锁骨远端骨折及肩锁关节脱位的疗效分析

目的比较分析两种不同手术方法治疗不稳定性锁骨远端骨折及肩锁关节脱位的疗效。方法对64例不稳定性锁骨远端骨折及肩锁关节脱位患者,分别行手术切开复位克氏针钢丝张力带和AO锁骨钩钢板治疗,平均随访13个月,采用Karlsson评分标准评估疗效。结果优良率为82.8%,其中克氏针钢丝张力带组优良率为76.3%,AO锁骨钩钢板组优良率为92.3%,两组相比有显著性差异（P〈0.05）。结论对不稳定性锁骨远端骨折及肩锁关节脱位,AO锁骨钩钢板是一种可靠的方法。     

锁骨钩钢板与克氏针张力带固定治疗锁骨远端骨折与肩锁关节脱位

目的 探讨使用锁骨钩钢板与克氏针张力带固定治疗锁骨远端骨折与肩锁关节脱位的疗效.方法 分别采用锁骨钩钢板和克氏针张力带内固定治疗锁骨远端骨折与肩锁关节脱位32例,术后给予前臂悬吊固定,并行肩关节功能锻炼.结果 随访6个月～5年,按照Lazzcano标准评定骨折愈合和肩关节功能优良率,锁骨钩钢板固定优于克氏针张力带(分别为93.3%,64.7%,二者比较P＜0.01).结论 锁骨钩钢板设计合理,对锁骨远端骨折与肩锁关节脱位固定可靠,允许肩关节早期功能锻炼,是一种有效的内固定方法 .     

锁骨钩钢板与克氏针张力带治疗肩锁关节脱位和锁骨远端骨折疗效比较

[目的]比较研究锁骨钩钢板与克氏针张力带治疗肩锁关节脱位和锁骨远端骨折的疗效。[方法]52例肩锁关节脱位或锁骨远端骨折患者，34例采用锁骨钩钢板、18例采用克氏针张力带内固定。回顾性分析比较其手术难易程度、治疗效果及并发症。[结果]术中两组手术难易程度无明显差异，P〉0．05；术后平均随访15个月，锁骨钩钢板组手术并发症发生率为0．0％，肩关节功能评定优良率为97．1％，优于克氏针张力带组的38．9％、72．2％，P〈0．05。[结论]锁骨钩钢板是一种在治疗肩锁关节脱位和锁骨远端骨折上优于克氏针张力带的新方法，值得推广。     

肩锁关节脱位三种治疗方法疗效分析

目的：评价肩锁关节脱位的治疗方法和临床疗效。方法：对86例患者分别行手术切开复位,螺丝钉克氏针内固定、螺丝钉内固定和锁骨钩钢板内固定治疗。平均随访时间1．5年,采用Karlsson评分标准评估治疗效果。结果：优良率为82．6％,其中螺丝钉克氏针内固定组优良率为75％,螺丝钉内固定组优良率为80．9％,锁骨钩钢板内固定组优良率为93．1％,三组比较,有显著性差异（P〈0．05）。结论：对肩锁关节脱位,锁骨钩钢板内固定疗效最佳,术中不一定要修复喙锁韧带、肩锁韧带。     

锁骨钩钢板治疗肩锁关节脱位36 例疗效观察

目的观察锁骨钩钢板治疗Ⅲ度肩锁关节脱位的疗效。方法2002年2月至2005年3月采用锁骨钩钢板内固定治疗新鲜Ⅲ度肩锁关节脱位36例，全部修复肩锁韧带，直接修复断裂的喙锁韧带21例，其余15例未予修复重建。回顾性对比分析以往使用克氏针、螺钉、克氏针张力带治疗同型新鲜肩锁关节脱位80例，进行疗效评定。结果按照Lazzcano标准评定患者术后功能，锁骨钩钢板固定组优良率远高于其他三组，所有患者均未发生感染，无钢板螺钉松动断裂，仅1例并发肩峰下撞击征。结论应用锁骨钩钢板治疗肩锁关节脱位较克氏针、螺钉、张力带治疗具有操作简单、复位好、动态固定、牢固可靠、喙锁韧带等长愈合、肩关节功能恢复快、优良率高、并发症少等特点，内固定取出后不复发，是目前治疗新鲜Ⅲ度肩锁关节脱位疗效确切而理想的方法，可推为首选。     

锁骨钩钢板治疗TossyⅢ型肩锁关节脱位的临床研究

目的比较研究锁骨钩钢板、克氏针张力带及加压螺钉治疗TossyⅢ型肩锁关节脱位的疗效。方法54例TossyⅢ型肩锁关节脱位患者,18例采用锁骨钩钢板、19例采用克氏针张力带、17例采取加压螺钉内固定。依据Kadsson标准回顾性分析比较治疗效果差异。结果术后平均随访12～18个月,锁骨钩钢板组肩关节功能评定优良率为94．44％,优于克氏针张力带组的47．37％及加压螺钉组的58．82％（P〈0．05）。结论锁骨钩钢板在治疗TossyⅢ型肩锁关节脱位上优于克氏针张力带及加压螺钉内固定。     

克氏针张力带与锁骨钩钢板治疗Ⅲ型肩锁关节脱位疗效分析

目的探讨克氏针张力带与锁骨钩钢板治疗Ⅲ型肩锁关节脱位的临床疗效。方法39例Ⅲ型肩锁关节脱位用两种内固定方法治疗。均为成人,分为两组,分别行克氏针张力带内固定和锁骨钩钢板内固定。全部病例均获得随访,时间6~18个月,平均10个月。结果克氏针张力带内固定与锁骨钩钢板内固定在治疗Ⅲ型肩锁关节脱位上结果无明显差异,各有优势。结论克氏针张力带与锁骨钩钢板治疗Ⅲ型肩锁关节脱位均具有固定可靠、术后可以早期肩关节活动等优点,能有效减少并发症,掌握好手术指征,是治疗Ⅲ型肩锁关节脱位的两种较理想方法。     

两种方法治疗肩锁关节脱位和锁骨远端骨折的疗效比较

目的比较采用锁骨钩钢板与克氏针加张力带钢丝内固定治疗肩锁关节脱位和锁骨远端骨折的临床疗效。方法回顾分析并比较采用克氏针加张力带钢丝固定治疗55例肩锁关节脱位和锁骨远端骨折及采用锁骨钩钢板固定治疗的37例肩锁关节脱位和锁骨远端骨折的疗效。结果前者55例患者中54例获得8~18个月随访,50例患者正常愈合,4例患者出现克氏针松动退出,导致固定失败,2次手术。后者37例患者全部获得8~18个月随访,全部正常愈合,无1例固定失败。结论采用锁骨钩钢板固定治疗肩锁关节脱位和锁骨远端骨折固定可靠,成功率高,符合生物力学要求,术后功能康复快,明显优于克氏针加张力带钢丝固定。     

锁骨钩钢板治疗肩锁关节脱位及锁骨远端骨折

肩锁关节脱位或锁骨外侧端骨折，以往采用克氏针、钢丝或螺钉固定，同时行喙锁韧带修补。但常因固定不牢导致骨折再移位或关节脱位，或需长时间外固定，发生肩关节僵硬及无力。2003年1月以来，我科采用锁骨钩钢板治疗肩锁关节全脱位及锁骨外侧端骨折15例，取得了满意的效果。     

AO锁骨钩钢板治疗肩锁关节脱位及锁骨远端骨折

目的 比较研究AO锁骨钩钢板与传统方法治疗肩锁关节脱位与锁骨远端骨折，评估A0锁骨钩钢板治疗肩锁关节脱位与锁骨远端骨折的临床疗效。方法 回顾性分析比较锁骨钩钢板治疗肩锁关节脱位及锁骨远端骨折12例与传统方法(克氏针张力带、钢丝环扎、螺钉固定等)治疗28例的治疗效果及并发症。结果 40例经12～20个月随访，平均14个月。按照Lazzcano标准，两组治疗优良率分别为100％和78．6％。对两组疗效比较作χ^2检验，P=0．025。锁骨钩钢板在治疗效果及并发症发生率上明显优于克氏针、钢丝环扎及螺钉固定等传统方法。结论 AO锁骨钩钢板治疗肩锁关节脱位与锁骨远端骨折具有固定确实，不损伤关节面，可以早期功能锻炼等优点，值得推广。     

Reduction of Plasma Fibrinogen, Immunoglobulin G, and Immunoglobulin M Concentrations by Immunoadsorption Therapy with Tryptophan and Phenylalanine Adsorbents

Abstract Immunoadsorption (1A) therapy with tryptophan (TR-350) or phenylalanine (PH-350) adsorbents has been used to reduce the concentration of serum antibodies in human lymphocyte antigen (HLA)-immunized patients. Other forms of plasma purification have been reported to reduce the level of fibrinogen, which affects the blood properties. In this study we investigated the effects of IA therapy using both adsorbents on plasma fibrinogen and immunoglobulins G and M in 13 patients (8 patients were treated with TR-350, and 5 patients were treated with PH-350). During each session 1 plasma volume (2.8 ± 0.4 L of plasma) was processed through the immunocolumn and then returned to the patient together with the blood cells. Compared with the pretreatment values, the plasma fibrinogen, IgG, and IgM concentrations were significantly reduced after IA therapy (p < 0.01 for TR-350; p < 0.04 for PH-350). There was a positive correlation between the degree of reduction of plasma proteins and the number of IA treatments given. A nonpara-metric test (Wilcoxon's signed-rank test or the Mann-Whitney test) was used for statistical analysis. We conclude from our study that IA therapy effectively lowers the plasma levels of fibrinogen, IgG, and IgM and thus can be considered a valuable alternative to other blood purification methods.     

The multiply injured child

Blunt trauma is the principal cause of childhood death in many developed countries. This review outlines the differences between adults and children with respect to resuscitation and treatment of orthopaedic injuries in a child with polytrauma. Recent advances in techniques of fracture stabilization are reported.     

Development of Selective Low-Density Lipoprotein (LDL) Apheresis System: Immobilized Polyanion as LDL-Specific Adsorption for LDL Apheresis System

Abstract: Low-density lipoprotein (LDL) is widely recognized as one of the major risk factors for developing coronary heart diseases. Despite intensive development of LDL-lowering drugs, there still exist those patients with refractory hyperlipidemia whose plasma LDL levels are not sufficiently lowered by drugs. LDL apheresis, direct removal of plasma LDL from circulating blood, is thought to be the most promising treatment for such refractory patients. Various techniques, such as the use of an im-munoadsorbent utilizing an anti-LDL antibody, have been used in an attempt to achieve the selective removal of LDL. However, none were widely used because of complications, poor selectivity, and so forth. To establish a safe and effective LDL apheresis system, we chose a synthetic affinity adsorbent as the LDL-removing device. Synthetic polyanion compounds were used as the affinity ligands for LDL adsorbent to simulate the anion-rich sequence of LDL binding sites in the human LDL receptor. Among various polyanion compounds, those polyanions with sulfate or sulfonate groups and hydrophilic backbone were found to have strong affinity for LDL. In contrast, polyanions with carboxyl groups showed poor affinity. Dextran sulfate (DS) was selected as the affinity ligand of LDL adsorbent for its high affinity and low toxicity. The influence of its charge density and molecular weight on its affinity for LDL was suitable. The affinity rapidly increased as the charge density increased, then, reached a constant value. Little affinity was found for either the DS monomer (glucose sulfate) or DS with a molecular weight higher than 10⁴ daltons whereas DS with molecular weights in the midrange showed strong affinity. DS with a midrange molecular weight was immobilized on cellulose hard gel to give LDL adsorbent clinical application. The adsorbent demonstrated an excellent selectivity for LDL and very low density lipoprotein (VLDL) in vitro. Adsorption of high-density lipoprotein and major plasma proteins was almost negligible. Additional study of the LDL-binding mechanism revealed that DS directly interacts with positively charged sites on LDL, which demonstrates that the nature of the interaction is the same as that of LDL receptor. An LDL adsorption column (Liposorber) packed with an LDL adsorbent and polysulfone hollow-fiber plasma separator (Sulflux) was developed as an efficient LDL apheresis system. Clinical investigation proved that this system is capable of intensively lowering the plasma LDL level without affecting major plasma components.     

Artificial organs 2010: a year in review

In this Editor's Review, articles published in 2010 are organized by category and briefly summarized. As the official journal of The International Federation for Artificial Organs, The International Faculty for Artificial Organs, and the International Society for Rotary Blood Pumps, Artificial Organs continues in the original mission of its founders "to foster communications in the field of artificial organs on an international level."Artificial Organs continues to publish developments and clinical applications of artificial organ technologies in this broad and expanding field of organ Replacement, Recovery, and Regeneration from all over the world. We take this time also to express our gratitude to our authors for offering their work to this journal. We offer our very special thanks to our reviewers who give so generously of time and expertise to review, critique, and especially provide such meaningful suggestions to the author's work whether eventually accepted or rejected and especially to those whose native tongue is not English. Without these excellent and dedicated reviewers the quality expected from such a journal could not be possible. We also express our special thanks to our Publisher, Wiley-Blackwell, for their expert attention and support in the production and marketing of Artificial Organs. In this Editor's Review, that historically has been widely received by our readership, we aim to provide a brief reflection of the currently available worldwide knowledge that is intended to advance and better human life while providing insight for continued application of technologies and methods of organ Replacement, Recovery, and Regeneration. We look forward to recording further advances in the coming years.     

Avaliação do clube de revista de anestesiologia por meio de mudanças semânticas

Background and objectives

The interactive approach of a journal club has been described in the medical education literature. The aim of this investigation is to present an assessment of journal club as a tool to address the question whether residents read more and critically.

Methods

This study reports the performance of medical residents in anesthesiology from the Clinics Hospital – University of São Paulo Medical School. All medical residents were invited to answer five questions derived from discussed papers. The answer sheet consisted of an affirmative statement with a Likert type scale (totally disagree–disagree–not sure–agree–totally agree), each related to one of the chosen articles. The results were evaluated by means of item analysis – difficulty index and discrimination power.

Results

Residents filled one hundred and seventy three evaluations in the months of December 2011 (n = 51), July 2012 (n = 66) and December 2012 (n = 56). The first exam presented all items with straight statement, second and third exams presented mixed items. Separating “totally agree” from “agree” increased the difficulty indices, but did not improve the discrimination power.

Conclusions

The use of a journal club assessment with straight and inverted statements and by means of five points scale for agreement has been shown to increase its item difficulty and discrimination power. This may reflect involvement either with the reading or the discussion during the journal meeting.     

Soluble TNFα Receptors Are Increased in Chronic Renal Insufficiency and Hemodialysis and Inhibit Neutrophil Priming by TNFα

Abstract: The oxidative burst of neutrophils from azotemic patients is refractory to priming by tumor necrosis factor-α (TNFα). Soluble TNFα binding proteins (TNFR) accumulate in the plasma of azotemic patients. To test the hypothesis that these increased sTNFR concentrations inhibit TNFa priming of oxidative burst activity, we measured plasma sTNFR concentrations in nondialyzed azotemic patients, hemodialysis patients, and normal subjects, and determined TNFa priming of fMet-Leu-Phe-stimulated superoxide production in neutrophils incubated in plasma with differing levels of sTNFR. These sTNFR concentrations increased significantly as creatinine clearance decreased and were significantly greater in hemodialysis patients than could be accounted for by loss of renal function alone. TNFα primed superoxide production by normal neutrophils in normal plasma, but this effect was significantly reduced in plasma with increased concentrations of sTNFR. Neutrophils from azotemic and hemodialysis patients were refractory to priming by TNFα in autologous plasma, and incubation in normal plasma only partially corrected this defect. We conclude that sTNFR accumulate as a result of the loss of renal function and hemodialysis and inhibit TNFα priming of neutrophils in azotemic and hemodialysis patients, but that these cells also have an intrinsic functional defect.     

Lymphocytapheresis

Abstract: Leukocytapheresis has long been performed with the centrifugal method. But in 1989 in Japan, the Asahi Medical Co. developed the extracorporeal leukocyte-removal filter, Cellsorba. This filter consists of non-woven fabric, which can remove leukocytes from whole blood during extracorporeal circulation. In the incipient stage, this filter was applied to collagen diseases, rheumatoid arthritis, and systemic lupus erythematosus. During the following studies, this filter has been found to have an immunosuppressive effect. Now, it is beginning to be applied to various kinds of autoimmune diseases. Moreover, this filter has recently been recognized to be effective in inflammatory bowel diseases, ulcerative colitis, and Crohn's disease. The outline of Cellsorba and the application of this filter is described here.