静脉用蔗糖铁纠正功能性缺铁对血液透析患者贫血的影响

目的：通过比较静脉铁剂蔗糖铁和口服铁剂琥珀酸亚铁分别联合应用基因重组人红细胞生长素（EPO），治疗伴有功能性缺铁的维持性血液透析患者贫血的疗效，探讨对功能性缺铁的补铁途径、安全性和方法。方法：采用前瞻性、随机、对照研究。30例维持性血液透析、存在功能性缺铁和贫血的患者随机分为静脉铁剂和口服铁剂治疗组。静脉铁剂组15例，100mg蔗糖铁溶于100ml生理盐水，静脉滴注，隔日1次，直至完成总预计补铁量；口服铁剂组，琥珀酸亚铁200mg，每日3次，共8周。两组患者均联合应用EFO治疗，剂量为100～180U·kg^-1·周^-1，均皮下注射。每2周检测1次患者的血红蛋白（Hb）、红细胞压积（Hct）和网织红细胞计数（Ret），以及血清铁（SF）和转铁蛋白饱和度（TS）。结果：治疗前静脉铁剂组和口服铁剂组之间在年龄、性别比例、体重、接受治疗前维持性血液透析时间及Hb、Hct、Ret、SF、TS等方面均无明显差异。静脉铁剂组SF和TS在治疗2周后明显升高，Hb、Hct、Ret在治疗4周后明显升高；口服铁剂组Hb、Hct、Ret在治疗6周后明显升高。结论：血液透析患者，即使铁储备正常，若存在功能性缺铁，仍然需要静脉补铁。与口服铁剂比较，静脉铁剂可更好地纠正透析患者的功能性缺铁，增加铁储备，改善EPO的疗效。     

蔗糖铁联合促红细胞生成素治疗血液透析肾性贫血疗效观察

目的:比较静脉应用蔗糖铁联合促红细胞生成素(EPO依倍成都地奥集团九泓制药生产2000iu/支)和口服维铁缓释片联合EPO治疗MHD患者肾性贫血的疗效与安全性.方法:50 例MHD伴肾性贫血患者随机分为静脉组和口服组,两组均给予EPO 治疗,静脉组给予蔗糖铁100mg静脉滴注,口服组给予维铁缓释片(每片含硫酸亚铁525mg)口服,疗程均16周.观察并比较两组患者贫血治疗的效果、铁代谢指标的变化和不良反应发生情况.结果:静脉组Hb、Hct、及TSAT,SF的指标明显高于口服组.结论:静脉注射蔗糖铁可有效地纠正MHD的铁缺乏,提高EPO的疗效,不良反应发生率低,安全性好.     

静脉铁剂在肾性贫血中的治疗作用

目的观察右旋糖酐铁静脉注射治疗尿毒症致肾性贫血的疗效和不良反应。方法80例尿毒症血液透析病人随机分为两组。对照组：速立菲200mg，每日3次，口服。治疗组：右旋糖酐铁100mg，每周1次，静脉滴注。两组均治疗10周，并同时应用促红细胞生成素（EPO）9000U/周。结果对照组治疗后血红蛋白（Hb）、红细胞压积（Hct）较治疗前有明显升高（P〈0．01），但转铁蛋白饱和度（TSAT）、铁蛋白（FT）与治疗前对比无明显提高（P〉0．05）。治疗组治疗后Hb、Hct、TSAT、FT较治疗前均有显著升高（P〈0．001）。两组治疗后的Hb、Hct、TSAT、FT对比，治疗组比对照组有显著升高（P〈0．001）。结论静脉注射铁剂能有效补充EPO治疗中所需要的铁储备，疗效优于口服，不良反应少。     

血液透析患者肾性贫血的维持性补铁方式研究

目的比较不同方式补铁治疗对血液透析患者在肾性贫血得以纠正达标后长期维持治疗期间的疗效和安全性,从而选择更佳的维持性治疗方式。方法选择2014年9月至2016年3月在湖北省中医院血液净化中心行维持性血液透析的患者40例,经规范治疗肾性贫血相关指标达标后,随机分为静脉组和口服组,每组20例。静脉组患者每周第一次透析时给予静脉注射蔗糖铁100mg,口服组患者口服多糖铁复合物胶囊150 mg,每日一次。2组患者均合并使用促红细胞生成素(erythropoietin,EPO)治疗,剂量为10 000 U/10d。观察12周后2组患者红细胞数量(red blood cell,RBC)、血红蛋白(hemoglobin,Hb)、红细胞比容(hematocrit,Hct)、血清铁蛋白(serum ferritin,SF)、转铁蛋白饱和度(transferin saturation,TSAT)、C反应蛋白(C reaction protein,CRP)等指标的变化及不良反应。结果治疗前静脉组和口服组患者在Hb、RBC、SF、TSAT和Hct等方面无明显差异(P0.05)。2组患者分别经过12周治疗后,Hb、RBC、SF等水平有下降趋势,口服组患者下降幅度更为明显。静脉组患者无明显不良反应。结论血液透析患者在肾性贫血得以纠正达标后仍维持性补充铁剂是有必要的。维持性静脉注射蔗糖铁与口服多糖铁复合物胶囊联合EPO治疗都能用于稳定大多数患者相关铁参数和Hb水平,但静脉注射蔗糖铁更为安全、有效,且依从性更高。     

口服与静脉铁剂治疗肾性贫血的对比观察

目的观察口服与静脉铁剂在维持性血液透析患者肾性贫血治疗中的应用。方法选择48例合并肾性贫血的维持性血液透析患者为研究对象,随机分为2组,口服组22例,静脉组26例。2组血液透析方案和红细胞生成素用量相同,口服组口服多糖铁复合物300mg／d,静脉组采用静脉滴注低分子右旋糖酐铁100mg／周,观察时间为6个月。结果6个月后,静脉组总有效率高于口服组（P〈0．01）,血红蛋白和血细胞压积高于口服组（P〈0．05）,2组转铁蛋白饱和度、血清铁蛋白及C反应蛋白无显著差异（P〉0．05）,而整体费用支出无显著差异（P〉0．05）。结论对于肾性贫血患者的长期巩固治疗,静脉补铁较口服补铁效果更好,并发症少,且并不增加治疗费用。     

蔗糖铁注射液与琥珀酸亚铁片治疗血液透析患者贫血疗效对比

目的比较蔗糖铁注射液与琥珀酸亚铁片治疗维持性血液透析患者肾性贫血的临床疗效与安全性,探讨补铁的途径和方法。方法选择40例维持性血液透析患者,试验前检测每例患者的血红蛋白、红细胞比容、血清铁蛋白、转铁蛋白饱和度,将患者随机分为静脉补铁组（20例）和口服补铁组（20例）,4、8、12周后复查上述指标。结果两组治疗后血红蛋白、红细胞比容、血清铁蛋白、转铁蛋白饱和度均升高,但静脉组比口服组高,差异有统计学意义,且上升速度快于口服组。治疗前、后两组肝功能、C反应蛋白等指标差异无统计学意义。结论在使用重组人促红细胞生成素的同时,静脉补铁较口服补铁能更快、更好地改善肾性贫血。     

静脉用右旋糖酐氢氧化铁注射液治疗血液透析患者肾性贫血的随机及多中心对照临床研究

目的 评价右旋糖酐氢氧化铁注射液治疗维持性血液透析(血透)患者铁缺乏的有效性与安全性。方法 159例维持性血透患者,肾性贫血程度:血红蛋白(Hb)60～90 g/L,或红细胞压积(Hct)0.18～0.27,随机分为静脉组与口服组,分别采用静脉注射右旋糖酐氢氧化铁及口服琥珀酸亚铁进行补铁治疗,总疗程8周。检测治疗前后血清铁指标、红细胞相关指标及生化指标,并对不良反应进行监测。结果 (1)共136例完成本研究,其中静脉组70例、口服组66例,两组患者年龄、性别、贫血程度、血清铁指标及EPO用量相匹配。(2)治疗8周时,静脉组Hb及Hct显著升高,分别上升(25.5±18.7)％和(28.9±21.1)％,幅度明显高于口服组[(12.0±16.8)％和(16.7±22.5)％],P<0.001。(3)治疗8周后两组血清铁蛋白(SF)与转铁蛋白饱和度(TSAT)均较治疗前显著升高,且静脉组升高幅度[SF(316.0±398.0)％,TSAT(89.7±99.0)％】明显高于口服组[SF(157.0±454.0)％,TSAT(35.2±57.0)％】,P<0.001。(4)治疗8周后静脉组血清白蛋白及血清钾较治疗前升高,白蛋白由(36.9±5.2)g/L升至(39.3±5.9)g/L,血清钾由(4.8±0.8)mmol/L升至(5.1±0.9)mmol/L,P<0.01。两组治疗前后血WBC及其它生化指标均相近。(5)静脉组4例有不良反应,1例出现药物相关皮疹,停药后消失,1例轻微心悸,2     

科莫非对维持血液透析的慢性肾衰竭患者的疗效观察

慢性肾衰竭(CRF)均有不同程度的贫血,促红细胞生成素(EPO)治疗肾性贫血疗效显著,可用于已作透析和还未作透析的患者.为使EPO充分发挥作用,应补足铁 [1].有文献报道,静脉补铁优于口服补铁[3].我们于2003年 9月～200 4年3月对维持血液透析的CRF患者给予静脉滴注科莫非(低分子右旋糖酐氢氧化铁复合物注射液),取得良好效果,现总结如下.     

静脉铁剂在肾性贫血治疗中的合理应用

贫血是慢性肾衰竭患者常见的合并症之一。肾性贫血的治疗,不仅需要合理应用促红细胞生成素（EPO）,还需要及时有效地补充铁剂,否则,即使长期大剂量使用EPO,贫血也难以纠正。据统计,在美国接受EPO治疗的终末期慢性肾衰竭患者中,43％红细胞压积（Hct）〈30％,其中50％以上存在缺铁。对于如何应用EPO,临床上已积累了较为丰富的经验,但对于如何补充铁剂临床上还认识不足。静脉补铁近年受到愈来愈多的关注,且临床上也证实有效。本文从临床实用角度综述静脉铁剂在肾性贫血治疗中的合理应用。     

口服与静脉补铁治疗CKD患者贫血的比较

贫血是慢性肾脏病（CKD）常见的并发症,使用红细胞生成素（EPO）治疗是有效的措施之一,但是其疗效常受铁缺乏的限制。补铁可由口服或静脉两种形式补充,口服补铁价格便宜、方便、安全,缺点是胃肠道反应影响吸收;静脉补铁可补充较大剂量,对某些患者可更好地耐受,但静脉补铁有可能出现过敏反应,特别是右旋糖酐铁。此外,人们还担心静脉补铁还可能因补充给致病菌铁剂增加感染机会、损伤内皮细胞、产生氧化应激造成动脉硬化、加速非透析的CKD患者肾损伤。既往的荟萃研究仅比较了儿童患者或包含了太多非CKD的患者而不能反映两种铁剂在CKD人群中真实的情况,本文的目的即在于荟萃分析CKD患者补铁的最佳方式。     

维生素D受体在糖尿病肾病足细胞损伤及蛋白尿缓解中的作用

目的探讨维生素D受体(VDR)在糖尿病肾病(DKD)足细胞中的表达水平及在足细胞损伤及蛋白尿缓解中的作用。方法(1)本研究纳入了65例诊断患有2型糖尿病(伴或不伴蛋白尿)的患者,并纳入了25例年龄和性别相匹配的健康体检者为对照组。根据白蛋白/肌酐(ACR)的尿排泄比例对2型糖尿病患者进行分组,分别为无蛋白尿(ACR<30 mg/g,n=24)、微量白蛋白尿(ACR 30~300 mg/g,n=18)和临床蛋白尿(ACR>300 mg/g,n=23)。另选择25例经肾活检确诊的DKD患者作为DKD组。正常肾脏组织标本均取自泌尿外科同一时期肾脏肿瘤切除患者10例。将各组检测指标进行对比,同时采用实时定量PCR、ELISA法和免疫组化法检测VDR在各组患者的血液、尿液样本和肾脏组织中的表达情况,以及使用Pearson相关分析分析VDR与尿蛋白的相关性。(2)在2型糖尿病肾病小鼠模型中对上述结果进行验证,将遗传背景均为C57BLKs/J的雄性db/db小鼠及同窝出生的db/m小鼠,随机分为正常对照组(A组)、DKD对照组(B组)、DKD二甲基亚砜处理组(C组)、DKD帕立骨化醇(VDR激动剂)处理组(D组),C、D组连续腹腔注射处理8周,对照组不做任何处理。小鼠10周龄时开始连续干预8周,在小鼠22周龄(开始干预后12周)检测各组小鼠体重、血、尿生化指标对比;Western印迹法检测β⁃catenin、VDR的变化;免疫荧光观察足细胞标志蛋白podocin及足细胞损伤蛋白α⁃SMA的表达变化。结果(1)与正常健康对照组相比,无蛋白尿组、微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿组的糖尿病患者相比,微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05)。(2)与正常健康对照组相比,无蛋白尿糖尿病组和DKD组患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿糖尿病组患者相比,DKD组患者血浆中VDR的mRNA和蛋白水平亦较低(均P<0.05)。(3)免疫组化结果显示,DKD组肾组织中VDR的表达明显少于正常对照组。(4)DKD患者血浆中VDR mRNA相对水平与ACR呈负相关(r=-0.342,P<0.05)。(5)各组尿液上清液中VDR的水平与血浆中的水平呈相反趋势。(6)Western印迹结果显示,B组、C组肾小球足细胞β⁃catenin蛋白表达高于D组(均P<0.05),VDR蛋白的表达低于D组(均P<0.05);免疫荧光结果显示,B组、C组肾小球足细胞podocin的表达低于D组(均P<0.05),α⁃SMA的表达高于D组(均P<0.05)。结论VDR高表达缓解DKD足细胞损伤及蛋白尿。     

Anterior Interosseous Nerve Palsy After Shoulder Arthroscopy Treated With Surgical Decompression: A Case Series and Systematic Review of the Literature

Background: Anterior interosseous nerve (AIN) palsy is a very uncommon cause of upper extremity pain and weakness that comprises less than 1% of all upper extremity nerve palsies. Rarely reported but also mentioned in the literature is AIN palsy after shoulder arthroscopy. Methods: A systematic review of the literature to date using PubMed was conducted to identify patients who suffered AIN palsy after shoulder arthroscopy procedures. Articles included met the following criteria: (1) published in English; (2) primary presentation of the data; (3) patients had undergone shoulder arthroscopy before developing symptoms of AIN palsy; and (4) diagnosis was confirmed with clinical symptoms of AIN palsy. Measured outcomes included patient demographics, specific shoulder procedure, anesthesia procedure, intra-operative patient positioning, intra-operative compressive dressing, intra-operative traction, surgical versus conservative treatment, abnormal findings during decompression procedure, proposed mechanism of injury, and follow-up. Results: The search yielded 6 articles, of which 4 (13 cases) met inclusion criteria. An additional 2 cases were included in this report totaling 15 cases. The average patient age was 49 years (range: 31-64) with 73% males. At average follow-up of 24 months, 67% of patients experienced complete resolution of symptoms—more than half of which underwent surgical decompression. Patients who failed to progress experienced weakness of the flexor digitorum profundus and flexor pollicis longus muscles. Conclusions: Proposed injury mechanisms for AIN palsy after shoulder arthroscopy range from mechanical trauma, compressive hematoma, and direct anesthetic neurotoxicity. Management should be directed by clinical symptoms, imaging, and patient factors with majority of patients expected to have excellent clinical outcomes.     

不同尿钙水平的Gitelman综合征患者临床特点比较

目的观察不同尿钙水平Gitelman综合征(GS)患者的临床特点,探讨尿钙在GS疾病临床分型中的价值。方法收集2016—2018年来自中国国家罕见病注册系统(NRSC)、在北京协和医院行SLC12A3基因检测诊断为GS患者的临床资料,分析其尿钙特点,比较不同尿钙水平患者的临床和实验室检查指标。氢氯噻嗪试验按照标准操作流程进行,测定患者基线和用药后3 h内氯离子排泄分数改变量的最大值(ΔFECl)。结果共有83例GS患者被纳入研究,其中低尿钙患者53例(63.86%)。低尿钙组尿钙/肌酐比明显低于非低尿钙组[(0.085±0.058)mmol/mmol比(0.471±0.284)mmol/mmol,t=7.349,P<0.001]。两组患者在年龄、性别、估算肾小球滤过率、血压、血尿电解质水平、代谢性碱中毒方面差异均无统计学意义。低尿钙组患者乏力(χ2=4.595,P=0.032)及多尿(χ2=5.778,P=0.016)发生比例低于非低尿钙组,两组患者在其他临床症状方面差异无统计学意义。低尿钙和非低尿钙组各有16例患者行氢氯噻嗪试验,中位ΔFECl结果分别为0.539%(0.430%,1.283%)和0.829%(0.119%,1.298%),均提示对氢氯噻嗪无反应,组间差异无统计学意义(U=130.000,P=0.956)。结论GS患者中低尿钙比例为63.86%,尿钙水平与疾病临床表型、NCC功能损伤严重程度之间均无明确相关性。     

Fibrinogen-thrombin collagen patch reinforcement of highrisk colonic anastomoses in rats

AIM To evaluate the effectiveness of human fibrinogenthrombin collagen patch(TachoSil~?) in the reinforcement of high-risk colon anastomoses.METHODS A quasi-experimental study was conducted in Wistar rats(n = 56) that all underwent high-risk anastomoses(anastomosis with only two sutures) after colectomies. The rats were divided into two randomized groups: Control group(24 rats) and treatment group(24 rats). In the treatment group, high-risk anastomosis was reinforced with TachoSil~? (a piece of Tacho Sil? was applied over this high-risk anastomosis, covering the gap). Leak incidence, overall survival, intra-abdominal adhesions, and histologic healing of anastomoses were analyzed. Survivors were divided into two subgroups and euthanized at 15 and 30 d after intervention in order to analyze the adhesions and histologic changes. RESULTS Overall survival was 71.4% and 57.14% in the TachoSil~? group and control group, respectively(P = 0.29); four rats died from other causes and six rats in the treatment group and 10 in the control group experienced colonic leakage(P 0.05). The intra-abdominal adhesion score was similar in both groups, with no differences between subgroups. We found non-significant differences in the healing process according to the histologic score used in both groups(P = 0.066).CONCLUSION In our study, the use of TachoSil~? was associated with a non-statistically significant reduction in the rate of leakage in high-risk anastomoses. TachoSil~? has been shown to be a safe product because it does not affect the histologic healing process or increase intra-abdominal adhesions.     

罗伊适应模式对腹股沟疝无张力疝修补术后恢复情况的影响

目的探讨罗伊适应模式对患者腹股沟疝无张力疝修补术后恢复情况的影响。 方法将2016年1月至2019年5月在秦皇岛市第二医院择期进行无张力修补术治疗的120例腹股沟疝患者，按照随机数字法分为对照组和观察组，每组各60例。对照组采用常规护理治疗，观察组在对照组的基础上采用罗伊适应模式。比较2组患者的术后临床指标、心理状态、围手术期并发症发生情况及满意度。 结果术后观察组患者的首次排气时间、恢复正常饮食时间、离床活动时间和术后住院时间均低于对照组（P<0.05）；术后观察组患者的抑郁自评量表（SDS）和焦虑自评量表（SAS）评分显著低于对照组（P<0.05）；术后2组患者均无切口感染发生，2组患者尿潴留、急性疼痛、认知功能障碍、发热、血肿等发生率相比无统计学差异（P>0.05）；术后观察组患者护理满意度为96.67%，显著高于对照组的83.33%（P<0.05）。 结论在常规护理的基础上，罗伊适应模式用于患者腹股沟疝无张力修补围手术期，能有效改善术后患者的焦虑/抑郁情绪，不增加围手术期并发症，促进术后患者的恢复及提高治疗满意度。     

Safety and tolerability of single intravenous doses of sugammadex administered simultaneously with rocuronium or vecuronium in healthy volunteers

BACKGROUND: Sugammadex rapidly reverses rocuronium- and vecuronium-induced neuromuscular block. To investigate the effect of combination of sugammadex and rocuronium or vecuronium on QT interval, it would be preferable to avoid the interference of anaesthesia. Therefore, this pilot study was performed to investigate the safety, tolerability, and plasma pharmacokinetics of single i.v. doses of sugammadex administered simultaneously with rocuronium or vecuronium to anaesthetized and non-anaesthetized healthy volunteers. METHODS: In this phase I study, 12 subjects were anaesthetized with propofol/remifentanil and received sugammadex 16, 20, or 32 mg kg(-1) combined with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1); four subjects were not anaesthetized and received sugammadex 32 mg kg(-1) with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) (n=2 per treatment). Neuromuscular function was assessed by TOF-Watch SX monitoring in anaesthetized subjects and by clinical tests in non-anaesthetized volunteers. Sugammadex, rocuronium, and vecuronium plasma concentrations were measured at several time points. RESULTS: No serious adverse events (AEs) were reported. Fourteen subjects reported 23 AEs after study drug administration. Episodes of mild headache, tiredness, cold feeling (application site), dry mouth, oral discomfort, nausea, increased aspartate aminotransferase and gamma-glutamyltransferase levels, and moderate injection site irritation were considered as possibly related to the study drug. The ECG and vital signs showed no clinically relevant changes. Rocuronium/vecuronium plasma concentrations declined faster than those of sugammadex. CONCLUSIONS: Single-dose administration of sugammadex 16, 20, or 32 mg kg(-1) in combination with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) was well tolerated with no clinical evidence of residual neuromuscular block, confirming that these combinations can safely be administered simultaneously to non-anaesthetized subjects. Rocuronium and vecuronium plasma concentrations decreased faster than those of sugammadex, reducing the theoretical risk of neuromuscular block developing over time.     

血浆凝血因子VIII水平与IgA肾病患者临床病理改变及预后的关系

目的探讨血浆凝血因子VIII(factor VIII,FVIII)水平与IgA肾病(IgAN)患者临床参数及预后的关系。方法收集2016年1月至2016年12月中南大学湘雅二医院确诊的IgAN患者的临床资料。按照时间依赖的受试者工作特征曲线(ROC)得出的血浆FVIII预测IgAN预后的临界值,将患者分为高FVIII组(FVIII>140.50%)和低FVIII组(FVIII≤140.50%),比较两组患者肾活检时基线临床参数的差异。以估算肾小球滤过率(eGFR)下降≥30%或进入终末期肾脏病(ESRD)为终点事件,采用Kaplan-Meier生存曲线及Cox回归方程法分析血浆FVIII水平对IgAN患者预后的影响。结果共93例IgAN患者纳入本研究,中位随访时间为35.15(33.77,36.76)个月,12例(12.90%)患者发生终点事件。高FVIII组患者年龄、血肌酐、尿素氮、血三酰甘油、血总胆固醇、血浆纤维蛋白原、D-二聚体、24 h尿蛋白量、蛋白C、蛋白S和eGFR下降速率高于低FVIII组(均P<0.05);eGFR、血白蛋白、中位随访时间低于低FVIII组(均P<0.05)。Kaplan-Meier生存分析结果显示,与低FVIII组比较,高FVIII组患者肾脏累积生存率降低(χ2=5.635,P=0.018)。在校正收缩压、eGFR、尿蛋白、肾小管萎缩/间质纤维化程度等因素后,多因素Cox回归分析结果显示,高血浆FVIII水平是IgAN患者肾脏预后不良的独立危险因素(HR=4.147,95%CI 1.055~16.308,P=0.042)。结论血浆FVIII水平与IgAN患者临床指标及预后相关,高血浆FVIII水平是IgAN患者肾脏预后不良的独立危险因素。     

Factors Associated With Reoperation After Silicone Proximal Interphalangeal Joint Arthroplasty

Background: Silicone proximal interphalangeal (PIP) joint arthroplasty has a high revision rate. It has been suggested that persistent ulnar deviation and joint instability influence the durability of PIP silicone arthroplasties. The goal of this study was to evaluate what factors are associated with reoperation after silicone PIP arthroplasty. Methods: We retrospectively evaluated all adult patients who underwent PIP silicone arthroplasty between 2002 and 2016 at one institutional system for inflammatory-, posttraumatic-, and primary degenerative arthritis. After manual chart review, we included 91 patients who underwent 114 arthroplasties. Fingers operated included 14 index, 41 middle, 38 ring, and 21 small fingers. Results: The overall reoperation rate was 14% (n = 16). Non-Caucasian race (P = .040), smoking (P = .022) and PIP silicone arthroplasty for post-traumatic osteoarthritis (P = .021) were associated with reoperation. The 1-, 5- and 10-year implant survival rates were 87%, 85%, and 85%, respectively. Conclusion: Caution should be exercised when considering PIP silicone arthroplasty of the index finger or in patients with post-traumatic osteoarthritis. It may be worthwhile addressing smoking behavior before pursuing silicone PIP arthroplasty.     

Role of Conventional and Diffusion-Weighted Magnetic Resonance Imaging of Spinal Treatment Protocol for Hydatid Disease

Objective:

To demonstrate the role of magnetic resonance imaging (MRI) in determining the treatment protocol for hydatid disease of the spine.

Design:

Case report; literature review.

Findings:

Diffusion-weighted MRI can help differentiate complicated infected hydatidosis from abscesses, epidermoid cysts from arachnoid cysts, and benign from malignant vertebral compression fractures. It is also helpful in differentiating between abscesses and necrotic tumors.

Conclusion:

Diffusion-weighted MRI can help differentiate between infections requiring immediate surgery and those that can be treated medically with antihelmintic treatment.     

Effect of the implementation of NICE guidelines for ultrasound guidance on the complication rates associated with central venous catheter placement in patients presenting for routine surgery in a tertiary referral centre

BACKGROUND: The National Institute for Clinical Excellence (NICE) guidelines of 2002 recommended the use of ultrasound (US) for central venous catheterization in order to minimize complications associated with central line placement. An ongoing audit of line placement by anaesthetists in the theatre complex of a tertiary referral centre looked at the associated complication rates. The objective of the study was to compare complication rates pre- and post-implementation of NICE guidelines. METHODS: This prospective, single centre audit looked at all patients in whom a central venous catheter was placed for surgery. Complication rates were assessed for procedures that were performed pre- and post-implementation of NICE guidelines. In total, 438 patients were identified for the study, and the procedures were performed either by trainee or by consultant anaesthetists. RESULTS: The pre- and post-implementation complication rates were 10.5% (16/152) and 4.6% (13/284), respectively, representing an absolute risk reduction of 5.9% (95% CI 0.5-11.3%). Comparison of those procedures in which US was used when compared with the landmark technique after implementation found a reduction of 6.9% in complications (95% CI 1.4-12.4%). The reduction in complication rates was larger for specialist registrars than for consultants (11.2% vs 1.6%). CONCLUSIONS: The implementation of NICE guidelines has been associated with a significant reduction in complication rates in our tertiary referral centre. In the light of the cross-speciality evidence of US superiority and our results, it is imperative that routine use of US guidance becomes more widespread.