Injection of intra-articular sodium hyaluronidate (Sinovial) into the carpometacarpal joint of the thumb (CMC1) in osteoarthritis. A prospective evaluation of efficacy

ObjectiveTo compare the efficacy on pain relief and function of one, two or three injections of intra-articular hyaluronic acid in symptomatic osteoarthritis (OA) of the carpometacarpal joint of the thumb (CMCJ).MethodsAmong subjects with symptomatic OA of the CMCJ of the thumb referred to the Rheumatology Department of Nice, patients free of any joint injection in last 6 months with pain visual analogue score (VAS) >40 and with Kellgren and Lawrence score between 2 and 4 were included. Each subject was randomly allocated to receive, at weekly intervals, 1 (group 1) or 2 (group 2) or 3 injections (group 3) of 1 ml Sodium Hyaluronidate (Sinovial^®). Injections were given under imaging control. Sociodemographic characteristics, VAS and functionality (Dreiser Functional Index) were assessed at baseline, at one month and at three months. An intention to treat analysis was performed.ResultsForty two subjects were enrolled in the study. Their mean age was 64.8 (8.0) years, and 90.5% were women. Baseline pain VAS, and mean Dreiser functional index were respectively 57.7 (17.1) and 12.5 (5.8). A repeated measure analysis of variance (ANOVA) model was used to compare the time-course profile of the three treatment groups for VAS and Dreiser index. Due to statistically significant groups-time interaction the analyses were conducted at each evaluation time. No difference was found for VAS at 1 month (p = 0.075) and 3 months (p = 0.382). Intra group differences between baseline and three months was significant in groups 2 and 3 (p = 0.012 and p = 0.002).ConclusionNo significant differences were found between each group over the study period for pain relief and function. But the intra groups analysis results show that intra-articular sodium hyaluronidate injections into the carpometacarpal joint of the thumb in osteoarthritis can be efficacious on pain and fuctionality. What is now needed is a controlled placebo randomised study with larger samples and longer term follow up of the achieved effects.     

Percutaneously absorbed NSAIDs attenuate local production of proinflammatory cytokines and suppress the expression of c-Fos in the spinal cord of a rodent model of knee osteoarthritis

BackgroundNonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used in clinical situations to reduce inflammation and pain. Percutaneous administration is one of the routes mainly used in Japan to deal with the pain from acute injuries, to chronic pain such as chronic low back pain and osteoarthritis (OA). There have been no studies that report the effect of percutaneous administration of NSAIDs on chronic pain in animal models. This study aimed to investigate the effect of percutaneously absorbed NSAIDs on a rodent model of OA.MethodsOA was induced with an intra-articular injection of monoiodoacetate into the right knees (left knee was treated with saline, normal control) of female Sprague-Dawley rats. Physical evaluation, diameter, and the range of motion (ROM) of the knee joint, as well as pain-related behavior, were evaluated. Animals were killed and perfused 7 days after the intra-articular injection, and then local tissue from the knee [for cytokine assay: tumor necrosis factor (TNF)-α, interleukin (IL)-6, and nerve growth factor (NGF)] and spinal cord (immunostained for c-Fos protein reflecting neuronal excitation) were evaluated (n = 7 each). Twenty-eight days after the injection, the other rats were then divided into three groups and were identified by a plaster tape containing an NSAID or a vehicle applied to their OA (ipsilateral) knees: a vehicle-treated group, a loxoprofen-treated (lox) group, and a ketoprofen-treated (ket) group. The behavior elicited by von Frey hairs, inflammatory cytokines, and c-Fos protein at 0, 8, and 24 h after tape application were evaluated (n = 7 each). The plaster tapes contained corresponding NSAIDs used in clinical settings: lox 2.8 mg and ket 1.1 mg. Three of the OA animals were histologically evaluated.ResultsAs the OA progressed, the ipsilateral knee joint showed OA-like appearance physically and histologically. The knee diameter increased and ROM decreased significantly (P < 0.05), showing histological OA-like cartilage degeneration. Pain threshold decreased significantly according to OA progression (P < 0.05). NSAID application significantly improved the threshold 24 h after application in both the lox and ket groups (P < 0.05) without any significant difference between groups. Cytokine concentrations and c-Fos were significantly suppressed in both lox and ket groups (P < 0.05). Lox suppressed TNF-α and NGF more than ket, whereas ket suppressed IL-6 more.ConclusionSuppression of proinflammatory cytokines and c-Fos expression by clinically used NSAIDs suggests that their percutaneous administration may have an analgesic effect for treating chronic pain at a molecular level.     

Influences of purposeful activity versus rote exercise on improving pain and hand function in pediatric burn

PurposeTo explore the influences of purposeful activities versus rote exercises on pain, range of motion and hand function in children with hand burn.MethodsThirty patients had superficial and deep partial and full-thickness burns, including hand and wrist with less than 25% total body surface area (TBSA) was included in this study. The patients were randomly allocated to one of the two groups; purposeful activity group (PA-group, n = 15) and rote exercises group (Rex-group, n = 15). Outcomes measured were pain severities using the self-report faces scale and analogue scale (VAS), total active motion (TAM) using standard dorsal hand goniometer, and hand function using Jebsen–Taylor hand function test (JTHFT). Measurements were recorded 72 h post-burn, after 1, 2, and 3 weeks, at the time of discharge and at 3 months follow up.ResultsIn PA-group, results regarding to pain modulation (p < 0.05), TAM (p < 0.01), and JTHFT (p < 0.01) was statistically significance in comparison to Rex-group.ConclusionThis study supports the belief that the purposeful activity based on playing, and games can reduce pain, improve hand movement and functions better than rote exercise. As well as its reusability and versatility, suggesting another option in the rehabilitation of children with hand burn.     

The influence of fault on health in the immediate post-crash period following road traffic crashes

ObjectiveTo compare the early health status of people who sustained injuries during road traffic crashes (RTC) in which they were at fault (AF), with people who sustained injuries in RTC in which they were not at fault (NAF).DesignProspective cohort study.SubjectsPeople presenting to the emergency department with mild to moderate musculoskeletal injuries following RTC.Main outcome measuresPhysical Component Score (PCS) and Mental Component Score (MCS) of the Short Form 36 (SF-36) health status measure; Hospital Anxiety and Depression Scale (HADS) and the Functional Rating Index (FRI) recorded immediately post-crash.Results193 people participated in the study and were enrolled a mean of 9.3 days following the crash. The mean age was 37 years and 60% were female. 71% were NAF. There was a significantly higher number of females in the NAF group (65% compared with 35% males; p < 0.001). Neck and back injuries were reported by 90.4% of the NAF group compared to 69.1% of the AF group (p < 0.001). There were no significant differences in PCS, FRI or pain intensity between the two groups at a mean of 9.3 days after the crash. The mean MCS for the NAF group was significantly worse than for the AF group (31.4 compared to 37.3; p = 0.005). The SF-36 domain revealed a significantly worse adjusted mean role emotional score for the NAF group (23.4 compared to 32.5, p = 0.002). Females had significantly worse MCS score than males (30.6 and 38.1 respectively; p < 0.001) and worse adjusted mean anxiety and depression scores (10 compared to 7.8; p = 0.002 and 7.6 compared to 5.5; p = 0.002 respectively).ConclusionsDespite there being no difference in physical health status, the NAF group demonstrated more emotional and mental disturbance than the AF group; and this was significantly worse for females. Treatment strategies should focus on addressing early pain and disability as well as providing appropriate psychological interventions, particularly for people not at fault following RTC.     

Effectiveness of therapeutic ultrasound in adhesive capsulitis

ObjectiveThere is a lack of evidence about the effectiveness of therapeutic ultrasound (US) compared with placebo US in the treatment of adhesive capsulitis. This study was performed to assess the effectiveness of therapeutic US in the treatment of adhesive capsulitis.MethodsForty-nine patients with adhesive capsulitis were randomized to US (n = 25) and sham US (n = 24) groups. Superficial heat and an exercise program were given to both groups. Ultrasound was applied to US group and imitative ultrasound was applied to sham US group for 2 weeks. Shoulder range of motion (ROM), pain and Shoulder Pain and Disability Index (SPADI) were assessed at the beginning, after treatment and after 3 months (control). Short Form-36 (SF-36) was applied for assessing general health status at the beginning and after 3 months. Compliance with the home exercise program was recorded daily on a chart for 3 months.ResultsShoulder ROM, pain with motion, two subscales and total score of SPADI and physical component summary score of SF-36 were improved significantly in both groups after the treatment and after 3 months (p < 0.0001). Improvements in flexion, inner and outer rotation values were significantly higher in the US group when we compared the differences between post- and pre-treatment values of shoulder ROM. The differences between control and pre-treatment values of inner and outer rotation were also significantly higher in the US group (p = 0.002 and p = 0.02 respectively). No significant difference was detected in pain, SPADI and SF-36 scores between groups. The exercise compliance was significantly higher in the sham US group (p = 0.04).ConclusionOur results suggest that US compared with sham US gives no relevant benefit in the treatment of adhesive capsulitis. Effectiveness of US might be masked by worse pre-treatment values of the US group and higher exercise compliance of the sham US group.     

Mean platelet volume (MPV) as an inflammatory marker in ankylosing spondylitis and rheumatoid arthritis

AimsThe aim of this retrospective study was to investigate the correlation between MPV and the clinical disease activity indices of rheumatoid arthritis and ankylosing spondylitis.MethodsThe study consisted of 32 active RA patients (males/females: 7/25, mean age: 49 ± 13) and 30 active AS patients (males/females: 15/15, mean age: 36 ± 12) along with 26 osteoarthritis (OA) patients (males/females: 4/22, mean age: 52 ± 8) and 29 age-matched healthy subjects (males/females: 5/24, mean age: 41 ± 7) as control groups for RA and AS, respectively.ResultsMPV was significantly lower in both AS patients and RA patients with active disease as compared to controls (RA vs OA p < 0.001, AS vs healthy subjects p < 0.001). After treatment MPV values significantly increased in AS and RA (p < 0.001 for all). However, MPV values remained somewhat lower in RA patients than OA patients (p = 0.019). There was a negative correlation between MPV values and BASDAI scores in AS patients after two months of treatment (r = ?0.507; p = 0.004).ConclusionOur results suggest that assessment of MPV may provide additional information about inflammation in AS and RA.     

Patient age and positive margins are predictive factors of residual tumor on mastectomy specimen after conservative treatment for breast cancer

AimsTo determine factors predictive of the presence of residual tumor on the specimen from mastectomy performed after conservative treatment for breast cancer in order to limit potentially unnecessary mastectomies (free of residual lesions).Materials and methods294 patients treated in 2 expert centers for breast cancer with breast-conserving therapy (BCT) followed by mastectomy, according to French recommendations, were investigated between January 1, 1998 and January 1, 2005. Patients with residual tumor on the mastectomy specimen were compared with patients whose mastectomy specimens did not reveal any residual tumor. All the clinical risk factors (age, previous history of breast cancer, tumor focality) and histological risk factors (tumor size, histological type, positive margins, estrogen and progesterone receptor expression, histological grade) for residual tumor after BCT were compared between the 2 patient groups.ResultsOf the 294 patients studied, 202 (68.71%) mastectomies had residual tumor and 92 (31.29%) were tumor-free. Four predictive factors for residual tumor were found in the univariate analysis: age under 45 years (p = 0.01), absence of estrogen receptor expression (p = 0.05), positive margins (p = 0.01), and presence of lymph node metastases (p = 0.05). The multivariate analysis revealed only 2 independent risk factors that were significantly associated with increased risk of residual tumor on the mastectomy specimen: age under 45 years (p = 0.05) and presence of positive margins on the lumpectomy specimen (p = 0.05).ConclusionYoung age of patients (under 45-years-old) and presence of positive margins on the operative specimen are independent risk factors of residual tumor after conservative treatment of breast cancer.     

Serum resistin level is associated with radiographic changes in hand osteoarthritis: cross-sectional study

ObjectiveThe aim of this study was to determine whether adipokines such as adiponectin and resistin were related to radiographic outcomes in patients with hand osteoarthritis (OA).MethodsA total of 156 female subjects (46 controls, 60 non-radiographic hand OA, and 50 radiographic hand OA) were enrolled. We measured serum adiponectin and resistin concentrations using an enzyme-linked immunosorbent assay (ELISA). Radiographic hand OA was defined by the presence of a ≥ 2 Kellgren-Lawrence radiological grade after assessment for 20 joints of both hands. The association between radiographic hand OA and each adipokine was assessed using multivariate logistic regression models controlling for confounding clinical parameters.ResultsSerum resistin levels in radiographic hand OA patients were higher than in non-radiographic hand OA and controls (p_adj = 0.020 and p_adj = 0.019, respectively), whereas there were no significant differences in serum adiponectin levels. The presence of radiographic changes in hand OA was shown to be dependent on serum resistin levels (p_adj = 0.028). Specifically, subchondral erosion in radiographic hand OA was associated with serum resisitin (p_adj = 0.028). However, there were no associations of serum adipokines with joint space narrowing, bony ankylosis, and cortical destruction.ConclusionsThis study suggests that resistin is involved in radiographic changes in hand OA, and that adipokines contribute to pathogenesis in radiographic outcomes in hand OA.     

Early or delayed operation,which is more optimal for kyphoplasty? A retrospective study on cement leakage during kyphoplasty

PurposeTo retrospectively assess the optimal operating time for kyphoplasty as far as the cement leakage during kyphoplasty is concerned.Materials and methodsOne hundred and six patients with a total of 117 osteoporotic vertebral compression fractures (VCFs) were enrolled in our study. According to the time of kyphoplasty, they were divided into two groups: group 1 (early operation group, who received the operation within 14 days after fracture, n = 46) and group 2 (delayed operation group, who received the operation between 15 and 28 days after fracture, n = 71). Preoperative and postoperative visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores were compared 3 days after surgery within each group and between the two groups. The radiographic outcomes were evaluated by the restoration rate (RR) of the treated vertebrae. The outcome of cement leakage was assessed after surgery using X-ray and computed tomography (CT) scans. Leaks of cement were classified into three types: those via the basivertebral vein (type B), via the segmental vein (type S) and through a cortical defect (type C).ResultsThe mean VAS and ODI scores decreased significantly from pre-surgery to post-surgery in each group, as did the RR (p > 0.05). There was no significant difference postoperatively on VAS and ODI scores (p > 0.05) between the two groups. However, significant differences were observed postoperatively on RR (p = 0.045) and vertebrae with leakage (p = 0.038). In addition, there was a significant difference on leakage site of type C between the two groups (p = 0.032).ConclusionBoth early and delayed operations of kyphoplasty can achieve satisfactory clinical and radiographic outcomes for osteoporotic VCFs. The risk of cement leakage during kyphoplasty will decrease obviously in delayed operation; so delayed operation, perhaps 2 weeks after fracture, is more safe and optimal than early operation as far as cement leakage is concerned, especially for vertebrae with cortical defects. But early operation of kyphoplasty is more effective in vertebral height restoration.     

Bone mass and anthropometry in patients with osteoarthritis of the foot and ankle

BackgroundPatients with hip and knee osteoarthritis (OA) have high bone mineral density (BMD) and high BMI. If the same accounts for patients with foot or ankle OA is unknown.MethodsWe measured BMD and femoral neck (FN) width by dual-energy X-ray absorptiometry in 42 women and 19 men with idiopathic OA in the foot or ankle, and in 99 women and 82 men as controls.ResultsWomen with OA had significant higher BMI than controls. Women with OA had higher BMI-adjusted BMD (p < 0.01) and smaller BMI-adjusted FN width (p < 0.01) than controls. Men with OA had higher BMI adjusted-BMD (p < 0.05) and smaller BMI-adjusted FN width (p < 0.01) than controls.ConclusionPatients with OA in the foot or ankle have higher BMD and smaller bone size than being expected by their BMI. This phenotype may provide unfavourable forces across the joint and is hypothetically important for development of OA.     

Effect of impact exercise and its intensity on bone geometry at weight-bearing tibia and femur

Introduction:Physical activity is known to enhance the mechanical competence of bone. However, information about the optimal type of exercise is limited. The aim of this study was to evaluate the contribution of jumping exercise to changes in bone geometry.Methods:We carried out a 12-month population-based trial with 120 women (aged 35–40 years), randomly assigned to an exercise group or to a control group. The exercise regimen consisted of supervised, progressive high-impact exercises three times per week and an additional home program. The intensity of impact loading was assessed as the magnitude of acceleration peaks using an accelerometer-based body movement monitor. The activity was analyzed as the daily number of impacts within five acceleration ranges (0.3–1.0g, 1.1–2.4g, 2.5–3.8g, 3.9–5.3g and 5.4–9.2g; g = acceleration of gravity, 9.81 m/s²). Bone geometry was assessed with spiral quantitative computed tomography (QCT) scanner at mid-femur, proximal tibia and distal tibia.Results:Thirty-nine women (65%) in the exercise group and 41 women (68%) in the control group completed the study. QCT and physical activity data were available from 65 subjects. The exercise group showed a significant 0.2% (p = 0.033) higher gain in bone circumference compared to the control group at mid-femur. Subgroup analyses revealed geometric changes indicating up to a 2.5% increment in bone strength in favor of the most active exercisers (> 66 exercise sessions during the 12 months) compared to the least active exercisers (< 19 sessions). In pooled groups, the changes in cortical attenuation and cross-sectional moment of inertia correlated positively (p < 0.05–p < 0.01) with the number of impacts exceeding 1.1g, while changes in cortical thickness (p < 0.05) and bone circumference (p < 0.05–p < 0.01) were positively associated with impacts 3.9g, or more. The number and intensity of impacts during the 12 months were the most significant predictors of changes in bone geometry explaining up to 36% of changes.Conclusions:Bone geometry adapts to impact exercise and the adaptation is most marked at the mid-femur. The changes in bone geometry are associated with the number and intensity of daily impacts while the redistribution of bone mineral appears to be the main mechanism in the skeletal adaptation to varying intensities of exercise.     

Role of respiratory viruses in pulmonary exacerbations in children with cystic fibrosis

BackgroundThe role of respiratory viruses in cystic fibrosis (CF) exacerbations is incompletely understood.MethodsCross-sectional study of CF children with a pulmonary exacerbation. Mid-turbinate swabs were tested by a direct immunofluorescent antibody assay and a multiplex PCR panel (ResPlex II v2.0, Qiagen). Resplex II was also applied to sputum or throat swab samples. Pulmonary function tests and quality of life and severity scores were recorded. Sputum cell counts, bacterial density and cytokines were measured.Results26/43 (60.5%) subjects tested positive for at least one respiratory virus by any diagnostic method applied to any sample type. Virus-positive patients were younger (p = 0.047), more likely to be male (p = 0.029), and had higher CF clinical severity (p = 0.041) and lower quality of life (physical) scores (p = 0.023) but similar IL-8, neutrophil percentage and elastase levels.ConclusionsCompared to non-viral exacerbations, viral-related exacerbations were associated with worse severity and quality of life scores but similar pulmonary inflammation.     

Radiation exposure in whole-body computed tomography of multiple trauma patients: bearing devices and patient positioning

BackgroundWhole-body computed tomography (WBCT) plays an important role in the management of severely injured patients. We evaluated the radiation exposure of WBCT scans using different positioning boards and arm positions.MethodsIn this retrospective study, the radiation exposure of WBCT using a 16-slice multislice computed tomography scanner was evaluated. Individual effective doses (E, mSV) was calculated. Patients were assigned to two groups according to placement on a plastic transfer mat (PTM, group 1) or on the Trauma Transfer?-Board (TTB, group 2). Data were collected for each group with arm placement on the abdomen (a) or in raising position (b), respectively. The maximum ventro-dorsal diameter [VDD] at the trunk was measured.Results100 patients with potentially life-threatening injuries were analysed. Patient demographics and VDD did not differ in the two groups. Radiation exposure in term of E did not reveal any significant differences between the two positioning boards using same arm position [group 1a (n = 26) vs. 2a (n = 24) (mSV): 16.7 ± 4.7 vs. 17.1 ± 4.4, group 1b (n = 26) vs. 2b (n = 24) (mSV): 13.1 ± 3.9 vs. 14.3 ± 1.5]. The arm raising positioning showed a significant reduction in E in comparison to the placement on abdomen position [group 1b vs. 1a (mSV): 13.1 ± 3.9 vs. 16.7 ± 4.7, p < 0.05, group 2b vs. 2a (mSV): 14.3 ± 1.5 vs. 17.1 ± 4.4, p < 0.05].ConclusionsPatient arm positioning for WBCT has an important influence on radiation exposure. Effective dose was 16–22% lower when arms were raised. An individual placement algorithm may lead to a relevant reduction of radiation exposure of severely injured patients.     

A controlled trial of the benefits of ultrasound-guided steroid injection for shoulder pain

ObjectivesWe studied the value of ultrasound (US) to define shoulder pathology and guide local steroid injection in comparison with a standard injection in the management of the acute painful shoulder.MethodsSeventy consecutive patients with acute shoulder pain were assessed clinically and by US. Patients were randomized to receive either a standard subacromial infiltration of 7 mg of betamethasone or a US-guided injection according to the US diagnosis. Follow-up evaluations were performed by an independent assessor who was blinded to the results of the initial US and clinical assessments.ResultsSixty-seven patients completed the study. Both groups showed a significant reduction in both daytime and night pain compared to baseline. The US injection group had significantly less pain at rest at 2 and 6 weeks (NRS: 1.6 vs 3.3, P < 0.005; 3 vs 4.2, P < 0.04). The percentage of good responders was significantly higher in US group at 2 weeks, (81% vs 54%, P < 0.005) and 6 weeks (64% vs 38%, P < 0.05). At 2 and 6 weeks, responder rate and activity pain scores as well as Constant score were in favour of US, though did not reach statistical significance.ConclusionLocal steroid injection for shoulder pain leads to significant improvements in pain and function for up to 12 weeks. An US examination to define the origin of shoulder pain as well as to guide injection provides significant additional benefits for up to 6 weeks. We recommend routine US examination as part of the management of acute shoulder pain.     

The effects of early rapid corticosteroid reduction on cell-mediated immunity in kidney transplant recipients

While being helpful in the prevention and treatment of acute rejection (AR) in kidney transplant patients, corticosteroids have many side effects associated with their long-term use. It is reasonable to minimize these adverse effects without affecting their benefits. In this prospective trial, we investigated the effects of early rapid corticosteroid reduction on the cell-mediated immunity, measured by the Cylex® Immune Cell Function Assay, the incidence of AR and infection and the allograft function after kidney transplantation to assess the feasibility of this strategy in the Chinese population. A method of rapid reduction of corticosteroid to 10 mg/day seven days post-transplantation was adopted for the experimental group, and the standard corticosteroid therapy for the control group. Comparison of intracellular ATP values detected two weeks post-transplantation for the control group (324 ± 45 ng/mL) and the experimental group (345 ± 91 ng/mL) did not reveal a significant difference (p > 0.05). The incidence of AR was analogous between groups (p > 0.05), while an increased incidence of infection was observed in the control group (53%) versus the experimental group (22%), where p < 0.05. The mean ATP concentration was lower in the control group (235 ± 35 ng/mL) than that of the experimental group (286 ± 16 ng/mL) when infection occurred (p < 0.05). The mean allograft function was similar between groups (p > 0.05). Rapid corticosteroid reduction early after kidney transplantation does not cause a significant rise in patient immunity or increase the incidence of AR, and contributes to infection control. This strategy may serve as a safe and effective therapy for kidney transplant patients in the Chinese population.     

Total dorsal ramus block for the treatment of chronic low back pain: a preliminary study

ObjectiveTo evaluate the use of total dorsal ramus block, which blocks all three major branches (medial, intermediate, and lateral branches) of lumbar dorsal ramus, for chronic low back pain.MethodsSpread of local anesthetics with radiocontrast dye (total volume of 5 ml per administration) after total dorsal ramus block to the L4–L5 level was evaluated using computed tomography (CT) in patients with chronic low back pain (n = 14; mean age, 71 years). In another group of patients, the effects of the total dorsal ramus block (n = 21; mean age, 71 years) were compared with those of trigger point injection (n = 22; mean age 73 years).ResultsIn all cases, the CT findings after total dorsal ramus block revealed the injectant spread over medial, intermediate, and lateral branches of both L3 and L4, those innervate the L4–L5 facet joint and surrounding back muscles. Significant alleviation of rest and motion pains evaluated with visual analogue scale was observed after total dorsal ramus block compared to the trigger point injection up to 7 days after the treatment (p < 0.01).ConclusionsThe results of this preliminary study show that the total dorsal ramus block procedure may sufficiently block all three branches of the lumbar dorsal ramus at the targeted level with significant pain reduction.     

Optimisation de la prise en charge anesthésique en chirurgie abdominale urgente chez le sujet âgé

ObjectivesPeroperative haemodynamic profile comparison of two anaesthetic protocols for emergency abdominal surgery of old patients.Patients and methodsNon-randomized monocentric study. Patients in the Optimization group were prospectively studied. Anaesthesia was induced by etomidate–succinylcholine and maintained with effect site and end-tidal target controlled administration of remifentanil and desflurane respectively to keep the BIS values between 45 and 55. These patients were matched with retrospectively studied patients constituting the Control group. The latter's were anaesthetized with etomidate–succinylcholine and anaesthesia was maintained by manually controlled administration of sufentanil and desflurane to keep systolic arterial pressure (SAP) within a range of more or less 30% of preoperative baseline SAP.ResultsTwelve patients (86 ± 5 yrs) were included in the Optimization group, 11 (86 ± 4 yrs) in the Control group. The time spent at a SAP within more or less 30% of baseline values was 92 ± 7% and 71 ± 29% of total anesthesia time in the Optimization and Control groups respectively (p < 0.05). That spent at a SAP less than 15 and 30% of baseline values was 23 ± 11% et 3 ± 5% of total anaesthesia time in the Optimization group, whereas in the MAN group it was 65 ± 21% and 27 ± 30% respectively (p < 0.05). Desflurane and ephedrine consumption was less in the Optimization group as well as crystalloid or colloid volume loading.ConclusionAnaesthetic agents target controlled administration and/or neurophysiologic depth of anaesthesia monitoring improve the time course of the haemodynamic effects in elderly patients undergoing abdominal surgery in emergency.     

Predictors of osteoarthritis following operative treatment of medial tibial plateau fractures

PurposeTo determine factors influencing the development of posttraumatic osteoarthritis (OA) following medial tibial plateau fractures and to evaluate concomitant injuries associated with these fractures.Materials and methodsA chart review of patients with operatively treated medial tibial plateau fractures admitted to our Level I trauma centre from 2002 to 2008 was performed. Of 63 patients, 41 participated in a clinical and radiographic examination. The mean age was 47 years (range 16–78) and the mean follow-up time was 7.6 (range 4.7–11.7) years. All patients had preoperative computed tomography (CT) scans and postoperative radiographs. At the end of follow-up, standing radiographs, mechanical axis, and CT scans were evaluated.ResultsOf the 41 patients, 24 had no or mild (Kellgren-Lawrence grade 0–2) OA and 17 had severe (grade 3–4) OA. Initial articular depression measured from preoperative CT scans was a significant predictor of OA (median 1.8 mm vs 4.5 mm, p = 0.009). Fracture line extension to the lateral plateau (p = 0.68) or fracture comminution (p = 0.21) had no effect on the development of posttraumatic OA, nor did articular depression at the end of follow-up (p = 0.68) measured from CT scans. Mechanical axis >4° of varus and ≥2 mm articular depression or step-off were associated with worse WOMAC pain scores, but did not affect other functional outcome scores. Six patients (10%) had permanent peroneal nerve dysfunction. Ten patients (16%) required LCL reconstruction and nine (14%) ACL avulsions were treated at the time of fracture stabilisation.ConclusionsThe amount of articular depression measured from preoperative CT scans seems to predict the development of posttraumatic OA, probably reflecting the severity of chondral injury at the time of fracture. Restoration of mechanical axis and articular congruence are important in achieving a good clinical outcome.     

Neuroprotective effects of racemic ketamine and (S)-ketamine on spinal cord injury in rat

BackgroundThe aim of this study was to investigate and to compare the potential neuroprotective effects of racemic ketamine, (S)-ketamine and methylprednisolone after an experimental spinal cord injury model in rats.MethodsFifty-nine Wistar albino rats were divided into three main groups as acute stage (A), subacute stage (SA) and sham groups and then acute and subacute stage groups were divided into four groups regarding the used drug as control (CONT), racemic ketamine (RK), (S)-ketamine (SK) and methylprednisolone (MP) groups. A dorsal laminectomy was performed; and spinal cord injury was induced by using a temporary aneurysm clip. Four hours later from the clip compression, except those of the sham and control groups, the drugs (60 mg/kg racemic ketamine, 60 mg/kg (S)-ketamine or 30 mg/kg methylprednisolone) were administered intraperitoneally. At 72th h and 7th days of the study, the spinal cords of rats were removed from T8 level to the conus medullaris level. The specimens were and evaluated histopathologically, tissue lipid peroxidation (LPO) and myeloperoxidation (MPO) levels were measured and biochemically.ResultsThe histopathological results were similar both in the acute and in the subacute stage groups. There was a statistically significant difference among all groups regarding the tissue LPO levels (p < 0.001). There was a statistically significant difference between the CONT-A group and the MP-A, RK-A and SK-A groups (p = 0.004, p < 0.001 and p = 0.007, respectively) in acute stage and between the CONT-SA group and SK-SA group (p = 0.002) in subacute stage. There was a statistically significant difference among all groups regarding the tissue MPO levels (p = 0.001). The median MPO levels were similar among acute stage groups (p = 0.057), but there was a statistical difference among subacute stage groups (p = 0.046).Conclusion(S)-ketamine is more effective than methylprednisolone and racemic ketamine to reduce the LPO levels in subacute stage of spinal cord injury in rats. And, it is as effective as methylprednisolone in preventing secondary spinal cord injury histopathologically.     

No differences of carotid intima-media thickness between young patients with ankylosing spondylitis and healthy controls

ObjectiveAccelerated atherosclerosis in inflammatory rheumatic diseases such as ankylosing spondylitis (AS) stands out among the leading causes of morbidity and mortality. We assessed the correlation between subclinical carotid atherosclerosis and its related clinical parameters in AS patients.MethodsTwenty-eight patients (23 males, 5 females) with AS and 27 sex- and age-matched controls were consecutively recruited to this study. We estimated the carotid intima–media thickness (IMT) and parameters related to arterial elastic properties, including the distensibility coefficient (DC), stiffness index (β), and incremental elastic modulus (E_inc) using high-resolution ultrasonography. Serum levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and monocyte chemoattractant protein-1 (MCP-1) were measured using enzyme-linked immunosorbent assay (ELISA).ResultsCarotid IMT values and arterial elastic parameters in AS patients showed no statistical significance compared to those of controls (0.57 ± 0.07 vs 0.55 ± 0.05, p = 0.387 for IMT, 28.45 ± 9.23 vs 31.93 ± 9.52, p = 0.175 for DC, 2.32 ± 0.18 vs 2.29 ± 0.15, p = 0.559 for stiffness index (β), and 0.14 ± 0.05 vs 0.12 ± 0.03, p = 0.116 for E_inc). The serum level of IL-6 in AS patients was significantly different compared with controls (p = 0.001), but not in serum levels of TNF-α and MCP-1 (p = 0.162, p = 0.087, respectively). Carotid IMT and all arterial elastic parameters calculated in this study were not found to be associated with serum levels of TNF-α, IL-6, and MCP-1.ConclusionThis cross-sectional study showed that carotid IMT and parameters related with arterial elastic properties in young AS patients without clinically evident cardiovascular risk factors were not different from those of sex- and age-matched healthy controls. Serum levels of TNF-α, IL-6, and MCP-1 did not reflect the degree of carotid subclinical atherosclerosis. However, these findings should be confirmed further in a larger population.