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Thoracic outlet syndrome (TOS) is an uncommon disorder, without a clear clinical presentation or a fully accepted definition. The patients usually present a set of symptoms arising from compression of the brachial plexus or subclavian vessels during their passage through the thorax, between the base of the cervical region and the axilla. The authors present a case of a 20 year old woman with sporadic paresthesia in the territory of C7-T1 nerve root. At the physical examination she had a positive Wright's test. The imaging studies revealed the presence of a right cervical rib. A partial rib resection was performed with exploration of the braquial plexus and at the current follow up; 24 months after the surgery, the patient is asymptomatic. Our objective is to present a case of TOS and to highlight the clinical-management and treatment challenges of this pathology. info:eu-repo/semantics/publishedVersion

In recent years, reducing energy consumption has been relentlessly pursued by researchers and policy makers with the purpose of achieving a more sustainable future. The demand for data storage in data centers has been steadily increasing, leading to an increase in size and therefore to consume more energy. Consequently, the reduction of the energy consumption of data center rooms is required and it is with this perspective that this paper is proposed. By using Computational Fluid Dynamics (CFD), it is possible to model a three-dimensional model of the heat transfer and air flow in data centers, which allows forecasting the air speed and temperature range under diverse conditions of operation. In this paper, a CFD study of the thermal performance and airflow in a real data center processing room with 208 racks under different thermal loads and airflow velocities is proposed. The physical-mathematical model relies on the equations of mass, momentum and energy conservation. The fluid in this study is air and it is modeled as an ideal gas with constant properties. The model of the effect of turbulence is made by employing a k&ndash, &epsilon, standard model. The results indicate that it is possible to reduce the thermal load of the server racks by improving the thermal performance and airflow of the data center room, without affecting the correct operation of the server racks located in the sensible regions of the room.

A Data Centre is a physical space that groups together computer equipment such as servers, storage arrays, among other equipment. It can be used for storage, processing and data protection. The majority of data centres operate 24 hours a day, and must provide the user with guarantees in terms of security and performance. Energy consumption is therefore permanent and the level of assistance and maintenance high. Data Centres have an ecological impact that is almost invisible to many users. In this paper a computational fluid dynamics (CFD) model of the airflow and thermal distribution of a real data centre room with 208 racks is proposed. Two case studies are presented and simulated with a high thermal load subjected to the minimum and maximum air flow velocity, respectively. The objective is to assess if the computer room air conditioning unit (CRAC) can cool the racks of the data centre in order to efficiently refrigerate all the hot spots.

The processing efficacy and energy efficiency of data centers (DC) is directly related with the cooling performance of the air-conditioning systems. The cooling effectiveness depends on airflow pattern and temperature distribution. This paper presents the parametric study of three-dimensional (3D) computational fluid dynamics (CFD) models to improve these technical characteristics. In this case study the most suitable thermal load, as deemed by the organization, of the heat flow boundary condition is simulated and studied for maximum and minimum airflow. The analysis of the numerical results provides a prediction of the thermal performance, i.e., the lower values and spatial gradients (hot spots) of air temperature and velocity while maintaining the computational processing requirements. These results allow the development of an optimized CFD model for setting up the operational parameters of CRAC systems for DC rooms.

ResumoObjetivoComparar os resultados de duas das técnicas cirúrgicas mais usadas, a descompressão in situ e a transposição subcutânea. Foram revistos os processos dos doentes tratados cirurgicamente num hospital universitário público entre janeiro de 2004 e dezembro de 2011. Foram excluídas compressões proximais do nervo, deformidades angulares do cotovelo e doenças sistêmicas associadas a neuropatia não compressiva.MetodosForam incluídos 97 casos (96 doentes). Segundo o escore modificado de McGowan, 14,4% dos pacientes encontravam‐se no Grau Ia, 27,8% no II, 26,8% no IIb e 30,9% no III. A neurólise in situ do cubital foi feita em 64 casos e a transposição anterior subcutânea em 33.ResultadosSegundo o escore modificado de Wilson e Knout, os resultados foram excelentes em 49,5%, bons em 18,6%, apenas satisfatórios em 17,5% e pobres em 14,4%. Na comparação das duas técnicas observamos valores similares de resultados excelentes ou bons. Os graus IIb e III estão associados a mais resultados menos satisfatórios ou maus independentemente da técnica cirúrgica.ConclusãoAs duas técnicas se revelam eficientes e seguras no tratamento do síndrome do túnel cubital.AbstractObjectiveTo compare the results from two of the most commonly used surgical techniques: in situ decompression and subcutaneous transposition. The processes of patients treated surgically in a public university hospital between January 2004 and December 2011 were reviewed. Cases of proximal compression of the nerve, angular deformity of the elbow and systemic diseases associated with non‐compressive neuropathy were excluded.MethodsNinety‐seven cases were included (96 patients). According to the modified McGowan score, 14.4% of the patients presented grade Ia, 27.8% grade II, 26.8% grade IIb and 30.9% grade III. In situ neurolysis of the cubital was performed in 64 cases and subcutaneous anterior transposition in 33.ResultsAccording to the modified Wilson and Knout score, the results were excellent in 49.5%, good in 18.6%, only satisfactory in 17.5% and poor in 14.4%. In comparing the two techniques, we observed similar numbers of excellent and good results. Grades IIb and III were associated with more results that were less satisfactory or poor, independent of the surgical technique.ConclusionBoth techniques were shown to be efficient and safe for treating cubital tunnel syndrome.

Football is a sport characterized by physical contact, which explains the high rate of musculoskeletal injuries in players described in the literature. The most common injuries are lower limb injuries. Herein, we discuss the main injuries involving the elbow and wrist encountered in football players.

O objectivo deste estudo foi determinar os resultados a medio prazo de uma artroplastia retentiva da base do polegar utilizada para o tratamento da artrose trapezio-metacarpiana (TMC). Reavaliamos clinica e radiograficamente 20 polegares (20 doentes) com um seguimento medio de 45 meses (R = 57-30). Utilizando a pontuacao de Buck-Gramko concluimos que funcionalmente 19 dos 20 doentes apresentavam um resultado considerado bom ou excelente. A avaliacao da forca e da mobilidade revelou resultados muito aproximados dos obtidos na mao nao intervencionada. A revisao radiografica demonstrou a existencia de areas de osteolise rodeando o componente trapeziano em 2 casos, e extensas ossificacoes envolvendo a neo-articulacao em dois casos adicionais. Na nossa serie registamos a presenca de 4 complicacoes: duas fracturas do trapezio, uma luxacao e uma perturbacao sensitiva transitoria. A protese trapezio-metacarpiana tem vindo a ganhar progressivamente mais adeptos, pois e clinicamente uma solucao muito vantajosa devolvendo ao paciente uma articulacao livre de dor, movel e estavel que lhe permite o rapido regresso a bons niveis de actividade e bem estar. Contudo os achados radiograficos da nossa serie levam-nos a recomendar a manutencao de uma atitude prudente e vigilante sobre estes casos que tem vindo a ser submetidos a artroplastias da TMC. The aim of this study was to determine the midterm results of a retentive arthroplasty of the base of the thumb used for the treatment of trapeziummetacarpal (TMC) osteoarthritis. We evaluated clinically and radiographically 20 thumbs (20 patients) with a mean follow-up of 45.0 five months (R = 57-30). Using the Buck-Gramko score we conclude that 19 of the 20 patients had a result considered good or excellent. The evaluation of the strength and mobility showed very similar results to those obtained in non-intervention hand. The radiographic review demonstrated the existence of areas of osteolysis surrounding the trapezium component in 2 cases, and extensive ossification involving neo-articulation in two additional cases. In our series we note the presence of four complications: two fractures of the trapezium, a dislocation and a transient sensory disturbance. The TMC prosthesis has gradually been gaining more fans, because it is clinically a very advantageous solution returning to the patient a pain-free joint, mobile and stable which allows rapid return to good levels of activity and wellness. However radiographic findings in our series lead us to recommend the maintenance of a prudent and vigilant attitude about these cases that have been submitted to the TMC arthroplasty.

Brachial plexus injuries are a major indication for shoulder arthrodesis. However, there is no consensus concerning the optimal position of the glenohumeral joint for fusion. Between 1997 and 2008, 19 shoulder arthrodeses were performed using pelvic reconstruction plates. The radiographic and functional characteristics of 13 patients of mean age 46 years were examined at a mean of 101 months after arthrodesis. Arthrodeses showed 30° mean angle of abduction, 32° forward flexion and 44° internal rotation of the humerus with respect to the scapula. Abduction >35° and forward flexion ≥30°seem to offer slightly better functional results. Internal rotation ≤45° significantly relates to better ability of the hand to reach the face ( p = 0.012). Neither abduction >35° nor forward flexion ≥30° showed a higher prevalence of periscapular pain. Abduction around 35° and forward flexion around 30° are needed for good functional results. Internal rotation should not exceed 45°.

A paralisia obstetrica do plexo braquial e rara originando disfuncao grave e defice marcado da rotacao externa e da abducao do ombro. Reviram-se retrospectivamente 11 casos de paralisia obstetrica do plexo braquial (sete com paralisia alta e quatro com paralisia completa) tratados cirurgicamente pela tecnica de L’Episcopo modificada por Hoffer. Estes resultados foram padronizados segundo o tipo de lesao (grupo A – lesao alta; grupo B – lesao completa) e a idade (grupo I ≤ 4 anos; grupo II > 4 anos). O seguimento medio foi de 35 meses. A idade media aquando da cirurgia era de 6,5 anos (r= 2–11). Todos, excepto um, apresentaram melhoria funcional, com aumento da pontuacao media de Mallet de 4,6 pontos. Os dois subtipos de paralisia tiveram pontuacao media de Mallet sobreponivel (grupo A – 4.6; grupo B – 4.7); a idade aquando da cirurgia nao influenciou o resultado clinico (pontuacao media (grupo I) – 4.8; (grupo II) – 4.4). Nao foram registadas complicacoes. A tecnica de L’Episcopo modificada por Hoffer e eficaz no tratamento paliativo do ombro em paralisia obstetrica do plexo braquial, permitindo recuperacao da abducao e rotacao externa do ombro. Esta indicada em paralisias altas e completas, quando associada a outras cirurgias de recuperacao da funcao do cotovelo, punho e/ou mao. Idade superior a 4 anos nao contra-indica a cirurgia desde que sejam excluidas alteracoes da articulacao glenoumeral. The obstetric brachial plexus palsy is a rare disorder causing severe deficit and limited external rotation and abduction. 11 cases of obstetric brachial plexus palsy were retrospectively reviewed (seven with high paralysis and four with complete paralysis) and surgically treated by the technique of L’episcope modified by Hoffer. These results were stratified according to the type of lesion (group A – high injury, group B – complete injury) and age (group I ≤ 4 years, group II> 4 years). The mean follow–up was 35 months. The mean age at the time of surgery was 6.5 years (r= 2–11). All but one showed functional improvement, with increased mean Mallet score of 4.6 points. The two subtypes of paralysis had similar mean Mallet score (group A – 4.6; group B – 4.7); the age at the time of surgery did not influence the clinical outcome (average score (Group I) – 4.8, (Group II) – 4.4). No complications were recorded. The technique L’episcope modified by Hoffer is effective in the palliative treatment of the shoulder in obstetric brachial plexus palsy, allowing recovery of abduction and external rotation of the shoulder. It seems to be indicated for high and complete paralysis, when combined with other surgeries to recover the function of the elbow, wrist and / or hand. Being older than 4 years old is not a contraindication for this surgery provided that changes of the glenohumeral joint are excluded.

Osteochondritis dissecans (OCD) is a musculoskeletal condition that occurs primarily during the maturation of the skeleton. It is a cause of elbow pain and disability in the adolescent athlete, and it is an uncommon disorder in the general population [1]. OCD typically affects adolescent athletes engaged in repetitive overhead or upper extremity weight-bearing activities (e.g., baseball, tennis, volleyball, and gymnastics).

The size and capacity of Data Centers (DCs) is growing at a rapid pace to meet the increased demand of data processing and storage capacity requested by a digital information society. Since DCs are infrastructures that have large energy consumption, there is a need to change their design approach to make them more efficient and more environment friendly. This research was motivated by the planning of a new DC in Portugal. It proposes a multi-criteria framework to assess the sustainability of a DC, which includes a new metric to evaluate the DC efficiency taking into account the environmental conditions of the DC location. ELECTRE TRI was chosen for aggregating different metrics concerning the environmental sustainability of a DC into sustainability categories. The evaluation methodology allows some freedom for each DC to place more weight on the aspects in which it is stronger, an analysis facilitated by the IRIS decision support system.

Purpose To review the results of scapholunate ligament reconstruction using a flexor carpi radialis tendon graft. Methods We performed a retrospective review of 22 patients with post-traumatic scapholunate instability who were treated with a modification of the Brunelli, a flexor carpi radialis tendon graft. Results The mean follow-up was 61 months. The average age was 40 years. The average loss of flexion was 23° and of extension was 22° compared with the contralateral side. Grip strength averaged 67% of the nonoperated side. All patients except 2 returned to work. Degenerative changes were seen in 3 patients at the time of revision. Complications occurred in 2 patients and included avascular necrosis of the scaphoid. Conclusions Perfect biomechanical reconstruction might not be possible for scapholunate dissociation. Our results show, however, that ligament reconstruction led to satisfactory results from the patient's point of view. Type of study/level of evidence Therapeutic IV.

Data Centers (DCs) are high energy intensive facilities due to the large power requirements of the computing equipment and the infrastructure needed to support it, in particular cooling systems. Nowadays, the capacity and consequently the energy demand of DCs is growing rapidly to meet the digitalization of the society. In order to meet sustainability concerns, the construction of a new DC must address the economic and environmental impacts of the different design options and one of the most crucial choices to be made concerns the location of the DC. This paper presents a brief overview of the current landscape of Portuguese DCs, based on the results of a survey. It also proposes a methodology to identify the best areas to locate a new DC in Portugal, using a new structure for evaluation criteria, based on inputs from industry experts. The relevant data was collected in a Geographical Information System (GIS) and successive filters were applied to progressively reduce the number of candidate sites. Finally, an analysis to the benefits of having DCs on those sites in comparison with their current locations was made, and the results show that the chosen sites to locate these facilities were not the best solution to achieve a more sustainable DC.

This is a PDF file of an unedited manuscript that has been accepted for publication in International Transactions in Operational Research. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. The final version will be available at: http://dx.doi.org/10.1111/j.1475-3995.2012.00874.x

The aim of this retrospective study was to evaluate the results of 44 percutaneous needle fasciotomies for Dupuytren's contracture, performed from March 2005 to June 2010. The mean age of the 36 patients was 58 years and the mean follow-up period was 28 months. The assessment was based on the clinical records and clinical evaluation. Pre-operative and postoperative total passive extension deficit and complications were registered. Recurrence and patient satisfaction were also noted. The results in stage I and II of Tubiana were interesting, with an average improvement of more than 70%. For more severe deformities, the correction obtained was not so satisfactory and decreased significantly over time. The cumulative rate of minor complications was significant (11/44) but there were no major complications or permanent sequelae. Most of the patients were satisfied with the result and would recommend the procedure or would be willing to repeat it if necessary. The recurrence rate was 9%. Percutaneous needle fasciotomy appeared in this study as a minimally invasive, simple and fast technique with low morbidity. These features make this technique a valid alternative in mild stages of Dupuytren's disease.

Radial osteotomy is currently advocated for patients with Lichtman’s stages II and IIIA of Kienböck’s disease; its place in the treatment of patients with stage IIIB disease remains controversial. The purpose of this study was to evaluate the medium-term results of this procedure and to compare the outcome in patients with stage IIIB disease and those with earlier stages (II and IIIA). A total of 18 patients (18 osteotomies) were evaluated both clinically and radiologically at a mean follow-up of 10.3 years (4 to 18). Range of movement, grip strength and pain improved significantly in all patients; the functional score (Nakamura Scoring System (NSSK)) was high and self-reported disability (Disabilities of Arm, Shoulder and Hand questionnaire) was low at the final follow-up in all patients evaluated. Patients with stage IIIB disease, however, had a significantly lower grip strength, lower NSSK scores and higher disability than those in less advanced stages. Radiological progression of the disease was not noted in either group, despite the stage. Radial osteotomy seems effective in halting the progression of disease and improving symptoms in stages II, IIIA and IIIB. Patients with less advanced disease should be expected to have better clinical results.

OBJETIVO: O objetivo deste estudo consiste em rever os casos submetidos a tratamento cirúrgico por duas técnicas: trapezectomia com ou sem ligamentoplastia e artroplastia com implante. MÉTODOS: Foram avaliadas 52 mãos tratadas cirurgicamente por rizartrose entre 1995 a 2008: 32 trapezectomias com ou sem ligamentoplastia (grupo A) e 20 artroplastias com implante (grupo B). Follow-up médio: grupo A - 72 meses, grupo B - 23 meses. Não houve resultados significativamente diferentes quanto à dor, atividades da vida diária, mobilidade e força. No estudo radiográfico, a altura escafometacarpiana foi mais preservada no grupo B. O tempo médio de recuperação foi de 10 semanas no grupo A e de 4,5 no grupo B. Foram registradas quatro complicações: um caso de algoneurodistrofia no grupo A e 2 casos de luxação e um caso de fratura do trapézio no grupo B. RESULTADOS: O resultado das próteses superam o tratamento tradicional da rizartrose com trapezectomia com ou sem ligamentoplastia pela rápida recuperação que proporcionam. CONCLUSÃO: Contudo, a sua aplicação deve ser criteriosa, pois existe potencial de complicações relacionadas com os implantes. OBJECTIVE: The aim of this study was to review cases that underwent surgical treatment using two techniques: trapeziectomy with or without ligamentoplasty and arthroplasty with implant. METHODS: Fifty-two hands that were surgically treated for rhizarthrosis between 1995 and 2008 were evaluated: 32 cases of trapeziectomy with or without ligamentoplasty (group A) and 20 with implant arthroplasty (group B). The mean follow-up for group A was 72 months and for group B, 23 months. There were no significantly different results with regard to pain, activities of daily living, mobility or strength. In the radiographic evaluation, it was found that the scaphometacarpal height was better preserved in group B. The mean time taken to achieve recovery was 10 weeks in group A and 4.5 in group B. Four cases with complications were recorded: one case of algoneurodystrophy in group A and two cases of dislocation and one case of fracture of the trapezium in group B. RESULTS: The results from prostheses were better than the results from the traditional treatment for rhizarthrosis using trapeziectomy with or without ligamentoplasty because of the rapid recovery that prostheses provide. CONCLUSION: However, prostheses should be applied carefully, because there is a potential for complications relating to the implants.