移位的股骨颈骨折手术方法选择与疗效分析

目的比较分析加压空心钉内固定与人工关节置换术治疗中老年移位的股骨颈骨折的适应证与临床疗效。方法1994～2004年分别使用加压空心钉内固定加带血管或肌骨瓣植入术(内固定组43例)和人工髋关节置换术(置换组46例)治疗中老年移位的股骨颈骨折共89例,随访并比较分析疗效及适应证。结果内固定组平均住院天数及手术时间较短,出血量少,与置换组比较差异有显著性意义(P＜0．05)；全部患者获得24～56个月(平均48．5个月)的随访；关节功能评价采用Harris评分,内固定组从术前的平均45．2分提高到术后79．6分,置换组从术前的平均45．2分提高到术后90．4分,两组术后功能差异有显著性意义(P＜0．05)。结论GardenⅢ型的新鲜股骨颈骨折患者(＜65岁)宜首选加压空心钉内固定加带血管或肌骨瓣植入术；年龄相对较大(＞65岁)的GardenⅢ、Ⅳ型患者宜首选人工髋关节置换术。     

加压空心钉与全髋关节置换治疗老年股骨颈骨折的疗效分析

目的 回顾性分析加压空心钉内固定术和全髋关节置换(THA)治疗老年股骨颈骨折的疗效. 方法 2002年1月至2008年6月共收治新鲜股骨颈骨折患者193例,符合入选标准者共60例,27例行加压空心钉内固定治疗,33例行THA.对两组患者的手术时间、术中出血量、住院时间、患肢术后下地活动时间、术后1年患髋Harris功能评分优良率、术后并发症发生率及再手术率进行比较. 结果 60例患者随访时间为12～56个月,平均32.5个月.两组患者在手术时间、出血量、住院时间及下地时间差异有统计学意义(P<0.05),在术后1年患髋Harris功能评分优良率、术后并发症发生率及再手术率差异无统计学意义(P>0.05).空心钉内固定组术后Harris评分优良率为85.2%,THA组为93.9%.空心钉内固定组患者中股骨头坏死3例(11.1%),骨折不愈合1例(3.7%).THA组患者中因假体松动行二次手术者2例(6.1%),另有髋关节脱位1例(3.0%). 结论对于无移位股骨颈骨折均采取内固定治疗;年龄小于70岁、活动能力好、骨质量好的老年移位型股骨颈骨折患者首选闭合或切开空心钉内固定术,保留股骨头是首选;有严重内科合并症不能耐受关节置换的老年患者可采用空心钉内固定治疗;年龄大于70岁的移位骨折及粉碎性骨折患者、伴有严重骨质疏松症或有其他老年病不宜长期卧床者、髋关节本身有骨关节炎的患者首选THA.     

内固定与关节置换治疗老年移位股骨颈骨折的前瞻性比较研究

目的 前瞻性研究比较老年有移位的股骨颈骨折经内固定和关节置换的预后情况.方法 1994年1月～2000年12月,对92例因意外导致新鲜有移位的老年股骨颈骨折(Garden Ⅲ、Ⅳ型)患者随机行内固定或关节置换治疗,内固定组48例,关节置换组36例.随访时比较两种治疗方法的并发症、髋关节功能、日常生活能力和SF-36生活质量指数. 结果 5例失访,3例在随访中死亡,84例获得5～11年(平均6.2年)随访.内固定组(36例)和关节置换组(36例)并发症发生率分别为25.0%和19.4%.两组患者都拥有中等以上的髋关节功能及日常生活能力.生活质量指数都处于相对自理的水平,关节置换组略高于内固定组.结论 老年有移位的股骨颈骨折分别经内固定和关节置换治疗的虽然均有较高的术后并发症发生率,但关节置换组在生活质量上略高于内固定组,因而关节置换治疗应为首选措施.     

生物型加长柄关节置换治疗高龄股骨转子间不稳定骨折的中期疗效分析

目的:探讨生物型加长柄关节置换治疗高龄股骨转子间不稳定骨折的临床疗效。方法:对2015年1月至2018年1月收治的64例高龄股骨转子间不稳定骨折患者进行回顾性分析,根据手术治疗方式分为关节置换组(生物型加长柄关节置换)及内固定组(PFNA)。关节置换组34例,男19例,女15例;年龄(81.32±3.81)岁;骨折Evans分型,Ⅲ型15例,Ⅳ型16例,Ⅴ型3例。内固定组30例,男14例,女16例;年龄(79.90±3.61)岁;骨折Evans分型,Ⅲ型10例,Ⅳ型15例,Ⅴ型5例。患者均因外伤致髋部肿痛、活动障碍,X线片及CT明确股骨转子间不稳定骨折。随访观察患者的手术时间、术中失血量、并发症情况。采用Harris髋关节功能评分及SF-36生活质量评分评价临床疗效。结果:患者手术切口均Ⅰ期愈合。所有患者获得随访,时间13～39个月,平均23.4个月。关节置换组患者手术时间及出血量均多于内固定组(P0.05);关节置换组发生1例肌间静脉血栓及1例因摔伤导致后脱位,内固定组发生1例骨折不愈合,2例肌间静脉血栓,4例轻度压疮,2例内固定松动,两组并发症差异有统计学意义(χ~2=4.929,P=0.026)。末次随访时,关节置换组患者髋关节Harris功能评分优于内固定组(P0.05);关节置换组患者SF-36生活质量评分优于内固定组(P0.05)。结论:采用生物型加长柄关节置换和内固定治疗股骨转子间不稳定骨折,均能获得良好的临床效果,但采用生物型加长柄关节置换治疗,术后并发症更少,髋关节功能恢复更好,患者生活质量及满意度更高。     

55岁以下成年移位股骨颈骨折内固定术后失败的研究分析

目的:回顾性研究年龄55岁以下成年患者移位股骨颈骨折内固定治疗失败病例以提高对其治疗的重视。方法:2007年1月至2010年6月治疗55岁以下移位股骨颈骨折内固定术后失败患者18例,男13例,女5例;年龄27～55岁,平均(48.0±6.0)岁;空心钉治疗17例,髓内钉治疗1例。入院时诊断为股骨头坏死16例,骨不连合并股骨头坏死2例。结果:18例患者内固定术后至手术失败时间8～32个月,平均23个月。复位内固定术后Garden指数不佳;入院时髋关节Harris评分33～80分,平均(56.0±12.5)分。8例股骨头坏死病例和2例骨不连合并股骨头坏死病例接受了全髋关节置换术,5例股骨头坏死病例接受了表面髋关节置换术,3例虽然影像学有股骨头坏死征象但临床症状不明显,接受了保守治疗。所有行髋关节表面置换和全髋关节置换的病例术后随访12～53个月,平均34个月,术后Harris评分(94.0±3.0)分(89～96分)。结论:股骨头坏死是55岁以下成年移位股骨颈骨折闭合复位内固定术后常见并发症,必须提高对青壮年股骨颈骨折闭合复位内固定治疗的重视。     

股骨头置换与内固定治疗高龄不稳定转子间骨折的比较研究

目的:比较股骨头置换与内固定治疗高龄不稳定股骨转子间骨折的临床疗效。方法:回顾性分析2016年1月至2019年1月收治的70例不稳定转子间骨折,采用闭合复位新型股骨近端髓内钉(InterTAN)固定39例,切开转子部重建人工股骨头置换31例。比较2组患者手术时间,术中出血量,住院时间,负重时间,术后并发症发生率及髋关节功能恢复情况(Harris评分)。结果:所有患者获得随访,时间12～24个月,两组术中出血量和住院时间差异均无统计学意义(P0.05),置换组手术时间较内固定组手术时间长(P0.05);置换组术后负重时间明显较内固定组早(P0.05)。置换组有1例肺部感染,1例深静脉血栓形成,1例假体周围骨折;内固定组有4例肺部感染,3例内固定失败,3例脑梗,2例泌尿系感染发生;两组比较差异有统计学意义(P0.05)。术后1个月置换组Harris评分高于内固定组(P0.05),而术后12个月两组Harris评分差异无统计学意义(P0.05)。结论:InterTAN和股骨头置换均可治疗高龄不稳定转子间骨折,但股骨头置换后可以早期下地活动,改善生命终末期的生活质量,减少术后并发症,利于内科共存疾病的治疗。     

中年人移位型股骨颈骨折内固定与关节置换的疗效比较

目的：分析比较年龄55～65岁中年人股骨颈移位型骨折内固定与关节置换的临床疗效。方法 ：2016年9月至2020年8月收治GardenⅢ型或Ⅳ型股骨颈骨折患者86例,根据手术方式的不同将其分为两组。其中38例采用平行拉力螺钉内固定治疗（内固定组）,男26例,女12例,年龄55～64(60.2±3.1)岁;48例进行全髋关节置换术（关节置换组）,男28例,女20例,年龄57～65(61.3±3.8)岁。受伤至手术时间1～3 d。比较两组患者的再手术率,深部感染发生率,髋关节功能Harris评分,疼痛视觉模拟评分（visual analogue scale,VAS）,患者主观报告功能评分采用欧洲五维健康量表（European five-dimensional Health Questionnaire,EQ-5D）。结果：所有患者获得随访,时间24～54(35.8±10.3)个月。平行拉力螺钉内固定组术后再手术率高于较全髋关节置换术组（P<0.05）。两组患者深部感染发生率比较,差异无统计学意义（P>0.05）。两组患者术后12个月时髋关节Harris评分及VAS比较,差异均无统...     

不同手术方法治疗中老年移位型股骨颈骨折的疗效分析

目的评价不同手术方法治疗中老年移位型股骨颈骨折的疗效。方法回顾性分析2006年1月至2009年6月收治的80例分别采用内固定（A组,25例）、人工股骨头置换（B组,27例）及全髋关节置换（C组,28例）手术治疗的中老年移位型股骨颈骨折患者资料,分析比较其住院时间、手术时间、术中出血量、术后并发症、术后Harris评分总分及分类评分等指标。结果 A组手术时间最短,术中出血量最少,C组手术时间最长,术中出血量最多;A组术后并发症发生率较B、C组高;随访结果B组Harris评分最低,C组最高;分类评分中C组的疼痛评分较B组高;功能评分C组最高,B组最低,以上差异均有统计学意义。A组、B组、C组住院时间差异及三组患者间的行走评分、活动度评分差异均无统计学意义。结论空心加压螺钉内固定适于相对年轻,骨质条件好,伤前活动能力较好且术后能耐受晚期负重的中年患者,全髋置换适于外伤前身体状况良好、术前活动量多、预期寿命较长或已有髋关节疾病的老年患者,人工股骨头置换适于一般情况较差、有较严重内科合并症但术前评估能耐受一般手术的患者。     

关节置换与内固定治疗高龄股骨粗隆间骨折的比较

[目的]比较关节置换与内固定治疗高龄股骨粗隆间骨折的临床疗效。[方法]回顾性分析2017年7月—2018年12月行手术治疗的120例高龄股骨粗隆间骨折患者,其中,60例采用关节置换,60例采用股骨近端抗旋转髓内钉(proximal femoral nail anti-rotation, PFNA)内固定。比较两组术前、围手术期、随访及影像学资料。[结果] 120例患者均顺利完成手术。固定组在手术时间、术中出血量、切口长度、术后引流量方面均优于置换组,而置换组在术中透视次数、住院时间方面显著优于固定组,差异均有统计学意义(P0.05)。两组患者随访12～36个月,平均(20.01±6.76)个月。置换组术后下地行走时间及完全负重活动时间均明显早于固定组(P0.05)。随时间推移,两组患者VAS评分显著减少(P0.05),而Harris评分显著增加(P0.05)。术后1个月,固定组VAS评分显著小于置换组(P0.05),术后6个月和末次随访时,两组间VAS评分差异无统计学意义(P0.05)。术后1个月和6个月时,置换组患者髋关节功能Harris评分均显著高于固定组(P0.05)。末次随访时,两组间髋关节功能Harris评分差异无统计学意义(P0.05)。[结论]关节置换及PFNA内固定两种方法治疗高龄股骨粗隆间骨折均可以取得满意的临床效果。个性化选择治疗方案是获得满意治疗效果的关键。     

空心螺钉内固定与人工双极股骨头置换治疗老年股骨颈骨折疗效比较

目的比较空心螺钉内固定和人工双极股骨头置换治疗股骨颈骨折的疗效。方法 65例老年股骨颈骨折患者中,35例采用空心螺钉内固定术（A组）治疗,30例采用人工双极股骨头置换（B组）治疗。观察2组手术时间、术中出血量、术后患者卧床时间及髋关节Harris评分。结果与A组比较,B组术中出血量较多（P〈0.05）、术后患者卧床时间较长（P〈0.05）、髋关节Harris评分较高。结论人工双极股骨头置换和空心螺钉内固定治疗老年股骨颈骨折疗效均可;应根据患者情况选择术式。     

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。     

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。     

Long-term follow-up of callotasis lengthening of the capitate after resection of the lunate for the treatment of stage III lunate necrosis

The callotasis lengthening technique was used to gradually lengthen the capitate after resection of the lunate in stage IIIa necrosis in 23 patients. Results of ten patients with a follow-up of at least 5 years showed rapid and sufficient callus formation in every patient regardless of age. The callotasis lengthening modification of the Graner II operation provides all advantages and avoids the major inconvenience of the traditional Graner II operation. There was no increased rate of disturbed fracture healing. Results of the DTPA-gadolinium MRI study did not show any significant impairment of vascularization within the region of the capitate bone. With the “intrinsic bone formation,” contrary to every other intercarpal arthrodesis at the wrist, there is no need for an additional bone graft.     

Comparison of University of Wisconsin and University of Pittsburgh solutions for heart transplantation

The effectiveness of University of Wisconsin (UW) and University of Pittsburgh (UP) solutions for the preservation of rat hearts was compared. Lewis rat hearts were preserved with UW (group A, n=45) or UP (group B, n=45) solution for 0 or 24 h and then transplanted heterotopically into the recipients' abdomen. Ten recipients in each group were observed to obtain 1-week graft survival rates. Tissue water content and tissue content of adenine nucleotides were measured 2 h after transplantation in six grafts from each group. Six hearts preserved for 0 h and seven hearts preserved for 24 h were taken from each group 24 h after grafting for histopathology. The 1-week graft survival rates of groups A24 and B24 were 60% and 10%, respectively. In the 24-h preserved grafts, adenosine triphosphate (ATP) and energy charge [(ATP+adenosine diphosphate/2)/(ATP+adenosine diphosphate+adenosine monophosphate)] of groups A and B were 0.972±0.165 and 0.200±0.123 mg/g wet tissue (P<0.05) and 74.4% and 61.1% (P<0.05), respectively. The tissue water content of group A24 was 71.7%, whereas that of group B24 was 74.1% (P<0.05). Histopathology revealed more severe muscle edema and necrosis and infiltration of polymorphonuclear cells in group B24 than in group A24. We conclude that UW solution is more appropriate for rat heart preservation than UP solution.     

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.     

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.     

Prolongation of lung xenograft survival in rats with a short course of deoxyspergualin and cyclosporin A

The efficacy of 15-deoxyspergualin (DSG), cyclosporin A (CyA), and splenectomy-alone or in combination-in prologing the survival of concordant lung xenotransplants was studied in the hamster-to-rat model. In the untreated group, rejection occurred within 3 days, with an elevation of lymphocytotoxic antibody titers. The rejected lung revealed that ED1+cells were more prevalent than MRC OX8+cells in the perivascular infiltrates. In the DSG group, the antibody response was suppressed and median survival increased to 7.5 days. The rejected lungs demonstrated a highly significant depression in ED1+cellular infiltration and a moderate MRC OX8+cellular infiltration. When maintenance CyA was combined with a short course of DSG, survival dramatically increased to beyond 100 days. There were no deposits of IgM, IgG, or C3 or of any cell infiltrate in the grafts of two animals sacrificed 107 and 119 days post-transplantation. We conclude that initial treatment with DSG combined with continuous CyA can suppress acute rejection in the hamster-to-rat lung xenograft model, resulting in longterm graft survival.     

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.     

Synergistic effect of donor-specific blood transfusion and a short course of deoxyspergualin in rat kidney transplantation

Deoxyspergualin (DSG), an analogue of spergualin produced by B. laterosporus, has a strong immunosuppressive effect in various transplantation models. We have investigated the mechanism of donor-specific prolongation of survival time in rat kidney grafting by donor-specific blood transfusion (DST) and a short course of DSG. Lewis (LEW) kidney allografts were transplanted into fully allogeneic BN rats. Fresh, whole LEW blood 1.0 ml, was injected i.v. into BN rats 2 days prior to transplantation. Then, DSG, 6 mg/kg per day, was administered by i.m. injection on days 0, 1, and 2 after transplantation. The recipients were divided into five groups: group 1 (n=6) no treatment: group 2 (n=6) DST only; group 3 (n=7) DSG only; group 4 (n=7) DST and DSG; and group 5 (n=6), third party (ACI rats) blood transfusion and DSG. Lymphocytes (cervical lymph nodes) and serum were harvested from BN recipients on day 7 postgrafting. For suppressor cell assays, lymphocytes from BN recipients in each group were added as a third cell to the mixed lymphocyte reaction (MLC) between nontransplanted BN lymphocytes (responder) and LEW or other third party (PVGC, ACI, WKA rats) lymphocytes (stimulator). Antidonor lymphocytotoxic antibody (ADLA) was checked by microcytotoxicity assays. Median survival times (MST) for each group were: group 1, 10 days; group 1, 10 days; group 3, 13 days; group 4, 75 days; and group 5, 13 days. Remarkable prolongation of MST was only noted in group 4. In the suppressor cell assay, group 4 showed significant suppression (40%; P<0.05); the other groups did not show any suppression. This suppressive activity in group 4 was effective only during the MLC between BN and LEW, not during the MLC of third party-BN combinations. Thus, suppressor cells from DST/DSG-treated BN recipients appear to be donor-specific. In the microcytotoxicity assay, the only group that showed any ADLA was group 2, which was not treated with DSG. These results clearly show that both induction of donor-specific suppressor cells and inhibition of ADLA production are associated with the remarkable donor-specific prolongation of kidney allograft survival in DST/DSG-treated recipients.