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991.
Paola Pisani Maria Daniela Renna Francesco Conversano Ernesto Casciaro Marco Di Paola Eugenio Quarta Maurizio Muratore Sergio Casciaro 《World journal of orthopedics》2016,7(3):171-181
Osteoporosis is a silent disease without any evidence of disease until a fracture occurs. Approximately 200 million people in the world are affected by osteoporosis and 8.9 million fractures occur each year worldwide. Fractures of the hip are a major public health burden, by means of both social cost and health condition of the elderly because these fractures are one of the main causes of morbidity, impairment, decreased quality of life and mortality in women and men. The aim of this review is to analyze the most important factors related to the enormous impact of osteoporotic fractures on population. Among the most common risk factors, low body mass index; history of fragility fracture, environmental risk, early menopause, smoking, lack of vitamin D, endocrine disorders(for example insulin-dependent diabetes mellitus), use of glucocorticoids, excessive alcohol intake, immobility and others represented the main clinical risk factors associated with augmented risk of fragility fracture. The increasing trend of osteoporosis is accompanied by an underutilization of the available preventive strategies and only a small number of patients at high fracture risk are recognized and successively referred for therapy. This report provides analytic evidences to assess the best practices in osteoporosis management and indications for the adoption of a correct healthcare strategy to significantly reduce the osteoporosis burden. Early diagnosis is the key to resize the impact of osteoporosis on healthcare system. In this context, attention must be focused on the identification of high fracture risk among osteoporotic patients. It is necessary to increase national awareness campaigns across countries in order to reduce the osteoporotic fractures incidence. 相似文献
992.
Efstathios J. Boviatsis Lampis C. Stavrinou Andreas T. Kouyialis Maria M. Gavra Pantelis C. Stavrinou Marios Themistokleous Panayiotis Selviaridis Damianos E. Sakas 《European spine journal》2008,17(6):831-837
This study is designed based on the retrospective analysis of patients treated in the Neurosurgical Department of two major
hospitals and review of the literature. The aim of this study is to evaluate the efficacy of surgery and address controversial
issues in the treatment of symptomatic lumbar intraspinal synovial cysts. Spinal juxtafacet cysts (synovial and ganglion cysts)
are a rare cause of low back and radicular leg pain. Although the relevant reports in the international literature are increasing,
the controversy about conservative versus surgical treatment and the need for concomitant fusion still exists. Data from seven
patients (age range 58–69 years, mean age 61 years) with low back and radicular leg pain due to a lumbar facet joint cyst
were retrospectively analyzed. Demographic data, cyst level, presence of concomitant local pathology, treatment and results
of treatment were recorded. A follow-up of at least 6 months (range 6–48 months) was conducted and results were noted. All
patients had back pain, while five also experienced unilateral radicular leg pain and one had bilateral leg pain. One patient
had neurogenic claudication. MRI identified the cyst and highlighted underlying pathology in all cases. All patients underwent
surgical cyst excision. No fusion was performed. Post-operatively, all patients showed a total resolution of symptoms with
sustained benefit at final evaluation. Review of the literature revealed a trend towards surgery, as this is correlated to
a more favorable outcome compared with conservative treatment. Fusion should be performed on a case-by-case basis only. Surgery
is a safe and effective treatment choice in this increasingly appearing ailment. A prospective, randomized trial should clarify
issues under debate.
An erratum to this article can be found at 相似文献
993.
Survival of Mammary Stem Cells in Suspension Culture: Implications for Stem Cell Biology and Neoplasia 总被引:9,自引:0,他引:9
There is increasing evidence that a variety of neoplasms including breast cancer may result from transformation of normal stem and progenitor cells. In the past, isolation and characterization of mammary stem cells has been limited by the lack of suitable culture systems able to maintain these cells in an undifferentiated state in vitro. We have recently described a culture system in which human mammary stem and progenitor cells are able to survive in suspension and produce spherical colonies composed of both stem and progenitor cells. Recent observation that adult stem cells from other tissues may also retain the capacity for growth under anchorage independent conditions suggests a common underlying mechanism. We propose that this mechanism involves the interaction between the canonical Wnt signal pathway and E-cadherin. The Wnt pathway has been implicated in normal stem cell self-renewal in vivo. Furthermore, there is evidence that deregulation of this pathway in the mammary gland and other organs may play a key role in carcinogenesis. Thus, the development of in vitro suspension culture systems not only provides an important new tool for the study of mammary cell biology, but also may have important implications for understanding key molecular pathways in both normal and neoplastic stem cells. 相似文献
994.
Arterial Hypertension due to Perirenal and Subcapsular Hematoma Induced by Renal Percutaneous Biopsy 总被引:2,自引:0,他引:2
Wanic-Kossowska M Kobelski M Oko A Czekałski S 《International urology and nephrology》2005,37(1):141-143
In this study we report three patients, in whom arterial hypertension was induced by compression of the kidney parenchyma due to perirenal or subcapsular hematoma following percutaneous blind renal biopsy with use of Vim-Silverman type needle. 相似文献
995.
Osteopenia: a bone disorder associated with diabetes mellitus 总被引:6,自引:0,他引:6
Duarte VM Ramos AM Rezende LA Macedo UB Brandão-Neto J Almeida MG Rezende AA 《Journal of bone and mineral metabolism》2005,23(1):58-68
Although osteopenia has been associated with human diabetes mellitus, the pathogenesis of diabetic osteopenia is unclear. In the present study, we evaluated the effect of diabetes on histomorphometry, bone mineral density (BMD)—measured by dual-energy X-ray absorptiometry (DXA)—and biomarkers of bone metabolism in rats up to 120 days after the onset of experimental diabetes. Female Wistar rats with a regular estrous cycle were randomly divided into two groups: control rats (n = 15) and diabetic rats without insulin treatment (n = 25). Diabetes was induced by injection of alloxan and was confirmed by the determination of blood glucose concentration (>250mg/dl). The results revealed an approximate threefold increase of femoral trabecular distance in diabetic rats compared to controls. Conversely, trabecular thickness and bone trabecular volume were reduced twofold and 77%, respectively. BMD in both the metadiaphyseal region and total area of the femur was found to be clearly reduced in diabetic animals, with no significant differences between the groups. Serum alkaline phosphatase (ALP) and tartarate-resistant acid phosphatase (TRAP) activities showed significant six- and twofold increases, respectively, in diabetic rats. There were significant decreases in serum calcium and albumin concentrations in diabetic rats, but no difference was observed in serum magnesium, phosphorus, or creatinine concentrations between the groups. Overall, our findings support the conclusion that the diabetic state is associated with alterations in bone turnover, resulting in the development of osteopenia, which is related to the time of evolution of the disorder. 相似文献
996.
Paulo Gustavo Sampaio Lacativa Laura Maria Carvalho de Mendon?a Pedro José de Mattos Patrício Filho José Raimundo Pimentel Manoel Domingos da Cruz Gon?alves Maria Lucia Fleiuss de Farias 《Journal of clinical densitometry》2005,8(3):352-361
Hyperparathyroidism contributes significantly to decreased bone mineral density (BMD) in end-stage renal disease patients, but this negative influence is not homogeneous throughout the skeleton. We studied the BMD by dual-energy X-ray absorptiometry on total body and on different regions of the skeleton in 42 patients with severe hyperparathyroidism on hemodialysis. We also evaluated the relationship between different risk factors and BMD found on the regions examined in these patients. The legs and other sites where cortical bone predominate were mostly affected, whereas trabecular bone was relatively preserved. This is probably the result of the different effects of hyperparathyroidism on cortical and trabecular bone, but we cannot rule out the interference of ectopic calcifications and sclerotic lesions of vertebral end-plates falsely increasing lumbar spine BMD. The main determinants of low total-body BMD were, in order of importance, immobility, high intact parathyroid hormone levels, low body mass index, and low albumin. Eleven patients presented with pathologic fractures, mainly in the legs, and BMD was lower in this group than in patients without fractures. In conclusion, our study makes clear that hyperparathyroidism is a great threat to bone density in hemodialysis patients, mainly in the legs, the site mostly affected by fragility fractures in our patients. Physicians must worry not only with high parathyroid hormone levels, but also with the nutritional state of these patients. 相似文献
997.
Serralta A Donato MT Martinez A Pareja E Orbis F Castell JV Mir J Gómez-Lechón MJ 《Cell transplantation》2005,14(10):837-843
A major problem for the isolation and transplantation of hepatocytes is the lack of resources for obtaining viable hepatocytes. Improving this situation would enhance hepatic cell transplantation programs. Our objective was to evaluate the influence of the preservation solutions used during organ retrieval on the quality of hepatocytes isolated from liver tissue. We compared the results of the collagenase perfusion technique for isolation of hepatocytes in human livers flushed with University of Wisconsin (UW) and Celsior preservation solutions. Yield (number of viable cells per gram of tissue), cellular viability, efficiency of cells to attach to culture plates and form a monolayer, and drug metabolizing competence of the hepatocytes were measured. Successful isolation was achieved in 63% of the procedures using the UW solution and 100% of the procedures using the Celsior solution. In the UW group, significantly lower cell viability (38 +/- 41% vs. 79 +/- 14%, p < 0.05), yield of cells (4.0 +/- 5.2 x 10(6) vs. 8.2 +/- 5.6 x 10(6) cells/g, p < 0.05), and protein content at 24 h of culture (0.6 +/- 0.6 vs. 1.2 +/- 0.3 mg protein per plate, p < 0.05) than in Celsior solution were found. However, similar values of P450 activities were found in both groups. The more successful isolation, better yield, and higher cell viability obtained from human liver grafts preserved in Celsior solution, in comparison to UW solution, suggest Celsior solution as the most appropriate for preserving cadaveric hepatic tissue to be used for hepatocyte harvesting. 相似文献
998.
Cortes RA Keller RL Townsend T Harrison MR Farmer DL Lee H Piecuch RE Leonard CH Hetherton M Bisgaard R Nobuhara KK 《Journal of pediatric surgery》2005,40(1):36-46
Background/Purpose
Fetal tracheal occlusion (TO) was developed in an attempt to enhance prenatal lung growth and improve survival in fetuses with severe congenital diaphragmatic hernia (CDH). We conducted a randomized, controlled clinical trial in 24 fetuses with severe left CDH (liver herniated into the thorax and low lung-to-head ratio) to compare survival after endoscopic fetal TO vs standard perinatal care (control) and prospectively followed up the 16 survivors (9 control, 7 TO) to compare neurodevelopmental, respiratory, surgical, growth, and nutritional outcomes.Methods
At 1 and 2 years old, subjects underwent evaluation consisting of medical and neurological history and physical, developmental testing, nutritional assessment, oxygen saturation and pulmonary function testing, chest radiograph, and echocardiogram. Growth and developmental measures were corrected for prematurity. Data were analyzed by Mann-Whitney rank sum test, Fisher's Exact test, and logistic and linear regression.Results
Infants with TO were significantly more premature at birth (control vs TO, 37.4 ± 1.0 vs 31.1 ± 1.7 weeks; P < .01). Growth failure (z score for weight <2 SDs below mean) was severe in both groups at 1 year of age (control vs TO, 56% vs 86%; P = .31). There was considerable catch-up growth by age 2 years (growth failure: control vs TO, 22% vs 33%; P = .19). There were no differences in other growth parameters. There were also no differences in neurodevelopmental outcome at 1 and 2 years. Supplemental oxygen at hospital discharge was a significant predictor of worse neurodevelopmental outcome at 1 and 2 years old (P = .05 and P = .02, respectively). Hearing loss requiring amplification has been diagnosed in 44% of the group (control vs TO, 44% vs 43%; P = 1.0).Conclusions
In this group of infants with severe CDH, there were no differences in outcome at 2 years old despite significant prematurity in the TO group. Oxygen supplementation at hospital discharge identified the most vulnerable group with respect to neurodevelopmental outcome, but all infants had significant growth failure, and hearing impairment is a substantial problem in this population. Severe CDH carries significant risk of chronic morbidity. 相似文献999.
Robotic-assisted heller myotomy versus laparoscopic heller myotomy for the treatment of esophageal achalasia: multicenter study 总被引:3,自引:0,他引:3
Santiago Horgan M.D. Carlos Galvani M.D. Maria V. Gorodner M.D. Pablo Omelanczuck M.D. Fernando Elli M.D. Federico Moser M.D. Luis Durand M.D. Miguel Caracoche M.D. Jorge Nefa M.D. Sergio Bustos M.D. Phillip Donahue M.D. Pedro Ferraina M.D. 《Journal of gastrointestinal surgery》2005,9(8):1020-1030
Laparoscopic Heller myotomy (LHM) has become the standard treatment option for achalasia. The incidence of esophageal perforation
reported is about 5%–10%. Robotically assisted Heller myotomy (RAHM) is emerging as a safe alternative to LHM. Data comparing
the two approaches are scant. The aim of this study was to compare RAHM with LHM in terms of efficacy and safety for treatment
of achalasia. A total of 121 patients underwent surgical treatment of achalasia at three institutions. A retrospective review
of prospectively collected perioperative data was performed. Patients were divided into two groups: group A (RAHM), 59 patients,
and group B (LHM), 62 patients. All the operations were completed using minimally invasive techniques. There were 63 women
and 58 men, with a mean age of 45 ±19 years (14–82 years). Fifty-one percent of patients in group A and 95% of patients in
group B reported weight loss. Duration of symptoms was equal for both groups. Dysphagia was the main complaint in both groups
(P = NS). There was no difference in preoperative endoscopic treatment in both groups (44% versus 27%, P = NS). Operative
time was significantly shorter for LHM in the first half of the experience (141 ± 49 versus 122 ± 44 minutes, P < .05). However,
in the last 30 cases there was no difference in operative time between the groups (P = NS). Intraoperative complications (esophageal
perforation) were more frequent in group B (16% versus 0%). The incidence of postoperative heartburn did not differ by group.
There were no deaths. At 18 and 22 months, 92% and 90% of patients had relief of their dysphagia. This study suggests that
RAHM is safer than LHM, because it decreases the incidence of esophageal perforation to 0%, even in patients who had previous
treatment. At short-term follow-up, relief of dysphagia was equally achieved in both groups.
Presented at the Forty-Sixth Annual Meeting of The Society for Surgery of the Alimentary Tract, Chicago, Illinois, May 14–18,
2005 (oral presentation).
This study was supported in part by a grant provided by Intuitive Surgical, Inc. and Ethicon Endo-Surgery, Inc. 相似文献
1000.
Percutaneous tracheostomy (PT) is an increasingly common procedure in the management of critically ill patients. Current practice for both open and percutaneous tracheostomies is a post-procedure chest X-ray to rule out potentially life-threatening complications such as a pneumothorax or tube malposition. Our study evaluated the utility of chest X-ray after PT. A retrospective chart review was conducted for patients undergoing PT at Kern Medical Center between January 1999 and December 2003. Charts were reviewed for age, sex, and clinical outcome as well as the radiologist's interpretation of the postprocedure chest X-ray. A total of 73 procedures were completed in 47 men and 26 women. The majority of the tracheostomies were in trauma patients who needed prolonged ventilatory support. There were no complications identified on postprocedure chest X-ray. A single patient was converted to an open procedure secondary to bleeding. We conclude that routine chest X-ray after PT is unnecessary. 相似文献