Biomedical subjects

Antonio Carlos Valezi

Publications and source records attributed to Antonio Carlos Valezi.

5 recordsLinked to original sources

PubMed2006

Rhabdomyolysis after bariatric surgery.

BACKGROUND: Rhabdomyolysis is a potential threat after bariatric surgey. The severity ranges from asymptomatic elevations of serum muscle enzyme levels to life-threatening cases associated with muscle necrosis, compartment syndrome, acute renal failure and cardiac arrest. METHODS: We studied 98 consecutive obese patients who underwent primary uncomplicated bariatric surgery during a 1-year period. A database was created for all patients (sex, age, BMI, duration of the operation); serum creatinine phosphokinase (CPK) was systematically measured before surgery and on the first and second postoperative day. RESULTS: The study sample consisted of 35 males (35.7%) and 63 females (64.3%) with preoperative CPK level 156.6 +/- 41.1 U/L (40 to 220), 24 hours postoperatively 1,075.2 +/- 596.5 U/L, (85 to 2,790 U/L) and 48 hours postoperatively 967.3 +/- 545.3 U/L (79 to 2,630). There was no difference in mean BMI (P=0.1) and mean duration of operation (P=0.5) between males and females. However, a statistically significant difference in mean elevation of CPK between males and females (P=0.003) was found. The variables sex, age, weight and duration of surgery were analyzed by multivariate logistic regression, but did not show a statistically significant difference. CONCLUSION: Rhabdomyolysis is a potentially fatal complication of surgical procedures in obese patients, and can be minimized with simple measures such as additional padding, aggressive hydration and urine alkalinization. Diagnosis requires a high level of physician awareness.

Adolescent↗

PubMed2006

Computerized baropodometry in obese patients.

BACKGROUND: Few studies have investigated the influence of obesity on the structural and functional performance of the feet, and its potential implications for the musculoskeletal system. Computerized baropodometric analysis (CPA) is a new investigation for the center of pressure, plantar surface area and plantar pressure while standing on the platform of a specialized apparatus. CPA is relevant to gait and posture, and may be important as well for postoperative musculoskeletal disorders. We investigated the biomechanical dysfunctions of foot pressure by means of CPA in bariatric and non-bariatric subjects. METHODS: Subjects (n=67, 71.6% females, age 40.8 +/- 13.8 years, BMI 31.4 +/- 11.0 kg/m(2)) included obese (BMI 30.0-60.0 kg/m(2), n=27), overweight (BMI 25.0-29.9 kg/m(2), n=12) and normal-weight controls (BMI 20.0-24.9 kg/m(2), n=28) of equivalent age and gender. Variables included center of pressure location, plantar ground contact area and pressure, and pressure patterns (maximum and average) in different regions of the foot, during quiet standing on the platform of the baropodometer. RESULTS: A significant increase was detected for peak pressure on forefoot and plantar ground contact area in the obese group, compared to control and overweight cases, during quiet standing. CONCLUSION: Excessive forefoot pressure and enlarged support area were a consequence of obesity, mirroring the efforts of the obese subject to acquire a wider and stronger support base. Although this is originally a physiological change, it may result in maladaptative and degenerative musculoskeletal consequences. Re-education exercises may be advised, in combination with bariatric surgery in the morbidly obese, aiming at restoration of normal gait and posture, as well as at minimization of stress damage to bones and joints in the axial skeleton.

Adult↗

PubMed2005

Accuracy of magnetic resonance in identifying traumatic intraarticular knee lesions.

PURPOSE: To evaluate the diagnostic accuracy of magnetic resonance imaging of the knee in identifying traumatic intraarticular knee lesions. METHOD: 300 patients with a clinical diagnosis of traumatic intraarticular knee lesions underwent prearthoscopic magnetic resonance imaging. The sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio for a positive test, likelihood ratio for a negative test, and accuracy of magnetic resonance imaging were calculated relative to the findings during arthroscopy in the studied structures of the knee (medial meniscus, lateral meniscus, anterior cruciate ligament, posterior cruciate ligament, and articular cartilage). RESULTS: Magnetic resonance imaging produced the following results regarding detection of lesions: medial meniscus: sensitivity 97.5%, specificity 92.9%, positive predictive value 93.9%, positive negative value 97%, likelihood positive ratio 13.7, likelihood negative ratio 0.02, and accuracy 95.3%; lateral meniscus: sensitivity 91.9%, specificity 93.6%, positive predictive value 92.7%, positive negative value 92.9%, likelihood positive ratio 14.3, likelihood negative ratio 0.08, and accuracy 93.6%; anterior cruciate ligament: sensitivity 99.0%, specificity 95.9%, positive predictive value 91.9%, positive negative value 99.5%, likelihood positive ratio 21.5, likelihood negative ratio 0.01, and accuracy 96.6%; posterior cruciate ligament: sensitivity 100%, specificity 99%, positive predictive value 80.0%, positive negative value 100%, likelihood positive ratio 100, likelihood negative ratio 0.01, and accuracy 99.6%; articular cartilage: sensitivity 76.1%, specificity 94.9%, positive predictive value 94.7%, positive negative value 76.9%, likelihood positive ratio 14.9, likelihood negative ratio 0.25, and accuracy 84.6%. CONCLUSION: Magnetic resonance imaging is a satisfactory diagnostic tool for evaluating meniscal and ligamentous lesions of the knee, but it is unable to clearly identify articular cartilage lesions.

Anterior Cruciate Ligament Injuries↗

PubMed2005

Postural changes in morbidly obese patients.

BACKGROUND: Postural deviations in morbidly obese individuals may contribute to low self-esteem and to long-term adverse effects on bones and joints. In a case-control study, the axial skeleton was investigated, to disclose the main abnormalities found in obese compared to non-obese groups. METHODS: 2 groups were compared. Group 1, severely obese patients (n= 32), age 41.5 +/- 8.2 years, BMI 49.4 +/- 6.6 kg/m2, 93.8% females, and group 2 non-obese (n= 30), age 43.5 +/- 5.8 years, BMI 24.6 +/- 5.1 kg/m2, 96.7% females, had their posture analyzed through clinical examination and radiological imaging. Variables measured were anterior, lateral and posterior angular deviation from the vertical body axis at the head, shoulders, pelvis, Thales triangle, spine, knees, ankles and feet. Data are shown as a percentage of abnormal angles in the 2 groups. RESULTS: On anterior analysis of the 2 groups, disturbances affected head (37.5% vs 13.3%), Thales angle (78.1% vs 53.3%), knees (84.4% vs 33.3%), legs (59.4% vs 30.0%) and support base (59.4% vs 26.7%) (P<0.05). On posterior view, the spine was the deranged segment (87.5% vs 36.7%) (P<0.05), and on lateral assessment, 100% of the results were abnormal. CONCLUSIONS: 1) Individuals with morbid obesity present important postural alterations. 2) Seriously altered posture was the rule for the obese population in this study, especially in the spine, knees and feet. 3) Most patients had compatible clinical complaints, but they rarely associated the bone and joint pain with the obesity and axial skeleton deviations. 4) Planned physical activity should be part of the treatment of severe obesity, in order to correct deviations, prevent new ones, and improve quality of life.

Adult↗

PubMed2005

Gait cinematic analysis in morbidly obese patients.

BACKGROUND: Functional co-morbidities of excess body weight such as gait problems are never life-threatening like those associated with certain metabolic sequelae. Nevertheless, they may interfere with quality of life and also act as a mirror of muscle, bone and joint stress. In this prospective study, the goal was to document dynamic aspects of gait in severely obese subjects. METHODS: An outpatient population (age 47.2+/-12.9 years, 94.1% females, BMI 40.1+/-6.0 kg/m2, n=34) had their gait analyzed by an experienced physical therapist. Variables included speed, cadence, stride, support base and foot angle, which were compared to reference values for the Brazilian population. RESULTS: All variables were significantly lower in the obese patients, except for support base which was increased. Speed was 73.3+/-16.3 vs 130 cm/s, cadence was 1.4+/-0.2 vs 1.8 steps/s, stride was 106.8+/-13.1 vs 132.0 cm, and support was 12.5+/-3.5 vs 10.0 cm (P<0.05). CONCLUSIONS: 1) Widespread cinematic impairment was the rule in the studied population. 2) These findings are consistent with poor skeletal muscle performance, high metabolic expenditure and constant physical exhaustion. 3) Attention should be paid not only to the metabolic management but also to the physical rehabilitation required in cases of advanced obesity.

Body Mass Index↗