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ResumoA luxação do ombro posterior traumática é de difícil diagnóstico e tratamento. Há séries que descrevem que 60%-80% dessas luxações não são diagnosticadas numa primeira ida ao serviço de urgência. Desse modo, casos de luxações com vários dias e por vezes semanas são frequentes, o que sempre torna o tratamento mais complexo. As luxações posteriores são geralmente acompanhadas por uma fratura de impressão na superfície anterior da cabeça umeral, conhecida como lesão de Hill-Sachs reversa. Esse defeito ósseo pode “encravar” na borda glenoidal posterior e levar a instabilidade recorrente e destruição progressiva da articulação. Os autores descrevem um procedimento de McLaughlin artroscópico modificado, que permite o preenchimento do defeito ósseo com o terço superior do tendão subescapular, evita a recorrência da instabilidade posterior. Associadamente, fez-se uma reparação da lesão de Bankart posterior e uma tenodese da longa porção do tendão bicipital. Essa técnica, além de reparar a lesão condrolabral posterior, cria um efeito de remplissage anterior, o que torna a reparação mais forte, é um ótimo procedimento no tratamento definitivo da luxação posterior recidivante. É um procedimento inteiramente feito por via artroscópica, não apresenta as desvantagens dos procedimentos abertos.

The diagnosis of and the treatment for traumatic posterior shoulder dislocation are challenging. Some series describe that between 60 and 80% of these lesions are not diagnosed during the first visit to the emergency room. As such, dislocations are frequently found after several days or even weeks, adding complexity to their treatment. Posterior dislocations are usually accompanied by a print fracture on the anterior surface of the humeral head, known as reverse Hill-Sachs injury. This bone defect can “engage” into the posterior glenoid ridge, leading to recurrent instability and progressive joint destruction. The authors describe a modified arthroscopic McLaughlin procedure, which allows filling the bone defect with the upper third of the subscapular tendon, avoiding recurrence of the posterior instability. Next, a posterior Bankart lesion repair is performed along with a tenodesis of the long portion of the bicipital tendon. This technique, in addition of repairing the posterior chondrolabral lesion, creates a remplissage effect, making the repair stronger and representing an optimal procedure for the definitive treatment of recurrent posterior luxation. It is an entirely arthroscopic procedure, avoiding the disadvantages of an open procedure.

Atrial Septal Defect (ASD) is one of the most frequently congenital heart diseases in adults and it is often asymptomatic until adulthood. We report a case of a 90-year-old woman admitted to hospital with dyspnea and orthopnea insidiously progressing over the preceding 5 years and becoming severe with dyspnea on minimal activities, orthopnea and paroxysmal nocturnal dyspnea, in the last 2 weeks. The transthoracic echocardiogram revealed an atrial septal defect ostium secundum type, with left-to-right shunt, moderate to severe tricuspid insufficiency, severe pulmonary hypertension (72 mmHg) and preserved biventricular function. With diuretic therapy optimization the patient showed symptomatic improvement. This present case represents and unusual and very late presentation of an atrial septal defect ostium secundum type, which is usually diagnosed at the mild adult age. Our patient lived symptom-free for over 80 years.

We conducted a systematic review of studies addressing the relation between cigarette smoking and gastric cancer to estimate the magnitude of the association for different levels of exposure and cancer locations.Published cohort, case-cohort, and nested case-control studies were identified through PubMed, Scopus, and Web of Science searches, from inception to July 2007. Relative risk (RR) estimates referring to the comparison of two categories of exposure (e.g., current smokers vs. never smokers) were combined using a random effects model. Generalized least squares regression was used for trend estimation. Heterogeneity was quantified using the I (2) statistic.Forty-two articles were considered for the systematic review. Comparing current smokers with never smokers: the summary RR estimates were 1.62 in males (95% CI: 1.50-1.75; I (2) = 46.0%; 18 studies) and 1.20 in females (95% CI: 1.01-1.43; I (2) = 49.8%; nine studies); the RR increased from 1.3 for the lowest consumptions to 1.7 for the smoking of approximately 30 cigarettes per day in the trend estimation analysis; smoking was significantly associated with both cardia (RR = 1.87; 95% CI: 1.31-2.67; I (2) = 73.2%; nine studies) and non-cardia (RR = 1.60; 95% CI: 1.41-1.80; I (2) = 18.9%; nine studies) cancers.Our study provides solid evidence to classify smoking as the most important behavioral risk factor for gastric cancer.