Osteoarthritis of the hip in patients under 60 years of age. A study of the importance of pain at rest as an indication for intertrochanteric osteotomy

Pain at rest with osteoarthritis of the hip may be due to increased intraosseous blood pressure, which falls immediately after an intertrochanteric osteotomy. Eighty-five consecutive hips from patients under 60 years of age at the time of operation were studied in order to evaluate if pain at rest was an indication for intertrochanteric osteotomy. Patients who operatively were predominantly in pain at rest had a significantly better prognosis than patients with a predominantly weight-bearing pain (P less than 0.05). Intertrochanteric osteotomy reduced pain for the group of patients with predominant pain at rest (n = 50) by 81%, 66%, and 56% at 5, 10, and 15 years respectively. In the group where weight-bearing pain was predominant (n = 35), the operation was a success in only 39% at 5 years and after.     

Inpatient hospital admission and death after outpatient surgery in elderly patients: importance of patient and system characteristics and location of care

HYPOTHESIS: Surgery at different outpatient care locations in the higher-risk elderly (age >65 years) population is associated with similar rates of inpatient hospital admission and death. DESIGN: Claims analysis of patients undergoing 16 different surgical procedures in a nationally representative (5%) sample of Medicare beneficiaries for the years 1994 through 1999. SETTING: Hospital-based outpatient centers, freestanding ambulatory surgery centers (ASCs), and physicians' office facilities. PATIENTS: Medicare beneficiaries older than 65 years. MAIN OUTCOME MEASURES: Rate of death, emergency department risk, and admission to an inpatient hospital within 7 days of outpatient surgery. RESULTS: We studied 564,267 outpatient surgical procedures: 360,780 at an outpatient hospital, 175,288 at an ASC, and 28,199 at a physician's office. There were no deaths the day of surgery at a physician's office, 4 deaths the day of surgery at an ASC (2.3 per 100,000 outpatient procedures), and 9 deaths the day of surgery at an outpatient hospital (2.5 per 100,000 outpatient procedures). The 7-day mortality rate was 35 per 100,000 outpatient procedures at a physician's office, 25 per 100,000 outpatient procedures at an ASC, and 50 per 100,000 outpatient procedures at an outpatient hospital. The rate of admission to an inpatient hospital within 7 days of outpatient surgery was 9.08 per 1000 outpatient procedures at a physician's office, 8.41 per 1000 outpatient procedures at an ASC, and 21 per 1000 outpatient procedures at an outpatient hospital. In multivariate models, more advanced age, prior inpatient hospital admission within 6 months, surgical performance at a physician's office or outpatient hospital, and invasiveness of surgery identified those patients who were at increased risk of inpatient hospital admission or death within 7 days of surgery at an outpatient facility. CONCLUSION: This study represents an initial effort to demonstrate the risk associated with outpatient surgery in a large, diverse population of elderly individuals.     

Purification, characterization and structural determination of chitinases produced by Moniliophthora perniciosa

The enzyme chitinase from Moniliophthora perniciosa the causative agent of the witches' broom disease in Theobroma cacao, was partially purified with ammonium sulfate and filtration by Sephacryl S-200 using sodium phosphate as an extraction buffer. Response surface methodology (RSM) was used to determine the optimum pH and temperature conditions. Four different isoenzymes were obtained: ChitMp I, ChitMp II, ChitMp III and ChitMp IV. ChitMp I had an optimum temperature at 44-73oC and an optimum pH at 7.0-8.4. ChitMp II had an optimum temperature at 45-73oC and an optimum pH at 7.0-8.4. ChitMp III had an optimum temperature at 54-67oC and an optimum pH at 7.3-8.8. ChitMp IV had an optimum temperature at 60oC and an optimum pH at 7.0. For the computational biology, the primary sequence was determined in silico from the database of the Genome/Proteome Project of M. perniciosa, yielding a sequence with 564 bp and 188 amino acids that was used for the three-dimensional design in a comparative modeling methodology. The generated models were submitted to validation using Procheck 3.0 and ANOLEA. The model proposed for the chitinase was subjected to a dynamic analysis over a 1 ns interval, resulting in a model with 91.7% of the residues occupying favorable places on the Ramachandran plot and an RMS of 2.68.     

Polytetrafluoroethylene microprosthesis in the arterial system of the rat

The experimental behavior of a 1-mm internal diameter (i.d.) polytetrafluoroethylene (PTFE) microprosthesis, as a substitute for an abdominal aortic segment in the rat, was reviewed. Fifty Wistar rats were divided into four groups: Group I--12 rats with autotransplant of an abdominal aortic segment (AAS); Group II--12 rats with allotransplant of an AAS obtained from Long-Evans rats; Group III--12 rats with xenotransplant of an AAS taken from rabbit femoral arteries; and Group IV--14 rats with substitution of an AAS by a 1-mm i.d. PTFE microprosthesis. The rats were sacrificed at different time intervals ranging from five to 360 days, with previous aortography. In Group I, there was a 100 percent patency at a mean of 152.41 days; in Group II, a 91.6 percent patency at a mean of 100.08 days; in Group III, an 83.3 percent patency with a 75 percent aneurysmal dilation at a mean of 107.58 days; in Group IV, a 71.42 percent patency with two anastomotic aneurysms at a mean of 105 days (P less than 0.05, chi square) between Groups I and IV, autotransplant vs. PTFE). The 1-mm PTFE microprosthesis placed in the arterial system of the rat proved to be a reliable alternative for microvascular substitution.     

Successful endovascular repair of an aneurysm of the ductus diverticulum with a branched stent graft: case report and review of literature

Aneurysm of the ductus diverticulum rarely has been reported in adults, and the reported aneurysms were treated with conventional open surgery or were diagnosed at autopsy. We report a successful endovascular repair of an aneurysm of the ductus diverticulum with the Inoue branched stent graft. In a 78-year-old woman, an abnormal shadow was noted at the aortopulmonary window on a chest x-ray film. A computed tomography scan demonstrated a 3.8-cm saccular aneurysm, which protruded inferiorly from the distal end of the aortic arch. The aneurysm was considered an aneurysm of the ductus diverticulum, and surgery was required. However, the patient was considered at high risk for respiratory dysfunction with conventional open surgery. Endovascular repair with an Inoue single-branched stent graft was performed with the patient under local anesthesia, successfully and without complication or endoleak. To our knowledge, this is the first report of endovascular treatment of an aneurysm of the ductus diverticulum.     

Prospective direct comparison study of fractional resurfacing using different fluences and densities for skin rejuvenation in Asians

BACKGROUND AND OBJECTIVE: Fractional resurfacing is a new concept of cutaneous remodeling whereby laser-induced zones of microthermal injury are surrounded by normal untreated tissue. The aim of this study is to compare the efficacy and complications of Fraxel laser treatment when using different fluences and density settings. STUDY DESIGN/MATERIALS AND METHODS: Thirty female Asian patients were enrolled in the study. Group 1 (n = 10); half of the face was treated with eight passes at 125 MTZ/cm2 at an energy setting of 8 mJ. The other half of the face was treated with eight passes at 250 MTZ/cm2 at an energy setting of 8 mJ. Group 2 (n = 10); half of the face was treated with eight passes at 125 MTZ/cm2 at an energy setting of 8 mJ. The other half of the face was treated with eight passes at 125 MTZ/cm2 at an energy setting of 16 mJ. Group 3 (n = 10); half of the face was treated with eight passes at 125 MTZ/cm2 at an energy setting of 16 mJ. The other half of the face was treated with eight passes at 250 MTZ/cm2 at an energy setting of 8 mJ. Ice pack cooling was used during and after laser treatment. The patients were evaluated for clinical efficacy and treatment-related side effects. RESULTS: Pain, erythema, and swelling were observed to be significantly more evident or persisted longer in patients treated with higher densities and fluences (P<0.01). Patient satisfaction is significantly greater in patients treated with higher fluences (P<0.05), but not in patients treated with higher densities. Hyperpigmentation was observed in two patients. CONCLUSION: Increased density was more likely to produce swelling, redness, and hyperpigmentation when compared to increased energy. Patient satisfaction is significantly higher when their skin is treated with high fluences, but not when patients' skin is treated with high densities.     

Surgical treatment of fractures of the greater trochanter associated with osteolytic lesions

BACKGROUND: A fracture of the greater trochanter through an osteolytic lesion may occur as a late complication after total hip arthroplasty. The optimal treatment for this difficult complication remains controversial. We have treated this problem with internal fixation and allogeneic bone-grafting at the time of revision of a loose acetabular component. METHODS: We retrospectively reviewed the results of treatment of a fracture through an osteolytic lesion of the greater trochanter in nineteen patients seen from 1996 to 2002. All fractures were treated with morselized allogeneic bone grafts and wire fixation at the time of revision of a failed acetabular component. Postoperative care included the use of an abduction orthosis and protected weight-bearing for at least three months. Follow-up of all patients consisted of radiographic examinations and clinical evaluation with use of the Harris hip score. RESULTS: At an average duration of 3.8 years after the revision, eighteen of the nineteen fractures had healed. The average time to healing was five months. The one treatment failure occurred in a patient who did not comply with the use of an abduction orthosis. The average Harris hip score for all patients improved from 32.5 points preoperatively to 91.2 points at the time of the latest follow-up. Polyethylene wear and recurrent osteolysis of the greater trochanter was noted in one hip at the eight-year follow-up examination. CONCLUSIONS: Fractures of the greater trochanter associated with osteolytic lesions can be effectively treated with open reduction, internal fixation with wire, and allogeneic bone-grafting.     

Penile vein dissection: A study of its long-term efficacy in impotence

Summary In recent years, venous leakage has been recognized as an important cause of erectile impotence. Dynamic cavernosography, a diagnostic test combining a cine-tape cavernosogram and intracavernous pressure measurement at three different infusion rates, was used to identify 49 patients with impotence caused by excessive venous drainage during erection. The patients underwent an operation to ligate some of the venous outflow, channels in the penis and were followed up between 2 and 52 (mean, 15.5) months afterward. Of the 49 patients, 35 initially had no erection at any infusion rate; 18/35 showed an improvement in erection at follow-up. The remaining 14 patients initially achieved partial erection at infusion rates of 120 or 180 ml/min; of these, 7/14 reported an improvement in erection at follow-up. Of the patients with no erection at any infusion rate, 56% showed a significant improvement at the time of follow-up.     

Standardisation of the preparation of platelet concentrates.

Platelet concentrates with a yield of 80,8% and an absolute number of platelets per pack of 0,86 X 10(11) were obtained, using an optimised harvesting method. This method involved standardised collection of whole blood with constant mixing of blood and anticoagulant, a first centrifugation at 750 g for 6 minutes at 22 degrees C (full brake) and a second centrifugation at 2 0000 g for 20 minutes at 22 degrees C (half brake). Resuspension of the platelet pellet in plasma was effected by leaving the pack at room temperature for 30 minutes. Platelet concentrates of 25 ml and 50 ml volume displayed satisfactory pH and count characteristics after 72-hour storage both at room temperature and at 2 - 10 degrees C.     

Role of class I and class II HLA antigens in cadaveric renal transplantation

HLA matching at MT and DQ appears to be an important predictor of allograft survival. Allografts with no MM at MT and DQ have a good outcome while a known MM at MT and DQ appears to be associated with poor allograft outcome. Thus, our priority should be to avoid an MM for these broad-reacting specificities and then to minimize incompatibilities at DR and HLA-B. Furthermore, our data indicate that allografts with MM at DQ and two MMs at HLA-B appear to be at a higher risk. Perhaps these latter transplants should not be performed with conventional immunosuppressive therapy.     

Role of family history and ethnicity on the mode and age of prostate cancer presentation

BACKGROUND: This study was conducted to investigate the role of family history of prostate cancer and ethnic variation on age at diagnosis and the mode of prostate cancer presentation among a multiracial cohort of men in the Bronx and on Long Island. METHODS: A retrospective hospital-based study of 953 men (62% white, 24% African-American, 9% Hispanic, and 5% other ethnicities) with biopsy-confirmed prostate cancer diagnosed between 1991 and 1996. Data were collected between 1996 and 1998 using self-administered questionnaires that assessed age at diagnosis, ethnicity, family history of prostate cancer, and first indication of potential prostate cancer. RESULTS: Men with a family history of prostate cancer were diagnosed at an earlier mean age than those who lacked a family history (P<0.001). Prostate cancer patients with an affected father had a significantly lower mean age at diagnosis than those patients who indicated that at least one brother (but not their father) was affected (P<0.001). African-Americans reported a family history of prostate cancer more often than whites (P<0.01) and were younger at diagnosis (P<0.0001). Hispanic patients were less likely to be identified by screening and more likely to present with symptoms compared with whites (P<0.0001) and African-Americans (P<0.001). CONCLUSIONS: Men with an affected father were more likely to have disease diagnosed at an early age. The lower rates of presentation by prostate cancer screening of Hispanic men with prostate cancer suggests that increased surveillance may be warranted in this population.     

小切口微创治疗新鲜跟腱断裂

[目的]探讨通过小切口应用跟腱缝合引导器微创治疗新鲜跟腱断裂的临床效果.[方法]2006年3月-2008年3月,通过小切口应用跟腱缝合引导器微创治疗连续的26例新鲜跟腱断裂病人,术后早期功能锻练.男24例,女2例.年龄22～58岁,平均37.6岁.24例获得12～36个月(平均21个月)的随访.采用美国足与踝关节协会(AOFAS)踝与后足功能评分标准进行评分,测量双侧小腿最大周径及跟腱断裂平面的周径,询问恢复工作及伤前体育活动的时间.[结果]无跟腱再断裂、切口表浅或深部感染、皮缘坏死等并发症.腓肠神经支配区皮肤感觉正常.AOFAS 平均得分为97分(86～100分).23例恢复伤前工作与学习,恢复工作时间平均为10周(4～20周).24例均恢复伤前体育活动,恢复伤前体育活动时间平均为20周(18～24周).小腿最大周径伤侧较对侧平均减少0.4 cm(0.2～0.8 cm),跟腱断裂平面周径伤侧较对侧平均增粗0.5 cm(0.3～0.7 cm).[结论]应用跟腱缝合引导器微创修复新鲜跟腱断裂结合早期功能锻练可得到满意的临床效果,可较早恢复伤前状态,有较少的并发症.     

Influence of output energy and pulse repetition rate of the Er:YAG laser on dentin ablation

OBJECTIVE: We sought to improve the efficiency of dentin ablation with the Er:YAG laser by investigating the effects of output energy and pulse repetition rate on ablation. Background Data: The Er:YAG laser is superior to other lasers in ablating dental hard tissues. However, the factors affecting the efficiency of ablation with an Er:YAG laser remain unclear. METHODS: Fifty bovine root dentin plates were irradiated with an Er:YAG laser at an output power of 1.0 W, 1.5 W, or 2.0 W under a water spray while moving the plate at 1 mm/sec. After irradiation, the depth and volume of each ablated site were measured by laser microscopy and the ablated surfaces were examined by scanning electron microscopy. RESULTS: The output power showed a strong positive correlation with the depth and volume of ablation. The output energy had much more pronounced effects on the depth and volume of ablation compared to the pulse repetition rate. The shape of the ablated site varied with the output power, and no cracking or vitrification was observed under the irradiated dentin. The most effective parameters for dentin ablation were an output power of 2.0 W, with an output energy of 80 mJ/pulse at 25 pulses per second (pps) or 100 mJ/pulse at 20 pps. CONCLUSION: These findings suggest that the output energy is the main factor affecting the efficiency of dentin ablation with an Er:YAG laser. We propose that the efficiency of dentin ablation can be improved by choosing an optimal combination of output energy and repetition rate.     

The use of osteo-articular allografts for reconstruction after resection of the distal radius for tumour

Several techniques have been described to reconstruct a mobile wrist joint after resection of the distal radius for tumour. We reviewed our experience of using an osteo-articular allograft to do this in 17 patients with a mean follow-up of 58.9 months (28 to 119). The mean range of movement at the wrist was 56° flexion, 58° extension, 84° supination and 80° pronation. The mean ISOLS-MSTS score was 86% (63% to 97%) and the mean patient-rated wrist evaluation score was 16.5 (3 to 34). There was no local recurrence or distant metastases. The procedure failed in one patient with a fracture of the graft and an arthrodesis was finally required. Union was achieved at the host-graft interface in all except two cases. No patient reported more than modest non-disabling pain and six reported no pain at all. Radiographs showed early degenerative changes at the radiocarpal joint in every patient. A functional pain-free wrist can be restored with an osteo-articular allograft after resection of the distal radius for bone tumour, thereby avoiding the donor site morbidity associated with an autograft. These results may deteriorate with time.     

Management of sacrococcygeal teratoma of the fetus

We present a case of a 22 year pregnant lady with a fetus having sacrococcygeal teratoma. The patient presented at 35 weeks of gestation with an ultrasound report showing growth at the sacral region. Emergency caesarean section was performed at 36 week and a baby girl with a huge mass on her sacral region was delivered. She was operated upon by the pediatric surgeons on the same day and the mass was excised. Histopathology of the mass confirmed the diagnosis of sacrococcygeal teratoma with an immature component. The infant is now 6 months old and there is no sign of recurrence.     

Multimodality therapy for small cell carcinoma of the lung--the role of surgical treatment

Reviewing the outcome of 70 cases of clinically localized small cell lung cancer (SCLC) treated with combined modality treatment, we attempted to define the role of resection in this disease. The survival rate for all cases was 37 per cent at 2 years and 23 per cent at 3 years with a median survival time (MST) of 14 months. For 25 resected cases the overall 5-year survival rate was 37 per cent with an MST of 26 months. According to clinical staging, 5-year survival was 64 per cent for stage I and 20 per cent for stage II. However, none of the stage III cases achieved long-term survival, of over 3 years. In 45 non-resected cases, the overall response rate was 84 per cent with a 44 per cent complete response. The overall survival rate was 27 per cent at 2 years and 14 per cent at 3 years with an MST of 11 months. The 20 cases who achieved complete response had an MST of 26 months with 51 per cent alive at 2 years and 19 per cent at 5 years. Thus, we consider that lung resection is definitely indicated in cases with stage I and probably stage II SCLC. For stage III, however, particularly in cases with N2 disease, resection seems to offer no special benefit in favor of survival compared to combination chemotherapy and radiotherapy.     

Reliability of tendon excursion measurements in patients using a color Doppler imaging system

PURPOSE: The purpose of this study was to assess the test-retest reliability of tendon excursion measurements with color Doppler imaging in patients with flexor tendon injuries following a modified Kleinert protocol. METHODS: One observer performed repeated measurements at 3 different time periods in 13 patients with flexor tendon injuries, following a modified Kleinert protocol. The intraclass correlation coefficient (ICC), the standard error of measurement (SEM), and related indices of measurement error were calculated. RESULTS: Measurements at 10 day after surgery had an ICC of.88 and an SEM of 1.1 mm. Measurements at 6 weeks after surgery had an ICC of.58 and an SEM of 2.0 mm. The measurements after 3 months had an ICC of.94 and an SEM of 1.2 mm. CONCLUSION: Measurements at 10 days and more than 3 months after surgery were reliable and were as reliable as the measurements performed on healthy subjects. At 6 weeks after surgery the measurements were less reliable. Color Doppler imaging is a reliable and noninvasive method to assess tendon excursion, even in patients with small tendon excursion movements.     

Predictors of Survival in Patients With Bone Metastasis of Lung Cancer

The prognosis of patients with bone metastasis from lung cancer has not been well documented. We assessed the survival rates after bone metastasis and prognostic factors in 118 patients with bone metastases from lung cancer. The cumulative survival rates after bone metastasis from lung cancer were 59.9% at 6 months, 31.6% at 1 year, and 11.3% at 2 years. The mean survival was 9.7 months (median, 7.2 months; range, 0.1-74.5 months). A favorable prognosis was more likely in women and patients with adenocarcinoma, solitary bone metastasis, no metastases to the appendicular bone, no pathologic fractures, performance status 1 or less, use of systemic chemotherapy, and use of an epithelial growth factor receptor inhibitor. Analyses of single and multiple variables indicated better prognoses for patients with adenocarcinoma, no evidence of appendicular bone metastases, and treatment with an epithelial growth factor receptor inhibitor. The mean survival period was longer in a small group treated with an epithelial growth factor receptor inhibitor than in the larger untreated group. The data preliminarily suggest treatment with an epithelial growth factor receptor inhibitor may improve survival after bone metastasis.     

封闭与微创手术治疗网球肘的疗效观察

目的:比较封闭与微创手术治疗网球肘的临床效果,探讨较好的治疗方法。方法:封闭组54例,其中男18例,女36例;年龄24~68岁,平均41岁;采用2%利多卡因2~3 ml 强的松龙25 mg在肘外侧痛点处封闭治疗(随访36例)。手术组36例,男14例,女22例;年龄28~62岁,平均39岁;采用局部2%利多卡因麻醉,在痛点处2 cm纵行切口,将伸肌总腱起点附着处半环形部分切断并向远段剥离,局部微血管神经微束切断并结扎(随访31例)。术后按Verhaar标准进行3、6、12个月随访。结果:封闭组3个月时优31例,良2例,可3例,差0例,优良率为91%;6个月时优23例,良4例,可7例,差2例,优良率为75%;12个月时优3例,良2例,可5例,差26例,优良率为14%。手术组在3个月时优27例,良3例,可1例,差0例,优良率为96%;6个月时优29例,良1例,可1例,差0例,优良率为96%;12个月时优25例,良3例,可2例,差1例,优良率为90%。结论:封闭治疗在短期内有较好的效果,微创手术在远近期的疗效都比较理想。     

Fifteen-year outcome of displaced intra-articular fractures of the distal radius

PURPOSE: We previously reported the functional and radiographic outcomes of 21 young adults at an average of 7 years after open reduction and internal fixation of an intra-articular distal radius fracture (original study). The purpose of the current investigation was to evaluate the same cohort at an average of 15 years after surgery to evaluate the effect of additional time on both function and radiographic appearance. METHODS: We re-evaluated 16 of the original patients at an average of 15 years after surgery. Subjective assessment was performed with the Musculoskeletal Functional Assessment and the Hand Function Sort questionnaires. Objective assessment included a detailed physical examination and strength measurement. Standardized radiographs and computed tomography were used to assess wrist morphology, residual articular step and gap displacement, and the presence and degree of arthrosis. RESULTS: Subjectively patients continued to function at a high level at the last follow-up evaluation: the average Musculoskeletal Functional Assessment score was 10 and 14 of the 16 patients functioned at a high level according to the Hand Function Sort. Strength and range of motion remained essentially unchanged from the original report. Radiocarpal arthrosis was noted in 13 of the 16 wrists and joint space was reduced an additional 67% compared with the 7-year follow-up evaluation. Nonetheless there continued to be no correlation between the presence or degree of arthrosis and upper-extremity function. CONCLUSIONS: Radiocarpal arthrosis after intra-articular distal radius fractures can be expected to worsen over time. Despite joint space narrowing and evidence of advanced arthrosis, however, patients maintained a high level of function at the long-term follow-up evaluation. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic, Level II.