Este procedimento foi realizado usando o aequalis invertida Shoulder Prótese Total por Tornier Inc. Consulte Tornier Inc. para mais informações: <a href="http://www.tornier-us.com/">http://www.tornier-us.com/</a> .

1. Introdução: A articulação glenoumeral é uma articulação complexa. Tem mínima restrições ósseas e depende de um complexo equilíbrio de tensões entre o apoio tecidos moles para a função normal. Esta relação essencial permite que o ombro para ter uma grande variedade de movimento funcional. Quando esse equilíbrio for desatrelada, diferentes graus de disfunção ocorrer. A perda da função do manguito rotador, como uma lágrima de grande porte, pode causar tradução superior da cabeça do úmero na glenóide. Isso muda o centro de rotação da articulação glenoumeral e, posteriormente, os braços tensão e momento da musculatura remanescente função, diminuindo. Além disso, as mudanças na posição da cabeça do úmero e alterações posteriores, em pressões de contato pode levar a danos progressivos à cartilagem articular e resultando artrite dolorosa. O uso de artroplastia do ombro padrão para estes casos tem proporcionado resultados sub-ótima e, por vezes catastróficas. Artroplastia ombro reverso total (RTSA) fornece uma solução para esses problemas complexos proporcionando melhorias significativas na faixa dor, do movimento e função. O projeto RTSA medializes o centro de rotação do úmero e traz para uma posição mais inferior. Esta mudança na biomecânica restaura a tensão no músculo deltóide barriga eo braço de alavanca funcional, melhorando a capacidade deltoids para mover o braço no espaço. Além disso, a cartilagem artrítica dolorosa é removido com o processo, melhorando significativamente a dor do paciente. 2. Apresentação de caso: Este paciente é um 71 anos de idade, saudável, com uma história de um &quot;mini-open&quot; manguito rotador 15 anos antes. Durante o ano passado, ela experimentou a dor aumentou e fraqueza no ombro com uma correspondente diminuição na sua amplitude de movimento. Sua abdução ativa foi de 30 °, flexão anterior ativa foi de 40 °, rotação externa ativa foi de 10 ° e rotação interna ativa para seu glúteo. Seu teste modificado abraço de urso demonstrou fraqueza mínima no tendão do subescapular e ela tinha um sinal de chifre soprador é negativo e teste de lag negativo. Sua amplitude de movimento passivo mostrou que 75 ° de flexão para a frente com um teste positivo queda braço. O exame neurovascular foi de outra maneira normal e não havia sinais de infecção associada com a reparação anterior do manguito rotador. 3. Tratamento / procedimento de diagnóstico: Avaliação radiográfica inicial deste paciente deve incluir uma visão tomada escapular, uma visão Grashey, e uma vista axilar. Dependendo da aparência da glenóide, um estudo mais aprofundado com uma tomografia computadorizada pode ser necessário avaliar a quantidade de erosão óssea, presença de displasia e estoque ósseo disponível. Em nosso paciente, radiografias iniciais exibiram moderada alterações degenerativas com migração superior do úmero evidenciado por uma diminuição da distância acrômio-umeral. Não houve perda óssea significativa associada à glenóide. A combinação de história do paciente, exame físico e análise radiográfica são consistentes com artropatia do manguito rotador com pseudoparalisia. Mais estudos de diagnóstico não seria indicada neste paciente. Antes de consideração de qualquer artroplastia importante em qualquer paciente um curso de medidas conservadoras devem ser realizadas. Estes devem incluir o tratamento médico com medicamentos anti-inflamatórios, injeções de corticóide na subacromial comunicação e espaços intracapsular e fisioterapia para o fortalecimento e amplitude de movimento. Após este tratamento, o paciente deve ser avaliado para sua dor, função atual, realista necessidades funcionais e desejos, qualidade de vida e comorbidades associadas. Se os riscos associados ao procedimento são determinados para ser aceitável para os pacientes esperados benefícios, a técnica de seguir para a artroplastia total de ombro reverso pode ser usado. 4. Reversa Artroplastia Total do Ombro <ol><li> O paciente é colocado na posição beachchair eo braço é preparado e drapejado livre na forma padrão. </li><li> A incisão padrão deltopeitoral ea abordagem é feita a exposição do manguito rotador e do espaço subacromial. Dissecção romba é usado para liberar o deltóide superfície inferior de qualquer aderências aos tecidos subjacentes. </li><li> O manguito rotador é examinado ao rasgamento e avaliados para a possibilidade de reparação. Se os tecidos parecem ser reparável, reparo e artroplastia convencional pode ser considerada. Caso contrário, qualquer manguito inúteis podem ser extirpado </li><li> O nervo axilar é identificado e protegido O tendão do subescapular é identificado e liberado do menor tuberosidade eo tendão é libertado proximalmente a partir de qualquer aderências sem liberar a origem </li><li> A cápsula inferior é liberado do úmero proximal e úmero é rodado externamente deslocando tele cabeça do úmero da articulação </li><li> O canal medular é localizado usando o furador de entrada que é o substituído pelo guia cabeça umeral ressecção eo corte do úmero proximal é feita a 0 ° de versão. O guia intramedular terão de ser removidos para completar o corte </li><li> Alargamento metafisário e diafisário é o feito no tamanho adequado à anatomia do paciente </li><li> Componentes de avaliação são então montados e colocados no úmero na versão apropriada com um protetor de corte para a preparação glenóide </li><li> O labrum é extirpado, a cápsula anterior e inferior são liberados da glenóide e afastadores são colocados expondo a glenóide </li><li> O guia de broca é utilizada para colocar o furo central, utilizando a broca 6 milímetros </li><li> Glenóide é fresada em preparação para a placa de base criando um sulco periférico </li><li> O furo central é então ampliada para 7,5 milímetros para a 8 milímetros centrais peg e placa de base é colocado, impactando nivelada com a glenóide reamed </li><li> Parafusos são colocados na placa de base com fixação cortical trans. Os parafusos anterior e posterior têm um arco de 30 ° para a colocação e parafusos são padrão cortical. Os parafusos superiores e inferiores são fixadas com parafusos de fixação de um arco de 30 ° nos planos superior e inferior, respectivamente </li><li> O glenosphere é, então, impactado sobre a placa de base eo parafuso central é apertado garantir a glenosphere </li><li> Um forro julgamento é então colocada na haste umeral julgamento e no ombro é reduzida. Exame de ROM e de estabilidade é, então, feito e os ajustes feitos conforme necessário </li><li> Implantes julgamento são, então, removido do úmero, os componentes finais são montados e inserido e impactado no úmero na versão apropriada </li><li> O ombro é reduzida e um exame final de ROM e de estabilidade é feito </li><li> O tendão do subescapular é, então, reparado no úmero proximal ea ferida é fechada em forma padrão </li></ol> 5. Resultados: Aos 6 meses de seguimento deste paciente classificou sua dor pós-operatória como um fora zero de dez na Escala Analógica Visual. Sua amplitude de movimento ativa incluídos frente a 140 ° de flexão, rotação externa ativa de 25 ° e rotação interna a seu glúteo. Este paciente não teve complicações intra-operatórias ou pós-operatório no último follow-up. 6. Conclusão: Na experiência do autor, RTSA fornece um paciente com artropatia do manguito rotador, com o alívio da dor confiável e melhorias na amplitude de movimento e resultados funcionais. Este paciente estava satisfeito com os resultados desta cirurgia.

<ol>
	<li>Boileau, P., Sinnerton, R. J., Choinard, C., Walch, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Arthroplasty+of+the+Shoulder.">Arthroplasty of the Shoulder.</a> J Bone Joint Surgery Br. 88, 562-575 (2006).</li><li>Boileau, P., Watkinson, D., Hatzidakis, A. M., Hovorka, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Neer+Award+2005:+The+Grammont+reverse+shoulder+prosthesis:results+in+cuff+tear+arthritis,+fracture+sequelae,+and+revision+arthroplasty.">Neer Award 2005: The Grammont reverse shoulder prosthesis:results in cuff tear arthritis, fracture sequelae, and revision arthroplasty.</a> J Shoulder Elbow Surg. 15, 527-540 (2006).</li><li>Boileau, P., Watkinson, D. J., Hatzidakis, A. M., Balg, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Grammont+reverse+prosthesis:+design,+rationale,+and+biomechanics.">Grammont reverse prosthesis: design, rationale, and biomechanics.</a> J Shoulder Elbow Surg. 14, 147S-161S (2005).</li><li>Cuff, D., Pupello, D., Virani, N., Levy, J., Frankle, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reverse+shoulder+arthroplasty+for+the+treatment+of+rotator+cuff+deficiency.">Reverse shoulder arthroplasty for the treatment of rotator cuff deficiency.</a> J Bone Joint Surg Am. 90, 1244-1251 (2008).</li><li>Edwards, T. B., Boulahia, A., Kempf, J. F., Boileau, P., Nemoz, C., Walch, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+influence+of+rotator+cuff+disease+on+the+results+of+shoulder+arthroplasty+for+primary+osteoarthritis:+results+of+a+multicenter+study.">The influence of rotator cuff disease on the results of shoulder arthroplasty for primary osteoarthritis: results of a multicenter study.</a> J Bone Joint Surg Am. 84, 2240-2248 (2002).</li><li>Frankle, M., Siegal, S., Pupelo, D., Saleem, A., Mighell, M., Vasey, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=There+reverse+shoulder+prosthesis+for+glenohumeral+arthritis+associated+with+severe+rotator+cuff+deficiency.+A+minimum+two-year+follow-up+study+of+sixty+patients.">There reverse shoulder prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. A minimum two-year follow-up study of sixty patients.</a> J Bone Joint Surg Am. 87, 1697-1705 (2005).</li><li>Guery, J., Favard, L., Sirveaux, F., Oudet, D., Mole, D., Walch, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reverse+total+shoulder+arthroplasty.+Survivorship+analysis+of+eighty+replacements+followed+for+five+to+ten+years.">Reverse total shoulder arthroplasty. Survivorship analysis of eighty replacements followed for five to ten years.</a> J Bone Joint Surg Am. 88, 1742-1747 (2006).</li><li>Martin, T. G., Lanotti, J. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reverse+total+shoulder+arthroplasty+for+acute+fractures+and+failed+management+after+proximal+humerus+fractures.">Reverse total shoulder arthroplasty for acute fractures and failed management after proximal humerus fractures.</a> Orthop Clin North Am. 39, 451-457 (2008).</li><li>Wall, B., Nove-Josserand, L., O'Conner, D. P., Edwards, T. B., Walch, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reverse+total+shoulder+arthroplasty:+a+review+of+results+according+to+etiology.">Reverse total shoulder arthroplasty: a review of results according to etiology.</a> J Bone Joint Surg Am. 89, 1476-1485 (2007).</li><li>Werner, C. M., Steinmann, P. A., Gilbart, M., Gerber, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Treatment+of+painful+pseudoparesis+due+to+irreparable+rotator+cuff+dysfunction+with+the+delta+III+reverse-ball-and-socket+total+shoulder+prosthesis.">Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the delta III reverse-ball-and-socket total shoulder prosthesis.</a> J Bone Joint Surg Am. 87, 1476-1486 (2005).</li></ol>

Não há conflitos de interesse declarados.

O uso de RTSA para artropatia do manguito rotador fornece melhorias significativas na faixa dor, do movimento e escores funcionais resultados. Satisfação geral do paciente variou de 80-95% na literatura atual. Como todos os procedimentos, RTSA não é sem risco. Relatos iniciais de complicação foram tão elevadas como 60%. Como as técnicas têm melhorado os índices de complicações diminuíram.

<table border="1"><tbody><tr><td> Nome do reagente </td><td> Companhia </td><td> Número de catálogo </td><td> Comentários </td></tr><tr><td> Aequalis invertida Ombro </td><td> Tornier, Inc. </td><td> nenhum </td><td> Para mais informações visite <a href="http://www.tornier-us.com/">http://www.tornier-us.com/</a> </td></tr></tbody></table>

reverse total shoulder arthroplasty

Artroplastia total de ombro reverso foi inicialmente aprovado para uso em artropatia do manguito rotador e bem como pseudoparalisia crônica sem artrite em pacientes que não eram apropriados para as reconstruções de transferência de tendão. Tradicionais opções cirúrgicas para esses pacientes eram limitados e os resultados funcionais foram sub-ótima e, às vezes catastróficas. O uso de artroplastia do ombro inverso foi encontrado para efetivamente restaurar esses pacientes a função e aliviar os sintomas associados com a doença. O procedimento pode ser feito através de duas abordagens, a deltopeitoral ou súpero. Taxas de complicações associadas ao uso da prótese têm variado 8-60% com relatórios mais recentes tendências inferiores, como experiente é adquirida. Opções para salvar um ombro reverso falhou prótese são limitadas e muitas vezes têm deficiência associada significativa. Indicações para o uso da prótese continuam a ser avaliados, incluindo seu uso para artroplastia de revisão, fratura do úmero proximal e tumor. Seleção cuidadosa do paciente é essencial porque os riscos significativos associados com o procedimento.

Watch this Scientific Journal Video about Reverse Total Shoulder Arthroplasty at JoVE.com

Reverse Total Shoulder Arthroplasty

Artroplastia ombro reverso total é indicado para o tratamento de condições que não podem ser tratados com artroplastia convencional ou outros procedimentos. Estes incluem, principalmente, condições degenerativas e incapacitantes, com irreparáveis ​​do manguito rotador e perda do acoplamento normais biomecânica do ombro.

Reversa Artroplastia Total do Ombro

Reverse total shoulder arthroplasty was initially approved for use in rotator cuff arthropathy and well as chronic pseudoparalysis without arthritis in ...

Research

JoVE Journal

Medicine

43.0K visualizações.  Case Western Reserve University. Artroplastia ombro reverso total é indicado para o tratamento de condições que não podem ser tratados com artroplastia convencional ou outros procedimentos. Estes incluem, principalmente, condições degenerativas e incapacitantes, com irreparáveis ​​do manguito rotador e perda do acoplamento normais biomecânica do ombro.

Vídeo: Reverse Total Shoulder Arthroplasty

Implantation of the Syncardia Total Artificial Heart

With advances in technology, the use of mechanical circulatory support devices for end stage heart failure has rapidly increased. The vast majority of such patients are generally well served by left ventricular assist devices (LVADs). However, a subset of patients with late stage biventricular failure or other significant anatomic lesions are not adequately treated by isolated left ventricular mechanical support. Examples of concomitant cardiac pathology that may be better treated by resection and TAH replacement includes: post infarction ventricular septal defect,&#160;aortic root aneurysm / dissection, cardiac allograft failure, massive ventricular thrombus, refractory malignant arrhythmias (independent of filling pressures), hypertrophic / restrictive cardiomyopathy, and complex congenital heart disease. Patients often present with cardiogenic shock and multi system organ dysfunction. Excision of both ventricles and orthotopic replacement with a total artificial heart (TAH) is an effective, albeit extreme, therapy for rapid restoration of blood flow and resuscitation. Perioperative management is focused on end organ resuscitation and physical rehabilitation. In addition to the usual concerns of infection, bleeding, and thromboembolism common to all mechanically supported patients, TAH patients face unique risks with regard to renal failure and anemia. Supplementation of the abrupt decrease in brain natriuretic peptide following ventriculectomy appears to have protective renal effects. Anemia following TAH implantation can be profound and persistent. Nonetheless, the anemia is generally well tolerated and transfusion are limited to avoid HLA sensitization. Until recently, TAH patients were confined as inpatients tethered to a 500 lb pneumatic console driver. Recent introduction of a backpack sized portable driver (currently under clinical trial) has enabled patients to be discharged home and even return to work. Despite the profound presentation of these sick patients, there is a 79-87% success in bridge to transplantation.

The purpose of this manuscript is to briefly review indications, management, and outcomes for the total artificial heart. Video operative techniques for device implantation are presented.

Implantação do Coração Artificial Total SynCardia

With advances in technology, the use of mechanical circulatory support devices for end stage heart failure has rapidly increased. The vast majority of ...

Medicina

Implantation of Total Artificial Heart in Congenital Heart Disease

In patients with end-stage heart failure (HF), a total artificial heart (TAH) may be implanted as a bridge to cardiac transplant. However, in congenital heart disease (CHD), the malformed heart presents a challenge to TAH implantation. 
In the case presented here, a 17 year-old patient with congenital transposition of the great arteries (CCTGA) experienced progressively worsening HF due to his congenital condition. He was hospitalized multiple times and received an implantable cardioverter defibrillator (ICD). However, his condition soon deteriorated to end-stage HF with multisystem organ failure. 
Due to the patient's grave clinical condition and the presence of complex cardiac lesions, the decision was made to proceed with a TAH. The abnormal arrangement of the patient's ventricles and great arteries required modifications to the TAH during implantation.
With the TAH in place, the patient was able to return home and regain strength and physical well-being while awaiting a donor heart. He was successfully bridged to heart transplantation 5 months after receiving the device. This report highlights the TAH is feasible even in patients with structurally abnormal hearts, with technical modification.

This is a case report of a patient with congenitally corrected transposition of the great arteries (CCTGA) who received a total artificial heart (TAH) as a bridge to heart transplant. The TAH was successfully implanted with modifications to accommodate the patient's congenitally malformed heart.

Implantação de Coração Artificial Total em cardiopatias congênitas

In patients with end-stage heart failure (HF), a total artificial heart (TAH) may be implanted as a bridge to cardiac transplant. However, in congenital ...

Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction

In orthopedic patients, foreign body-associated infections, especially periprosthetic joint infections (PJIs), are a devastating complication of arthroplasty. Infection requires complex treatment, may result in long hospitalization and causes considerable costs. Multiple surgical revisions can be necessary in these patients, with a loss in function as well as in quality of life.
The routine preoperative diagnostics include blood examination for C-reactive protein (CRP) and other biomarkers, as well as joint aspirate analysis for cell count, differentiation, and culture. Intraoperative specimens for histology and microbiology are also standard procedure. The microbiological examination of removed implants with sonication, in combination with the implementation of molecular biology techniques in microbiology, represent two novel techniques currently employed to enhance the differential diagnostics of PJI.
We present here the step-wise procedure of analyzing joint aspirate and sonication fluid, using a cartridge-based multiplex polymerase chain reaction (PCR) system. Results were matched against conventional cultures and consensus criteria for PJI. Conventional microbiological cultures from tissue biopsies, joint aspirate and sonication fluid showed a sensitivity of 66.7%, 66.7%, and 88.9%, respectively, and a specificity of 82.3%, 54.6%, and 61.5%, respectively. The PCR diagnostic of the sonication fluid and the joint fluid showed a sensitivity of 50.0% and 55.6%, respectively, and both a specificity of 100.0%. Both PCR diagnostics combined had a sensitivity of 66.7% and a specificity of 100.0%. The multiplex PCR therefore presents a rapid diagnostic tool with moderate sensitivity but high specificity in diagnosing PJI.

Differential diagnostics in painful arthroplasty is crucial for treatment success. Joint aspiration is routinely performed preoperatively. Multiplex polymerase chain reaction of the joint aspirate and the sonication fluid, a feasible tool for quick pathogen detection from these samples is described.

Diagnóstico de romance em artroplastia de revisão: implante Sonication e reação em cadeia da polimerase Multiplex

In orthopedic patients, foreign body-associated infections, especially periprosthetic joint infections (PJIs), are a devastating complication of ...

Use of Two Intracorporeal Ventricular Assist Devices As a Total Artificial Heart

Mechanical circulatory support (MCS) has been introduced as a viable alternative to heart transplantation primarily through the use of intracorporeal ventricular assist devices (VADs) for support of the left ventricle. However, certain clinical scenarios warrant biventricular mechanical support. One strategy for some patients is the excision of both ventricles and the implantation of two VAD pumps as a total artificial heart (TAH). This has recently been made possible by the improvements in device design and the small profile of centrifugal devices. This TAH approach remains experimental with many important challenges such as the device settings to balance the right and left circulation, the orientation of the devices and the outflow graft with their influence on hemolysis and stability, and the outcome of chronic support using such an orientation. This protocol aims to provide a reproducible approach for total artificial heart replacement with two intracorporeal centrifugal VADs in a cow model.

Here, we present a protocol using two centrifugal pumps as a total artificial heart replacement.

Uso de dois dispositivos de Assistência Ventricular Intracorporeal como um coração Artificial

Mechanical circulatory support (MCS) has been introduced as a viable alternative to heart transplantation primarily through the use of intracorporeal ...

Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty

Bone- and soft-tissue sparing short stems are increasingly used in total hip arthroplasty (THA). However, there are a large variety of models of short stems, differing in design and function. Calcar-guided short stems provide an anatomical curvature in the medial calcar region, thus, positioning is done individually alongside the calcar in the "round-the-corner" technique. Depending on the level of the neck's osteotomy, stems can be aligned individually in a large bandwidth of varus- and valgus anatomies. This differs from conventional total hip arthroplasty and potentially includes a severe learning curve. Given that a great variety of caput-collum-diaphyseal (CCD)-angles can be retained, the reconstruction of femoro-acetabular offsets can be achieved precisely. However, particularly extensive varus- and valgus positioning has raised concerns in regard to stability and bone remodeling. The purpose of the present manuscript is to showcase the implantation technique in calcar-guided short-stem THA and to summarize short-term clinical and radiological results.

This protocol describes the round-the-corner technique and the individualized stem-positioning of calcar-guided short stems alongside the medial calcar, depending on the level of the osteotomy. This differs from conventional total hip arthroplasty and includes a learning curve.

Haste-posicionamento individualizado em Calcar-guiados Short-tronco Artroplastia Total de quadril

Bone- and soft-tissue sparing short stems are increasingly used in total hip arthroplasty (THA). However, there are a large variety of models of short ...

Bedside Ultrasound for Guiding Fluid Removal in Patients with Pulmonary Edema: The Reverse-FALLS Protocol

Fluid retention is the most common risk factor for mortality and cardiovascular complications in patients with volume-overloaded disease states. The extent of diuresis or fluid removal is frequently determined by physical examination which is subject to inaccuracies.
Bedside ultrasound (US) is a portable tool that brings real-time diagnostic imaging to the patient's bedside. This versatile modality makes it possible for the clinician to investigate patients' extravascular and intravascular volume states. The extravascular volume, particularly in the case of pulmonary edema, can be quantitatively assessed by US of the anterior chest. Intravascular volume is estimated by visualizing the inferior vena cava (IVC) caliber. Taken together, the degree of extravascular lung water and the IVC caliber provide objective data that can guide the clinician to determine the level of diuresis needed to effectively yet safely treat pulmonary edema. 
The objective of this article is threefold: 1) to summarize the findings of previous studies on the efficacy of portable US to guide fluid management, 2) to describe a proposed ultrasound protocol to help guide fluid management, and 3) to elucidate techniques that address the measurement of intravascular and extravascular volumes using portable US.

We describe an imaging protocol that enables the clinician to visualize, in real-time, the patient&#39;s intravascular and extravascular space volumes and set diuresis and fluid removal parameters accordingly for the safe and efficient treatment of pulmonary edema.

Ultrassom de cabeceira para a remoção de fluido orientador em pacientes com Edema pulmonar: O protocolo reverso-Cataratas

Fluid retention is the most common risk factor for mortality and cardiovascular complications in patients with volume-overloaded disease states. The ...

Studying Left Ventricular Reverse Remodeling by Aortic Debanding in Rodents

To better understand the left ventricular (LV) reverse remodeling (RR), we describe a rodent model wherein, after aortic banding-induced LV remodeling, mice undergo RR upon removal of the aortic constriction. In this paper, we describe a step-by-step procedure to perform a minimally invasive surgical aortic debanding in mice. Echocardiography was subsequently used to assess the degree of cardiac hypertrophy and dysfunction during LV remodeling and RR and to determine the best timing for aortic debanding. At the end of the protocol, terminal hemodynamic evaluation of the cardiac function was conducted, and samples were collected for histological studies. We showed that debanding is associated with surgical survival rates of 70-80%. Moreover, two weeks after debanding, the significant reduction of ventricular afterload triggers the regression of ventricular hypertrophy (~20%) and fibrosis (~26%), recovery of diastolic dysfunction as assessed by the normalization of left ventricular filling and end-diastolic pressures (E/e&#39;&#160;and LVEDP). Aortic debanding is a useful experimental model to study LV RR in rodents. The extent of myocardial recovery is variable between subjects, therefore, mimicking the diversity of RR that occurs in the clinical context, such as aortic valve replacement. We conclude that the aortic banding/debanding model represents a valuable tool to unravel novel insights into the mechanisms of RR, namely the regression of cardiac hypertrophy and the recovery of diastolic dysfunction.

Here we describe a step-by-step protocol of surgical aorta debanding in the well-established mice model of aortic-constriction. This procedure not only allows studying the mechanisms underlying the left ventricular reverse remodeling and regression of hypertrophy but also to test novel therapeutic options that might accelerate myocardial recovery.

Estudando remodelagem reversa ventricular esquerda por debandagem aórtica em roedores

To better understand the left ventricular (LV) reverse remodeling (RR), we describe a rodent model wherein, after aortic banding-induced LV remodeling, ...

An In Vivo Mouse Model of Total Intravenous Anesthesia During Cancer Resection Surgery

Anesthesia is a routine component of cancer care that is used for diagnostic and therapeutic procedures. The anesthetic technique has recently been implicated in impacting long-term cancer outcomes, possibly through modulation of adrenergic-inflammatory responses that impact cancer cell behavior and immune cell function. Emerging evidence suggests that propofol-based total intravenous anesthesia (TIVA) may be beneficial for long-term cancer outcomes when compared to inhaled volatile anesthesia. However, the available clinical findings are inconsistent. Preclinical studies that identify the underlying mechanisms involved are critically needed to guide the design of clinical studies that will expedite insight. Most preclinical models of anesthesia have been extrapolated from the use of anesthesia in in vivo research and are not optimally designed to study the impact of anesthesia itself as the primary endpoint. This paper describes a method for delivering propofol-TIVA anesthesia in a mouse model of breast cancer resection that replicates key aspects of clinical delivery in cancer patients. The model can be used to study mechanisms of action of anesthesia on cancer outcomes in diverse cancer types and can be extrapolated to other non-cancer areas of preclinical anesthesia research.

An In Vivo Mouse Model of Total Intravenous Anesthesia During Cancer Resection Surgery

This paper describes a method for modeling total intravenous anesthesia (TIVA) during cancer resection surgery in mice. The goal is to replicate key features of anesthesia delivery to patients with cancer. The method allows investigation of how anesthetic technique affects cancer recurrence after resection surgery.

Um modelo de camundongo In Vivo de anestesia intravenosa total durante a cirurgia de ressecção do câncer

Anesthesia is a routine component of cancer care that is used for diagnostic and therapeutic procedures. The anesthetic technique has recently been ...

Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer

Since their approval for clinical use, da Vinci surgical robots have shown great advantages in gastrointestinal surgical operations, especially in complex procedures. The high-quality 3-D visual, multijoint arm and natural tremor filtration allow the surgeon to expose and dissect more accurately with minimal invasion. Total mesorectal excision is the standard surgical technique for the treatment of resectable rectal cancer. To reduce the lateral recurrence rate, lateral pelvic lymph node dissection can be performed, as it is a safe and feasible procedure for locally advanced middle-low rectal cancer with a high possibility of metastasis to the lateral lymph nodes. However, the complexity of the anatomic structures and the high postoperative complication rate limit its application. Recently, several surgeons have increasingly used robotic techniques for total mesorectal excision and lateral pelvic lymph node dissection. Compared with open and laparoscopic surgery, the robotic technique has several advantages, such as less blood loss, fewer blood transfusions, minimal trauma, shorter postoperative hospitalization, and quicker recovery. A robotic approach is generally regarded as a reasonable alternative for complicated procedures such as lateral pelvic lymph node dissection, although there are a limited number of high-quality prospective randomized controlled studies reporting direct evidence. Here, we provide the detailed steps of robot-assisted total mesorectal excision and lateral pelvic lymph node dissection performed at the First Affiliated Hospital of Xi&#39;an Jiaotong University.

The robotic technique described herein aims to detail a stepwise approach to robot-assisted total mesorectal excision and lateral pelvic lymph node dissection for locally advanced (T3/T4) rectal cancer located below the peritoneal reflection.

Excisão total mesorectal assistida por robô e dissecção de linfonodo pélvico lateral para câncer retal médio-baixo localmente avançado

Since their approval for clinical use, da Vinci surgical robots have shown great advantages in gastrointestinal surgical operations, especially in complex ...

The Use of Mixed Reality in Custom-Made Revision Hip Arthroplasty: A First Case Report

The technology of 3D printing and visualization of anatomical structures is rapidly growing in various fields of medicine. A custom-made implant and mixed reality were used to perform complex revision hip arthroplasty in January 2019. The use of mixed reality allowed for a very good visualization of the structures and resulted in precise implant fixation. According to the authors' knowledge, this is the first described case report of the combined use of these two innovations. The diagnosis preceding the qualification for the procedure was the loosening of the left hip's acetabular component. Mixed reality headset and holograms prepared by engineers were used during the surgery. The operation was successful, and it was followed by early verticalization and patient rehabilitation. The team sees opportunities for technology development in joint arthroplasty, trauma, and orthopedic oncology.

A complex revision hip arthroplasty was performed using a custom-made implant and mixed reality technology. According to the authors&#39; knowledge, this is the first report of such procedure described in the literature.

O Uso da Realidade Mista na Artroplastia de Quadril de Revisão Personalizada: Um Primeiro Relato de Caso

The technology of 3D printing and visualization of anatomical structures is rapidly growing in various fields of medicine. A custom-made implant and mixed ...