滑膜切除术治疗血友病关节出血26例随访报告

本文作者报告了２６例（３５个关节）滑膜切除术治疗血友病关节出血的远期随诊结果。３５个关节中（１５个膝关节、１５个肘关节、３个踝关节及２个肩关节）８个膝关节行镜下滑膜切除术，余２７个关节行开放切除术。术后平均随诊５８个月。２１个关节无再出血，占６０％，１４个关节偶有出血，占４０％。关节功能改善者６个关节，占１７。２％，无变化者１１个关节，占３１。４％，减少者１８个关节，占５１。４％，镜下膝关节滑膜切     

关节镜在单关节滑膜炎诊治中的作用

自１９８６年８月～１９９４年６月，我院对３２例原因不明，保守治疗无效的单关节滑膜炎进行关节镜检查及镜下滑膜切除术。镜检结果结合滑膜病理和各项实验室检查，１２例诊断为类风湿性关节炎，４例关节结核，３例色素沉着绒毛结节性滑膜炎，２例慢性化脓性关节炎，１１例慢性非特异性滑膜炎。滑膜切除术后平均随访２年８个月，疗效优者１７例（５３．１％），良８例（２５％），可４例（１２．５％），差３例（９．４％）。作者认为关节镜检查结合滑膜活检可显著提高滑膜炎的病因诊断率，关节镜下滑膜切除术对多种滑膜炎有效，且创伤小，并发症很少，不失为慢性滑膜炎经短期保守治疗无效者较为理想的外科治疗方法。     

膝关节滑膜切除术与关节腔灌洗术在治疗类风湿性关节炎中的疗效分析

[目的]探讨膝关节滑膜切除术与关节腔灌洗术2种不同方法治疗类风湿性关节炎（RA）的疗效。[方法]对32例RA患者（36个膝关节）根据美国风湿病学会（ARA）进行分期，分别采用膝关节滑膜切除术与关节腔灌洗术2种不同方法进行治疗，对其中20例（22个膝关节，以Ⅰ期为主）行关节腔灌洗术配合注射透明质酸钠治疗，对12例（14个膝关节，以Ⅱ期为主）行膝关节滑膜切除术，所有患者术前、术后均给予正规抗类风湿治疗，术后随访6个月，按Lysholm标准评分，判断手术疗效。[结果]术后早期症状均改善，灌洗组优良率为86．4％；滑切组优良率为85．7％。[结论]对于早期RA患者，经系统的抗类风湿治疗后，病变局限于单侧或双侧膝关节时，行关节腔灌洗术配合注射透明质酸钠治疗，可以取得比较满意疗效，对于中期以上滑膜重度增生，关节软骨部分破坏的患者，为抢救关节功能，宜尽早施行开放滑膜切除手术。     

关节镜下滑膜切除术：病例选择和手术技术（附89例报告）

作者旨在说明关节镜下滑膜切除术是治疗早期滑膜炎的优选手术方法。作者从１９８３年２月～１９９２年１２月应用关节镜下滑膜切除术治疗各类滑膜炎，有随访资料的共８９例，１１１个关节。年龄１４～６０岁，平均３８岁。无一例感染，并在术后两周关节活动度恢复正常。随访２～１１年，平均５．９年，仅４例复发，其中２例再手术，疗效肯定。要获得良好的手术效果，必须注意病例的选择，和掌握手术技术。     

滑膜切除术治疗膝类风湿关节炎45例短期随访报告

对４５例类风湿关节炎病人５９个膝关节滑膜切除术进行短期追访及疗效评价．平均年龄４３．４岁，平均随访时间２６．８个月．３３．９％患者疼痛完全缓解，７２．９％肿胀明显减轻，大部分病人自我评价满意，其中Ⅰ、Ⅱ期患者术后优良率达９０％以上．因此作者认为在类风湿关节炎早期，膝关节滑膜肿胀渗出，滑膜切除术仍是值得重视的外科治疗方法之一．     

跖骨头切除的手术方法及疗效分析24例类风湿关节炎前足矫形

自１９８９年起作者对２８例（４５足）类风湿前足畸形施行了跖骨头切除，其中２４例（３９足）获得随访。双侧１５例，单侧９例，经平均３．２年随访，显示临床疗效明显，优良率达７４．３％。作者认为在掌握适应证的条件下，跖骨头切除术不失为治疗类风湿关节炎前足畸形的一种良好术式。本文还分析了第二～五跖骨头切除术结合不同方式第一跖趾关节成形术它们各自的疗效，并就手术具体问题进行了探讨。     

小儿半月板损伤

作者报道了２４例小儿半月板损伤，其中临床表现以漆部疼痛为主，均行半月板切除术治疗随访３－３０年，平均１３．４年，结果优５例，良１０例，可７例，差２例，优良率达到６２．５％。Ｘ线检查发现膝关节有明显退行性改变者占８７％，作者提出术前应全面检查作出准确诊断，手术应尽量保留半月板的功能。     

胆囊癌的外科治疗

探讨各种手术对胆囊癌预后的影响。方法 ６０例胆囊癌患者病变早期组５例，行单纯胆囊切除术；晚期组５５例，行探查活检术２４例，姑息切除２６例，根治性切除术５例结果 早，晚期组１，３，５年生存率分别为１００％，６０％，２０％和１８．２％，５．５％，１．８％，晚期组探量活检术者均在１年内死亡；姑息性切除术者１年生存率２３．１％，无３年，５年生存；根治性切除术者１，３，５年生存率分别为８０％，６０％，２０％     

糖尿病患者的人工膝关节置换

糖尿病患者行人工关节置换术易出现感染、假体松动等并发症。为探讨其有关问题,作者介绍了９例１６膝患者置换人工关节的经验。本组病例术后近期未出现伤口感染,后期深部感染发生率为６．３％。根据ＨＳＳ评分统计。术前平均得分为２８．４分,术后为７８．２分,优良率为９４％。平均随访３．９年,ＨＳＳ平均得分为７４．４,优良率８７．５％,其临床结果与同期置换的２０９例非糖尿病患者的２８７个关节相近。感染率略高于非糖尿病组患者（３．５％）。作者认为,糖尿病患者如果没有严重的心、肾及周围血管并发症,经过周密正确的围手术期处理和良好的血糖控制等内科治疗,是可以接受人工关节置换术的。     

贲门癌切除术后应用丙谷胺辅助治疗的临床观察

为探讨丙谷胺辅助治疗对提高贲门腺癌切除术后生存率的作用。作者对行近侧胃大部分切除术的７３例贲门腺癌病人，术后持续餐前服用丙谷胺，每天３次，每次０．４ｇ。对照组６２例为单纯手术治疗。经３年以上随诊，结果见丙谷胺组１、２、３年生存率分别为８７．７％（６４／７３）、７５．３％（５５／７３）、４３．８％（３２／７３），明显高于对照组（Ｐ＜０．０１和Ｐ＜０．００１）。作者认为丙谷胺服用方便，无明显毒副作用，术后长期服用可提高贲门癌切除术后的生存率。     

The Importance of New Generation Sequencing (NGS) HLA Typing in Renal Transplantation—Preliminary Report

Introduction

Thanks to new generation sequencing (NGS) and expansion of HLA typing with additional loci, it will be possible to increase the effectiveness of graft survival and to avoid complications related to the immune system. New pharmacogenetic factors are still being researched to develop better immunosuppressive treatment.

Impact of lumbar arthrodesis on outcomes after elective total hip arthroplasty

BackgroundAcetabular component malpositioning has been associated with major complications including dislocation, edge-loading, stripe wear and squeaking. Anteversion is determined by pelvic orientation; flexion of the pelvis increases and extension decreases acetabular anteversion. The degree of pelvic movement is determined by lumbar spine sagittal balance and it is well established that lumbar arthrodesis procedures influence spinal and pelvic parameters including sagittal balance. The purpose of this study is to determine the impact of prior lumbar arthrodesis and revision lumbar arthrodesis on complications after primary elective THA.MethodsA database review using the entire Medicare sample within the PearlDiver database was performed using International Classification of Diseases, 9th Edition codes. The search identified 14,439 patients who underwent primary THA after prior lumbar arthrodesis and 1,157 patients who underwent primary THA after prior revision lumbar arthrodesis. A search for patients who underwent primary THA without prior history of lumbar or revision lumbar fusion yielded 749,403 patients who served as a control. Incidence (IN), odds ratios (ORs) and their respective 95% confidence intervals (CIs) for 30-day, 90-day and overall complications were calculated.ResultsThe following complications reached statistical significance (p < 0.001) for THA after primary lumbar arthrodesis: bleeding (IN:9.7%, OR:2.33, CI:2.21–2.47), dislocation (IN:5.6%, OR:1.95, CI:1.81–2.09), infection (IN:3.6%, OR:1.99, CI:1.85–2.12), mechanical complication (IN:0.7%, OR:1.42, CI:1.16–1.73), mechanical loosening (IN:2.3%, OR:1.74, CI:1.56–1.94), other mechanical complication (IN:2.1%, OR:2.13, CI:1.90–2.39), DVT/PE (IN:8.4%, OR:1.50, CI:1.42–1.60), acute renal failure (IN:22%, OR:1.20, CI:1.15–1.25), periprosthetic fracture (IN:1.6%, OR:1.45, CI:1.27–1.65), and prosthetic-related complication (IN:30%, OR:1.85, CI:1.78–1.91). Higher complications rates were observed in patients who had revision lumbar arthrodesis: bleeding (IN:12.4%, OR:3.06, CI:2.57–3.65), dislocation (IN:9.7%, OR:3.54, CI:2.92–4.31), infection (IN:5%, OR:3.32, CI:2.71–4.06), mechanical complication (IN:6.9%, OR:14.94, CI:11.88–18.79), mechanical loosening (IN:3.2%, OR:2.41, CI:1.74–3.35), other mechanical complication (IN:3.5%, OR:3.56, CI:2.61–4.87), DVT/PE (IN:10.7%, OR:1.96, CI:1.63–2.36), acute renal failure (IN:25.5%, OR:1.46, CI:1.28–1.66), periprosthetic fracture (IN:2.7%, OR:2.47, CI:1.72–3.52), and prosthetic-related complication (IN:40%, OR:2.88, CI:2.56–3.24).ConclusionsLumbar arthrodesis and revision lumbar arthrodesis significantly negatively impact postoperative complication rates after THA. Level of Evidence: Therapeutic Level III     

Phalangeal quantitative ultrasound technology and dual energy X-ray densitometry in patients with primary hyperparathyroidism: influence of sex and menopausal status

Fifty-one patients with surgically proven primary hyperparathyroidism (PHPT), 11 males and 40 females, mean age+/-SD: 55.9+/-14.1 years, and 58 age- and sex-matched normal subjects were studied. The femoral and L(2)-L(4) bone mineral density (BMD; Hologic QDR 4500 C), as well as quantitative ultrasonometry (QUS; DBM-Sonic 1200) of the phalanges of both hands were measured in patients and controls. QUS measurements included amplitude-dependent speed of sound (AD-SoS), and other parameters derived from the graphic trace: signal dynamics (Sdy), first wave amplitude (FWA), bone transmission time (BTT) and ultrasound bone profile index (UBPI). Patients with PHPT showed significantly lower dual energy X-ray densitometry (DXA) values and QUS parameters compared to controls (lumbar spine Z-score: controls: -0.16+/-1.12, PHPT: -0.70+/-1.14, P=0.016; femoral neck Z-score: controls: -0.28+/-1.74, PHPT: -1+/-1.01, P=0.013; total femur Z-score: controls: -0.33+/-1.12, PHPT: -1.01+/-0.95, P=0.0013; AD-SoS Z-score: controls: -0.89+/-1.22, PHPT: -1.97+/-1.78, P=0.0003; FWA Z-score: controls: 0.36+/-1, PHPT: 0.62+/-0.85, P<0.0001; BTT Z-score: controls: 0.04+/-1.03, PHPT: -0.45+/-1.37, P=0.044; UBPI Z-score: controls: -0.02+/-1.01, PHPT: -0.68+/-1.05, P=0.002; SDy (mV/micros(2)): controls: -295+/-256, PHPT: -498+/-306, P=0.0003). In male patients, BMD values measured on the lumbar spine and femoral regions were similar to those found in male controls, while QUS values were significantly lower (lumbar spine Z-score: controls: -1.05+/-1.41, PHPT: -1.75+/-1.21, P=0.21; femoral neck Z-score: controls: -0.37+/-1.84, PHPT: -1.11+/-1.14, P=0.27; total femur Z-score: controls: -0.16+/-1.59, PHPT: -1.02+/-1.20, P=0.168; AD-SoS Z-score: controls: -0.52+/-1.58, PHPT: -1.57+/-1.77, P=0.149; FWA Z-score: controls: 0.67+/-1.01, PHPT: -0.74+/-0.79, P=0.0016; BTT Z-score: controls: 1.22+/-0.83, PHPT: 0.75+/-1.51, P=0.478; UBPI Z-score: controls: 0.56+/-0.94, PHPT: -0.47+/-1.10, P=0.025; SDy (mV/micros(2)): controls: -167+/-230, PHPT: -485+/-307, P=0.01). Women with PHPT were further divided into two subgroups: premenopause ( n=11) and postmenopause ( n=29). The premenopausal women with PHPT showed significantly lower DXA values than those of the premenopausal control ones, but similar QUS parameters (lumbar spine Z-score: controls: 0.12+/-0.66, PHPT: -0.59+/-0.85, P=0.03; femoral neck Z-score: controls: 0.06+/-2.85, PHPT: -1.48+/-1.05, P=0.11; total femur Z-score: controls: -0.51+/-0.97, PHPT: -1.48+/-0.63, P=0.009; AD-SoS Z-score: controls: 0.78+/-0.89, PHPT: -1.26+/-1.88, P=0.42; FWA Z-score: controls: 1.14+/-0.77, PHPT: 0.12+/-0.80, P=0.007; BTT Z-score: controls: 0.13+/-0.60, PHPT: 0.25+/-1.15, P=0.757; UBPI Z-score: controls: 0.73+/-0.49, PHPT: 0.24+/-0.96, P=0.15; SDy (mV/micros(2)): controls: -118+/-123, PHPT: -271+/-301, P=0.106). The postmenopausal women with PHPT showed both DXA and QUS parameters significantly lower than those found in the postmenopausal controls (lumbar spine Z-score: controls: 0.09+/-0.96, PHPT: -0.31+/-0.96, P=0.004; femoral neck Z-score: controls: -0.38+/-1.01, PHPT: -0.76+/-0.91, P=0.14; total femur Z-score: controls: -0.33+/-0.97, PHPT: -0.81+/-0.92, P=0.057; AD-SoS Z-score: controls: -1.08+/-1.17, PHPT: -2.38+/-1.68, P=0.31; FWA Z-score: controls: -0.013+/-0.81, PHPT: -0.86+/-0.74, P=0.0009; BTT Z-score: controls: -0.58+/-0.68, PHPT: -1.13+/-0.93, P=0.016; UBPI Z-score: controls: -0.62+/-0.83, PHPT: -1.11+/-0.82, P=0.034; SDy (mV/micros(2)): controls: -419+/-242, PHPT: -589+/-269, P=0.012). The relative risk of osteopenia was significantly increased in PHPT patients at several measurement sites. There was a highly significant correlation between spine and femoral BMD and QUS parameters, while PTH serum levels did not correlate with any of the densitometric variables. In conclusion, QUS parameters would seem to be able to distinguish patients with PHPT from normal controls in male subjects and in postmenopausal women, but not in premenopausal women. This would suggest that the higher estrogen levels in premenopausal patients might preserve the bone from significant structural changes. This may also suggest that hyperparathyroidism, in addition to the reduction of bone mineral content, can cause an alteration of bone structure with an additional increase in fracture risk in postmenopausal women. Furthermore, the alterations in QUS parameters in patients who do not show significant changes in DXA measurements suggest an involvement of bone that is independent of mineral content and may be helpful for selecting candidates for surgery, according to NIH criteria.     

Effect of fluvastatin on apolipoprotein-defined lipoprotein subclasses in patients with chronic renal insufficiency

According to the concept of apolipoprotein (apo)-defined lipoproteins, apoA-I-containing lipoproteins consist of two subclasses referred to as lipoprotein A-I (LpA-I) and lipoprotein A-I:A-II (LpA-I:A-II), and apoB-containing lipoproteins of five subclasses, namely lipoprotein B (LpB), lipoprotein B:C (LpB:C), lipoprotein B:E (LpB:E), lipoprotein B:C:E (LpB:C:E), and lipoprotein A-II:B:C:D:E (LpA-II:B:C:D:E). The purpose of this study was to determine the levels of apoA-I- and apoB-containing lipoprotein subclasses before and after fluvastatin treatment of patients with chronic renal insufficiency. ApoA-I- and apoB-containing lipoprotein subclasses were measured in 15 patients with chronic renal failure and 15 asymptomatic subjects. The effect of fluvastatin on lipoprotein subclasses was determined in a randomized, double-blind, placebo-controlled, two-way, treatment period crossover study. Patients were administered fluvastatin 40 mg/day or placebo during 8 weeks in a randomized order. Patients were characterized by significantly higher levels of LpB (P < 0.001), LpB:C (P < 0.001), and LpB:E (P < 0.05), and slightly higher levels of LpB:C:E and LpA-II:B:C:D:E than controls. The levels of LpA-I:A-II were significantly lower (P < 0.01) in patients than controls. Fluvastatin treatment reduced all apoB-containing subclasses, but only the reduced level of LpB subclass was statistically significant (P < 0.02). The levels of LpA-I and LpA-I:A-II were not affected. Fluvastatin treatment reduced and normalized LpB and LpB:E subclasses. Although slightly reduced, the levels of markedly atherogenic LpB:C subclass were not normalized. The potential role of LpB:C on the progression of coronary artery disease in chronic renal insufficiency remains to be determined in future studies.     

Contributions to know the involvement of cardio-vascular diseases in glaucoma etiology, studied on a sample of 996 patients assisted in Clinic of Ophthalmology, "Prof. N. Oblu" Emergency Hospital, Iasi

MATERIAL AND METHOD: The authors present the results of clinical and epidemiological research on a sample of 8118 patients assisted in the Ophthalmology Clinic of the Hospital "Prof. Dr. N. Oblu", including 996 (12.1%) with glaucoma, of which 54.1% primary open angle glaucoma (POAG), 22.6%, normal tension glaucoma (NTG), 5.7% primary angle closure-glaucoma (PACG) and 17.6% secondary glaucoma, during 2006-2010. RESULTS: For patients with glaucoma authors assessed the prevalence of arterial hypertension (POAG: 33.1%; NTG: 32%; PACG: 8.7%, secondary: 8%), diabetes mellitus (POAG : 19.9%, TNG : 12.9%; PACG : 5.3%, secondary : 5.2%), atherosclerosis (POAG: 10.2%, TNG: 12%; PACG: 5.2%, secondary: 2.9%), vasospasm (POAG: 45 2%, TNG: 47.3%; PACG: 39.3%, secondary: 44.3%).     

Long-term investigations of laser-assisted microvascular anastomoses with the 1.318-micron Nd:YAG laser

Laser-assisted microvascular anastomoses can be performed with the most diverse types of laser (Dujovny et al: 4th Annu Gen Sci Meet LANSI, 1986; Godlewski et al: World J Surg 10:329-333, 1986; Gomes et al: Rev Hosp Clin Fac Med Sao Paulo 37:255, 1982; Quigley et al: Laser Surg Med 5:357-367, 1985; Quigley et al: Lancet 1:334, 1985; Quigley et al: Neurosurgery 18(3):292-299, 1986; Jain: J Microsurg 1:436-439, 1980; Jain: Lancet 2:816-817, 1984; Krueger and Almquist: Lasers Surg Med 5:55, 1985; Neblett et al: Neurosurgery 19(6):914-934, 1986; Schober et al: Science 232:1421-1422, 1986; Ulrich et al: 2nd Annu Gen Sci Meet LANSI, 1984; Ulrich and Bock: Optoelectronics in Medicine, Spring-Verlag 418-423, 1986). However, postoperative complications in the form of thromboses and aneurysmatic sacs could be detected in 7-29.8% in longitudinal investigations. By conversion of the beam geometry (1.3 micron Nd:YAG laser, 200 micron light conductor) and use of three concentrically applied 10.0 backstitch sutures in 25 end-to-end anastomoses of the common carotid artery of adult albino rats 0.8-1.2 mm in diameter, early and late complications could be markedly reduced (12%).     

Detection of early nephropathy in Mexican patients with type 2 diabetes mellitus

BACKGROUND: The aims of this study were to determine the prevalence of early nephropathy in patients with type 2 diabetes mellitus (DM2) attending primary care medical units and to identify risk factors for nephropathy in this population. METHOD: Seven hundred fifty-six patients with DM2 attending 3 primary care medical units were randomly selected. In a first interview, an albuminuria dipstick and a detailed clinical examination were performed, and a blood sample was obtained. If the albuminuria dipstick was positive, then a 24-hour urine collection was obtained within the next 2 weeks to quantify the albuminuria. In the blood sample, glucose, creatinine, and lipids were determined. Glomerular filtration rate was calculated using the Modification of Diet in Renal Disease Study equation. Demographics and medical history were recorded from clinical examination and medical charts. RESULTS: Prevalence of early nephropathy (EN) was 40%, normal function (NF) was found in 31%, and overt nephropathy (ON) in 29%. Patients with more severe kidney damage were older (NF: 54 +/- 10; EN: 60 +/- 11; ON: 63 +/- 10 years, P < 0.05) and had a higher proportion of illiteracy (NF: 11%, EN: 17%; ON: 25%, P < 0.05). The more severe the nephropathy, the longer the median duration of DM2 (NF: 6.0; EN: 7.0; ON: 11.0 years; P < 0.05); the higher the frequency of hypertension (NF: 38%; EN: 52%; ON: 68%; P < 0.05); and the higher the systolic blood pressure (NF: 126 +/- 21; EN: 130 +/- 19; ON: 135 +/- 23 mm Hg; P < 0.05). Both nephropathy groups had a significantly higher proportion of family history of nephropathy (NF: 4%; EN: 9%; ON: 13%) and a higher frequency of cardiovascular disease (NF: 5%; EN: 12%; ON: 25%), whereas only patients with ON had peripheral neuropathy (NF: 21%; EN: 22%; ON: 43%) and retinopathy (NF: 12%; EN: 18%; ON: 42%) more frequently than others. Fasting glucose was poorly controlled in all groups (NF: 186 +/- 70; EN: 173 +/- 62; ON: 183 +/- 73 mg/dL). Large body mass index (NF: 29.3 +/- 5.3; EN: 29.7 +/- 5.6; ON: 29.6 +/- 5.5 kg/m(2)), smoking (NF: 45%; EN: 43%; ON: 44%), and alcoholism (NF: 29%, EN: 29%; ON: 26%) were frequently found in this population, although there were no significant differences. In the multivariate analysis, only age, duration of DM2, and presence of retinopathy, hypertension, and cardiovascular disease were significantly associated with nephropathy. CONCLUSIONS: Two thirds of Mexican patients with DM2 attending primary health care medical units had nephropathy, 40% of whom were at an early stage of the disease. Many modifiable and nonmodifiable risk factors were present in these patients, but the most significant predictors for nephropathy are older age, longer duration of diabetes, and the presence of retinopathy, hypertension, and cardiovascular disease.     

Book Reviews

Book reviewed in this article: VASCULAR SURGERY, VOLUME 1, PERIPHERAL ARTERIAL DISEASES.: By JOHN J. CRANLEY A SHORT TEXTBOOK OF SURGERY.: By SELWYN TAYLOR SURGERY IN WORLD WAR II: ORTHOæDIC SURGERY IN THE ZONE OF INTERIOR.: By MEDICAL DEPARTMENT ANGIOGRAPHY OF TRAUMA.: By WHEI-RUNG FU HAMILTON BAILEY'S “EMERGENCY SURGERY”.: Edited by T. J. McNAIR DU VRIES' SURGERY OF THE FOOT.: Edited by VERNE T. INMAN COMMON SURGICAL EMERGENCIES.: By C. BAKRIE WILLTAMS PATIENT CARE IN CARDIAC SURGERY.: By DOUGLAS M. BEHRENDT THE PARANASAL SINUSES: ANATOMY AND SURGICAL TECHNIQUE.: By FRANK N. RITTER PRINCIPLES OF CLINICAL ELECTROCARDIOGRAPHY.: By MERVIN J. GOLDMAN CURRENT PRACTICE IN ORTHOæDIC SURGERY.: Edited by JAMES P. AHSTROM EXENTERATIVE SURGERY OF THE PELVIS.: By JOHN S. SPRATT FEMORAL SHAFT FRACTURES IN ADULTS.: By GAUKE KOOTSTRA GENERAL UROLOGY.: By DONALD R. SMITH THE OXYGENATOR: VOLUME II OF MANUAL ON ARTIFICIAL ORGANS.: By YUKIHIKO NOSE INSTRUCTIONAL COURSE LECTURES.: By THE AMERICAN ACADEMY OF ORTHOæDIC SURGEONS SYMPOSIUM ON æSTHETIC SURGERY OF THE NOSE, EARS AND CHIN.: Edited by F. W. MASTERS and J. R. LEWIS PLASTIC AND RECONSTRUCTIVE SURGERY OF THE GENITAL AREA.: Edited by CHARLES E. HORTON ATLAS OF æSTHETIC PLASTIC SURGERY.: By JOHN RANSOM LEWIS     

The association between the etiology of a spinal cord injury and time to mortality in the United States: A 44-year investigation

Objective: To determine the association between spinal cord injury (SCI) etiology categories and mortality, and examine the association between etiology sub-categories and mortality.

Design: Prospective cohort study.

Setting: Model Systems and Shriners Hospital SCI units.

Participants: Data were analyzed from 42,627 cases in the SCI Model System Collaborative Survival Study Database from 1973 to 2017. Those with SCI etiologies categorized as vehicular, violent, sports, falls, pedestrian, and medical were included.

Interventions: Not applicable.

Outcome Measure: Time to mortality after SCI.

Results: Relative to the sports related etiology category, those with medical, pedestrian, violence, falls, and vehicular related SCIs had a 2.00 (95% confidence intervals (CIs): 1.79–2.24), 1.57 (CIs: 1.34–1.83), 1.54 (CIs: 1.41–1.68), 1.35 (CIs: 1.25–1.45), and 1.26 (CIs: 1.17–1.35) higher hazard for mortality, respectfully. Persons with SCIs from automobile crashes had a 1.38 (CIs: 1.23–1.56) higher hazard for mortality, whereas those with SCIs from motorcycle crashes had a 1.21 (CIs: 1.04–1.39) higher hazard for mortality, relative to other etiologies within the vehicular category. Those with SCIs from diving had a 1.37 (CIs: 1.18–1.59) higher hazard for mortality relative to other etiologies within the sports category.

Conclusions: Injury etiology categories and certain sub-categories were associated with a higher risk for early mortality. Understanding how additional factors such as socioeconomic status, co-occurring injuries, medical co-morbidities, and environmental aspects interact with SCI etiologies may provide insights for how etiology of injury impacts survival. These findings may serve as a development for extending long-term life expectancy by informing SCI prevention programs and care post-injury.     

Injuries due to falls from a considerable height. A comparative analysis from injuries and clinical course after international or accidental fall Eine vergleichende Analyse von Verletzungsmuster und Verlauf nach suizidalem und akzidentellem Absturztrauma

The aim of this study was to compare the outcome and clinical course of multiple trauma patients with accidental or intentional (suicide related) fall from heights > 4 m. 211 patients with an injury severity score (ISS) > 17 were assigned to the following groups: I: intentional fall, n = 94; A: accidental fall, n = 117) and ISS (I: 28 ± 1; A: 30 ± 1), ventilation time (I: 16 ± 2; A: 15 ± 1) were not different. Significant differences were found in sex (m/f: I: 56/44; A: 73/27 %), fractures of lumbarspine (I: 34; A: 15 %), pelvis (I: 51; A: 38 %), lower leg (I: 47; A: 20 %), pilon (I: 15; A: 5 %), and os calcis (I: 17; A: 9 %). Liver lacerations occured more often after intentional fall (I: 16; A: 6 %). Single or multiple organ failure (MOF) was diagnosed significantly more often in group A (I: 1; A: 8 %). Main cause of death in both groups was single or multiple organ failure (MOF: I: 47; A: 69 %) or related to brain-injuries (I: 35; A: 19 %). Prognosis and rehabilitation of multiple trauma patients after intentional fall is related to brain-injuries, spine-fractures and the functional outcome of the injured lower leg. Prognosis of patients after accidental fall is related to the development of MOF during the ICU-course.