Publications by authors named "Nelson Fabrício Gava"

5 Publications

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Results of muscle strength and range of motion after total open knee synovectomy.

Int Orthop 2020 05 11;44(5):863-868. Epub 2020 Feb 11.

Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, SP, Brazil.

Aim Of The Study: Scar tissue formation after synovectomy limits range of motion and causes muscle atrophy. The functional results for patients who underwent total open knee synovectomy often included questionnaires, and assessment of muscle strength was lacking in the literature. Therefore, we aimed to identify the strength and range of motion outcomes for patients who underwent total open synovectomy and to compare the results with the contralateral limb and healthy individuals.

Method: Knee range of motion and muscle strength were assessed in fourteen patients that underwent total (anterior and posterior) open knee synovectomy and were compared with the contralateral limb and with 14 healthy individuals matched by sex, age, height, and weight.

Results: The range of motion of flexion decreased 8.4% compared with the contralateral limb (95% CI - 18.9 to - 4.7, p = 0.002) and 9.9% compared with the control group (95% CI 3.9-14.9, p < 0.01). Knee extension strength decreased by 35% compared with the contralateral limb (95% CI 11.1-77.2, p = 0.01) and 37% compared with the control group (95% CI - 112.4-12.1, p = 0.01).

Conclusion: Despite the aggressiveness of the surgical procedure, the patients achieved satisfactory functional results.
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May 2020


Acta Ortop Bras 2019 Mar-Apr;27(2):104-107

Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Biomecênica, Medicina e Reabilitaçaõ do Sistema Locomotor, Ribeirão Preto, SP, Brazil.

Objective: Hemipelvectomy is a complex surgery with a high complication rate. Here, we aimed to identify factors related to the onset of complications and calculate their impacts on hospital costs.

Methods: We evaluated 31 consecutive patients who underwent hemipelvectomy between 1999 and 2015. We assessed the clinical and radiographic data to determine the patients' demographic factors, tumor and surgical characteristics, and complications. The individual hospital stays and financial balances were assessed up to 6 months following the index surgery.

Results: The overall complication rate was 61% (19/31). Infection was the most prevalent complication (36%). Immediate postoperative death occurred in 5/31 patients (16%); another 5 (16%) died after hospital discharge due to disease progression. Histological grade, previous surgery, and previous radiotherapy were not associated with complications or infection. Acetabular resections, bone reconstruction, and longer operative times were associated with infection, whereas older age, pelvic organ involvement, and comorbidities were associated with immediate postoperative death. Complications and infection were associated with 4.8- and 5.9-fold increases in hospital costs, respectively.

Conclusions: Acetabular resection and bone reconstruction are important factors that increase short-term complication rates, infection rates, and hospital costs. Mortality was associated with older age and adjacent pelvic tumor progression.
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April 2019

Osteointegration of porous absorbable bone substitutes: A systematic review of the literature.

Clinics (Sao Paulo) 2017 Jul;72(7):449-453

Departamento de Biomecânica, Medicina e Reabilitação do Aparelho Locomotor, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, BR.

Biomaterials' structural characteristics and the addition of osteoinductors influence the osteointegration capacity of bone substitutes. This study aims to identify the characteristics of porous and resorbable bone substitutes that influence new bone formation. An Internet search for studies reporting new bone formation rates in bone defects filled with porous and resorbable substitutes was performed in duplicate using the PubMed, Web of Science, Scielo, and University of São Paulo Digital Library databases. Metaphyseal or calvarial bone defects 4 to 10 mm in diameter from various animal models were selected. New bone formation rates were collected from the histomorphometry or micro-CT data. The following variables were analyzed: animal model, bone region, defect diameter, follow-up time after implantation, basic substitute material, osteoinductor addition, pore size and porosity. Of 3,266 initially identified articles, 15 articles describing 32 experimental groups met the inclusion criteria. There were no differences between the groups in the experimental model characteristics, except for the follow-up time, which showed a very weak to moderate correlation with the rate of new bone formation. In terms of the biomaterial and structural characteristics, only porosity showed a significant influence on the rate of new bone formation. Higher porosity is related to higher new bone formation rates. The influence of other characteristics could not be identified, possibly due to the large variety of experimental models and methodologies used to estimate new bone formation rates. We suggest the inclusion of standard control groups in future experimental studies to compare biomaterials.
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July 2017

CT-guided percutaneous drilling is a safe and reliable method of treating osteoid osteomas.

Springerplus 2013 Dec 31;2(1):34. Epub 2013 Jan 31.

Department of Orthopedics and Traumatology, School of Medicine of Ribeirão Preto, University of São Paulo, Hospital das Clínicas 11° andar, Av. Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP 14049-900 Brazil.

Computed tomography (CT)-guided percutaneous drilling is an alternative for osteoid osteoma treatment. This study aims to evaluate the remodeling of the drill orifice. The success rate and complications were also recorded and compared with other treatment methods. Fifteen patients with an average age of fourteen years (ranging from 4 to 25) submitted to CT-guided percutaneous drilling between 2003 and 2009 were retrospectively analyzed according to clinical and radiological criteria. Fourteen cases showed complete alleviation of pain one week after surgery. No relapse was detected even in the subject who continued complaining of pain. All patients were treated with a day-hospital regimen and were discharged with partial weight bearing. Total weight bearing was allowed after one month, and sports were allowed after consolidation, which occurred in all but one case after the third month. One patient, who did not follow our medical advice, returned to sports activities after two weeks and experienced a fracture as a result. Atrophy of the vastus lateralis muscle developed after the procedure in another patient. Our case series suggests that this method is reliable and safe. The level of complexity is comparable with other minimally invasive percutaneous procedures. The cost is low because there is no need to buy probes or other equipment. The negative points include weakening of the bone and the logistical problem of assembling the orthopedic surgeon, radiologist, and anesthesiologist in the tomography room.
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December 2013

[Effects of intrinsic denervation of the jejunum after extensive enterectomy in the rat bowel syndrome].

Acta Cir Bras 2006 Jan-Feb;21(1):43-6. Epub 2006 Feb 13.

Departamento de Patologia, Faculdade de Medicina de Ribeirão, USP.

Purpose: To investigate the effects of intrinsic denervation of the jejunum after the extensive intestinal resection in rats.

Methods: Thirty male Wistar rats were distributed into three groups, depending on the experimental procedure: Group C (control), Group R (resection) and Group D (resection plus denervation). The body weight gain and a histomorphometric study of the jejunal mucosa were performed.

Results: The mean body weight of the group D animals showed a higher increase when compared to group R (D=312.2+/-21 g and R=196.7+/-36.2g). The number of jejunum myenteric neurons was smaller in group D (344.8+/-34.8 neurons/mm) when compared to other groups (R=909.0+/-55.5 and C=898.5+/-73.3). A hyperplasia of the jejunum mucosal epithelium was observed in the group D but also in the group R (R=7.3+/-3.9 mm2 and D=10.8+/-4.3 mm2), when compared to group C (C=5.8+/-3.0 mm2). The epithelial cell proliferation of the jejunum was higher in group D animals (48.7%) when compared to the other groups (R=31.9% and C=23.6%).

Conclusions: The denervated animals presented an increase the body weight gain and mucosal cell proliferation responses when compared to the control group. This experimental model may provide new strategies for the surgical treatment of the short bowel syndrome.
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August 2006