共查询到20条相似文献,搜索用时 0 毫秒
1.
2.
3.
4.
Ohtsuka H 《Annals of plastic surgery》2000,44(6):649-650
Bizarre hypertrophy of the right great toe presented in a 50-year-old woman with an ingrown nail, as well as mild hypertrophy of the left great toe. A fingerlike overgrowth was thought to be a reactive change resulting from repetitive formation of granulation from the histopathological analysis. 相似文献
5.
Verbalis JG 《Journal of the American Society of Nephrology : JASN》2007,18(12):3056-3059
For nearly 60 years, we have known that the brain plays a pivotal role in regulating the osmolality of body fluids. Over this time period, scientists have determined the structure and function of arginine vasopressin and its receptors, the role of the posterior pituitary as a storage site, and the determinants of vasopressin release. The cellular mechanisms by which the kidney responds to vasopressin are also well understood. One area that remains unclear is the neural mechanisms underlying osmoreception. New findings have implicated the TRPV family of cation channels as osmo-mechanoreceptors that may mediate the neuronal responses to changes in systemic tonicity. This topic is reviewed here. 相似文献
6.
7.
Barink M Meijers H Spruit M Fankhauser C Verdonschot N 《Acta orthopaedica Belgica》2004,70(6):534-539
During total hip arthroplasty the final clinical position of the cementless CLS stem (Centerpulse) is not always identical to the position of the final rasp with which a successful trial reduction was performed. Therefore, the rasp-stem correspondence of CLS system (Centerpulse) was investigated in a laboratory study and compared to the CBC-T system (Mathys). Both systems showed an average rasp-stem mismatch below 2 mm in three orthogonal directions. It was found that this mismatch related to geometric differences at the corners between rasp and stem. The measured mismatch is not expected to have adverse clinical consequences. 相似文献
8.
9.
Byron E. Chalidis George E. Petsatodis Nick C. Sachinis Christos G. Dimitriou Anastasios G. Christodoulou 《Strategies in trauma and limb reconstruction (Online)》2009,4(2):89-94
The need for reaming and the number of locking screws to be used in intramedullary (IM) tibial nailing of acute fractures
as well as routine bone grafting of tibial aseptic nonunions have not been clearly defined. We describe the results of reamed
interlocked IM nails in 233 patients with 247 tibial fractures (190 closed, 27 open and 30 nonunions). Ninety-six percent
of the fractures were united at review after an average of 4.9 years. No correlation was found between union and nail diameter
(P = 0.501) or the number of locking screws used (P = 0.287). Nail dynamization was effective in 82% of fractures. Locking screw(s) breakage was associated with nonunion in
25% of cases. Bone grafting during IM nailing was found not to increase the healing rate in tibial nonunions (P = 0.623). None of the IM nails were removed or revised due to infection. A dropped hallux and postoperative compartment syndrome
were found in 0.8 and 1.6% of cases, respectively. Anterior knee pain was reported in 42% of patients but nail removal did
not alleviate the symptoms in almost half. This series confirms the place of reamed intramedullary nailing for the vast majority
of tibial diaphyseal fractures. It provides an optimum outcome and minimizes the need for supplementary bone grafting in aseptic
nonunions. 相似文献
10.
OBJECTIVE: To evaluate whether an open technique used to obtain reduction during intramedullary nailing of closed tibial shaft fractures increases the risk of infection, compared to closed reduction and nailing. SETTING: University level 1 trauma center. DESIGN: Retrospective database analysis. PATIENTS/PARTICIPANTS: One hundred seventeen patients with 119 fractures from our trauma database who had sufficient follow-up and met study criteria. The patients were grouped by open versus closed reduction. Only OTA fracture types 42 A to C were included in this study. INTERVENTION: Locked reamed intramedullary nailing for closed tibial shaft fractures accomplished through either open or closed reduction. MAIN OUTCOME MEASUREMENT: The presence or absence of infection as determined by the clinical presentation (erythema, warmth, purulent drainage, fevers, chills, increased pain at the fracture site), indicative laboratory work (complete blood count, erythrocyte sedimentation rate, C-reactive protein), and/or positive culture. RESULTS: There were 85 males and 32 females. The average age was 35.7 years; the average follow-up was 14.3 months. Of the 119 fractures, 79 had closed reduction whereas 40 had open reduction. The open reductions consisted of 13 with a formal incision (>1 cm in length), 22 with percutaneous incisions, and 5 with fasciotomies. There were no infections in the closed reduction group and 2 infections (5%) in the open reduction group. This difference was not statistically significant (P=0.1). The average time to union was 7.0 months in closed reductions and 7.3 months in open reductions. By latest follow-up, 107 fractures had reached union (89.9%), 1 had not (0.8%), and 11 were lost to final follow-up (9.2%). CONCLUSIONS: Limited open techniques can greatly facilitate the reduction of closed tibial shaft fractures but raise concern for infection through exposure of the fracture site. This study found that the rate of infection for open versus closed reductions was higher but not statistically different. Judicious use of open reduction techniques during intramedullary nailing of closed tibia fractures seems to have a minimal risk of infection. 相似文献
11.
Metabolism and nutrition of the critical ill are dynamic parameters of the severe disease influencing the blood glucose concentration. After the finding of increased survival in an initial study in tight glucose control, further large multicenter trials could not show such a benefit and even an increased mortality has been found. Hyperglycemia may be a feature of the stress metabolism and is possibly an adaptive process. Next to the endogenous response, therapy with catecholamines and glucosteroids impacts the response to insulin and the glucose metabolism. Hypo- and hypercaloric nutrition also interact with the insulin therapy. Nutritional therapy should be adapted to the actual state of the patient avoiding hypercaloric feeding and an energy deficit. Using this framework, therapy with insulin may be used to achieve a targeted range of glucose avoiding an increased risk of hypoglycaemia. 相似文献
12.
Crooks A 《Journal of wound care》2005,14(5):222-223
Ageing is thought to impair wound healing, but this review of current research shows that there is conflicting evidence concerning many cellular mechanisms, while concomitant factors in older people may result in delayed healing. 相似文献
13.
Stahel PF Smith WR Morgan SJ 《Journal of orthopaedic trauma》2008,22(7):504; author reply 504-504; author reply 505
14.
15.
Kubiak EN Egol KA Scher D Wasserman B Feldman D Koval KJ 《The Journal of bone and joint surgery. American volume》2005,87(8):1761-1768
BACKGROUND: Operative treatment of tibial fractures in children requires implants that do not violate open physes while maintaining tibial length and alignment. Both elastic stable intramedullary nails and external fixation can be utilized. We retrospectively reviewed our experience with these two techniques to determine if one is superior to the other. METHODS: We retrospectively reviewed the operative records and trauma registries of three institutions within our hospital system and identified thirty-five consecutive patients with open physes who had undergone operative treatment of a tibial fracture between April 1997 and June 2004. Four patients were excluded because they had been managed with locked intramedullary nails or with pins and plaster. Of the thirty-one remaining patients, sixteen had been managed with elastic stable intramedullary nails and fifteen had been managed with unilateral external fixation. The clinical and radiographic outcomes were compared. The functional outcomes were compared with use of the Pediatric Outcomes Data Collection Instrument. Complications related to treatment, such as malunion, delayed union, nonunion, infection, and the need for subsequent surgical treatment also were compared. RESULTS: Thirty-one patients with thirty-one operatively treated tibial fractures were available for evaluation. Fifteen patients had been managed with external fixation. Seven of these patients had a closed fracture, and eight had an open fracture. There were seven healing complications in this group, including two delayed unions, three nonunions, and two malunions. Sixteen patients had been managed with elastic stable intramedullary nailing. Eleven patients had a closed fracture, and five had an open fracture. The mean time to union for the intramedullary nailing group (seven weeks) was significantly shorter than that for the external fixation group (eighteen weeks) (p < 0.01). The functional outcomes for the intramedullary nailing group were significantly better than those for the external fixation group in the categories of pain, happiness, sports, and global function (the mean of the mean scores of the first four categories) (p < 0.01 for these comparisons). CONCLUSIONS: When surgical stabilization of tibial fractures in children is indicated, we believe that the preferred method of fixation is with elastic stable intramedullary nailing. 相似文献
16.
Cameron HU 《Contemporary orthopaedics》1992,24(3):326-330
A prospective, nonrandomized study was conducted in an attempt to determine if the addition of a stem to the tibial component in noncemented total knee replacement reduces the incidence of sinkage. A stemmed tibial component was used in 125 cases and an identical artificial knee without a stem was used in 307 cases. Follow-up was two to six years. Sinkage occurred in 0.8% of the cases with stemmed tibial components and in 3.5% of the nonstemmed tibial components, among which two (0.8%) required revision. The clinical results for both groups were similar. A small group of 34 patients who had a stemmed tibial component on one side and a nonstemmed component on the other also were examined. Fifty percent of these patients preferred the stemmed component knee. The results of these studies suggest that the addition of a stem to the tibial component in noncemented total knee replacement is of value in preventing tibial sinkage. 相似文献
17.
C. Lowell Parsons 《Translational andrology and urology》2015,4(6):605-610
Background
Interstitial cystitis (IC) does not start as an endstage disease, it has a beginning when symptoms are milder, intermittent and the disease is misdiagnosed. To determine how IC develops patients were interviewed on when their symptoms began, what they were and are now as well as the various diagnoses that they received before they were determined to have IC.Methods
One hundred female IC patients were screened. They filled out a questionnaire asking about the age their disease presented, their initial and current symptoms, what their original diagnoses were, effect of the menstrual cycle and sexual activity on their symptoms and about any relatives with bladder symptoms or a current diagnosis of IC.Results
By age 30, 81% of patients had bladder symptoms, 21% before age 10. The first symptom was frequency in 81%, pain present in 59% and the symptoms were intermittent in 64%. Most common early misdiagnosis was UTI in 74% with 93% reporting negative urine cultures. Sex was painful and causes symptom flares in 82%, symptoms flared the week before the menses in 75%. Most common gynecologic diagnosis was yeast vaginitis, 42%. Urge incontinence was present in 33%. There were 51% that reported bladder symptoms in a first degree female relative.Conclusions
IC begins primarily with frequency and is intermittent in most patients with symptom flares associated with sexual activity. Pain and urgency incontinence tend to be a later symptoms. When IC flares the most common misdiagnosis is UTI. Symptoms begin before age 30 in most but an IC diagnosis is often not made until age 40. Genetics appear to play a significant role. It is important to consider these facts when evaluating women with “early IC” because correct diagnosis will result in proper therapy and reduced health care costs. 相似文献18.
19.
《Injury》2017,48(2):506-510
IntroductionTraditional methods of nailing distal tibial fractures have an unacceptable risk of mal-alignment due to difficulty in obtaining and maintaining reduction intra-operatively. Methods to obtain and maintain reduction when nailing these fractures, and therefore reducing the risk of Mal-alignment include modified external fixators, distractors and commercial reduction tools. Semi-extended intramedullary nailing of distal tibial fractures via a supra-patellar approach is now being used more commonly. The aim of this study was to assess whether a commercial reduction device (Staffordshire Orthopaedic Reduction Machine − STORM, Intelligent Orthopaedics, Stafffordshire, UK) is necessary to reduce the risk of mal-alignment in patients undergoing semi-extended nailing for distal tibial fractures.MethodologyA case-control study was conducted in 20 patients who had STORM-assisted reduction of distal tibial fractures prior to intramedullary nailing and 20 controls without STORM. The control group was matched for age, sex, fracture type (AO/OTA), ASA and gender. All patients had an intramedullary nail (IMN) using the semi-extended system. Primary outcome measures were coronal and sagittal mal-alignment. Secondary outcome measure was unplanned return to theatre for complications and problems with fracture healing.ResultsThere was no difference in post-operative mal-alignment in both groups. There was no significant difference in time to union in both groups Both groups had equal number of patients requiring unplanned return to theatre. The STORM group was associated with a significantly increased operative time [p = 0.007, 130.3 min (SD 49.4) STORM vs 95.6 mins (SD 22.9) Control].ConclusionIntraoperative use of STORM significantly increases operative time with no difference in outcome. The superior orthogonal views and manual control obtained during semi-extended nailing via a supra-patellar approach obviate the need for additional methods: of intraoperative reduction for this fracture group. 相似文献
20.
Williamson JM Jones IH Hocken DB 《Annals of the Royal College of Surgeons of England》2011,93(1):9-12