste, mostraram uma taxa menor de acúmulo de sódio, assim como um menor fluxo sangüíneo 20 minutos e 6 horas após reperfusão. A ausência de obstrução microvascular nos infartos (n = 4) esteve associada a taxas maiores de acúmulo do sódio e maior restabelecimento do fluxo sangüíneo miocárdico. Além disso, o tamanho do infarto por imagem por ressonância magnética do sódio-23 apresentou boa correlação com o tamanho do infarto pela anatomopatologia (cloreto de trifeniltetrazólio ou TTC) e pela imagem de ressonância do hidrogênio realçada por contraste (hiperintensificação ou realce tardio) 9 horas após reperfusão. Conclui-se que, em infartos do miocárdio reperfundidos, o acúmulo de sódio é dependente da integridade microvascular e está diminuído em regiões de obstrução microvascular, comparado com regiões miocárdicas com microvasculatura patente. A imagem por ressonância do sódio-23 pode ser um instrumento útil para a monitorização in vivo do conteúdo do sódio no infarto agudo do miocárdio. / Loss of membrane permeability caused by ischemia leads to cellular sodium accumulation and myocardial edema. This phenomenon has important implications to left ventricular structure and function in the first hours after myocardial infarction. We hypothesized that during this period of time, after prolonged coronary occlusion and complete reflow, the rate of myocardial sodium accumulation is governed by microvascular integrity. We used 3-dimensional 23 Na magnetic resonance imaging to monitor myocardial sodium content changes over time in an in vivo closed-chest canine model (n = 19) of myocardial infarction and reperfusion. Six animals had ventricular fibrillation during occlusion or immediately after coronary reperfusion, and did not finish the protocol. Myocardial infarction was not detected in four experiments, by any of utilized methods. In one experiment, we produced permanent coronary occlusion. The remaining eight animals constituted the reperfused myocardial infarction group. From those, infarcts with microvascular obstruction n = 4) defined by both radioactive microsphere and contrast-enhanced 1 H magnetic resonance imaging showed a slower rate of sodium accumulation as well as lower blood flow at 20 minutes and 6 hours after reperfusion. Conversely, the absence of microvascular obstruction (n = 4) was associated with faster rates of sodium accumulation and greater blood flow restoration. In addition, infarct size by 23 Na magnetic resonance imaging correlated best with infarct size by triphenyltetrazolium chloride and contrast-enhanced 1 H magnetic resonance imaging at 9 hours after reperfusion. We conclude that in reperfused myocardial infarction, sodium accumulation is dependent on microvascular integrity and is slower in regions of microvascular obstruction compared with those with patent microvasculature. Finally, 23 Na magnetic resonance imaging can be a useful tool for monitoring in vivo myocardial sodium content in acute myocardial infarction.

Dissertation (Ph.D.)--University of South Florida, 2009. / Title from PDF of title page. Document formatted into pages; contains 164 pages. Includes vita. Includes bibliographical references.

Thesis (Ph. D.)--Uniformed Services University of the Health Sciences, 2005. / Typescript (photocopy).

Thesis (M.S.)--Uniformed Services University of the Health Sciences, 2005. / Typescript (photocopy).