The Bankart repair versus the Putti-Platt procedure: A randomized study with WOSI score at 10-year follow-up in 62 patients

Background and purpose This randomized study compared clinical results after surgery for posttraumatic shoulder instability with either an anatomical repair or an older, less anatomical but commonly used method. The less anatomical procedure has been considered quicker and less demanding, but it has been questioned regarding the clinical result. We therefore wanted to compare the clinical outcome of the two different procedures. Our hypothesis was that the anatomical repair would give less residual impairment postoperatively.Methods Patients with anterior posttraumatic shoulder instability were consecutively randomized on the day before surgery to either a Bankart repair using Mitek GI/GII anchors combined with capsular imbrication (B) (n = 33) or a Putti-Platt procedure (P) (n = 33). Follow-up was performed by examination at 2 years and using a self-evaluation score at 10 years.Results At the 2-year follow-up, we found no difference in muscle strength between patients treated with the two surgical methods and there were no statistically significant differences in the Rowe scores (mean 90 units for both groups). Compared to preoperatively, the decrease in external rotation 2 years after surgery was 10 degrees in the P group and 3 degrees in the B group (p = 0.03). 10 years after surgery, 62 of 66 patients replied to a questionnaire sent by mail. It included a self-evaluating quality of life score for shoulder instability (WOSI) for evaluation of their shoulder function. In the P group 15 patients and in the B group 19 patients reported they had experienced either a redislocation or a subluxation with a new feeling of shoulder instability. Mean WOSI score was similar in the P and B groups: 80% and 83%, respectively. The WOSI score was 87% for patients with stable shoulders (n = 28) and 77% for those with unstable shoulders (n =34) (p = 0.005).Interpretation With assessment of pain and general shoulder function, only a small difference was found between the two methods. The WOSI scores for stable shoulders indicated that some shoulders still had impaired function even though the shoulders had become stable.     

Intramuscular myxoma of the hypothenar muscles

Intramuscular myxomas of the hand are rare entities. Primarily found in the myocardium, these lesions also affect the bone and soft tissues in other parts of the body. This article describes a case of hypothenar muscles myxoma treated with local surgical excision after frozen section biopsy with tumor-free margins. Radiographic images of the axial and appendicular skeleton were negative for fibrous dysplasia, and endocrine studies were within normal limits. The 8-year follow-up period has been uneventful, with no complications. The patient is currently recurrence free, with normal intrinsic hand function.     

Actitud expectante en el síndrome del cascanueces

Nutcracker syndrome is caused by compression of the left renal vein between the aorta and the superior mesenteric artery where it passes in the fork formed at the bifurcation of these arteries. The phenomenon results in left renal venous hypertension. The syndrome is manifested by left flank and abdominal pain, with or without unilateral haematuria. The nutcracker syndrome has been treated in various ways. We report one case of the syndrome and discuss the place of surveillance in its management.     

七氟醚对罗库溴铵肌松效应的影响

目的 观察七氟醚对罗库溴铵肌松作用的影响.方法 成人全麻手术患者60例随机均分为三组.每组20例.Ⅰ组丙泊酚静脉麻醉,Ⅱ组吸入七氟醚(1 MAC)15 min,Ⅲ组吸入七氟醚(1 MAC)45 min.在麻醉平稳(Ⅱ、Ⅲ组在呼气末七氟醚浓度稳定在1 MAC)后静脉注射罗库溴铵0.6 mg/kg,记录TOFr的变化.结果 Ⅱ、Ⅲ组罗库溴铵的起效时间分别为97.60 s和94.50 s,明显短于Ⅰ组的119.90 s(P<0.05);Ⅱ和Ⅲ组完全肌松时间(T1消失)明显长于Ⅰ组(32.7 min和44,6 min vs.21.3 min)(P<0.05),Ⅲ组明显长于Ⅱ组(P<0.05);TOF的T2～T4出现的时间及TOFr恢复到25%、50%和75%的时间,Ⅱ、Ⅲ组均长于Ⅰ组,且Ⅲ组长于Ⅱ组(P<0.05).结论 持续吸入1 MAC七氟醚能随吸人时间延长而增强罗库溴铵的神经肌肉阻滞效应.     

马铃薯切片外敷治疗动静脉内瘘并发症效果观察

目的观察新鲜马铃薯外敷治疗动静脉内瘘肿胀、硬结、疼痛等并发症的疗效。方法将维持性血液透析患者60例,随机分成观察组和对照组各30倒,分别使用新鲜马铃薯薄片外敷和50％硫酸镁湿热敷并进行疗效比较。结果观察组疗效及显效、痊愈时间显著优于对照组（P＜0．05,P＜0．01）。结论马铃薯片外敷治疗动静脉内瘘并发症疗效显著。且能缩短治疗时间。     

马铃薯切片外敷治疗动静脉内瘘并发症效果观察

目的 观察新鲜马铃薯外敷治疗动静脉内瘘肿胀、硬结、疼痛等并发症的疗效.方法 将维持性血液透析患者60例,随机分成观察组和对照组各30例,分别使用新鲜马铃薯薄片外敷和50%硫酸镁湿热敷并进行疗效比较.结果 观察组疗效及显效、痊愈时间显著优于对照组(P<0.05,P<0.01).结论 马铃薯片外敷治疗动静脉内瘘并发症疗效显著,且能缩短治疗时间.     

老年性脊柱结核的特点及保守治疗疗效观察

目的:探讨老年性脊柱结核的特点及单独应用抗结核药物治疗早期老年脊柱结核的疗效。方法:对2008年1月至2010年7月纳入选择标准的36例经单纯应用抗结核药物行保守治疗的老年性脊柱结核病例进行分析研究,其中男19例,女17例;年龄60～85岁,平均73.5岁。36例患者病灶均处于活跃期,血沉及CRP水平高于正常。治疗方法为联合用药(3HRZE/6-9HRE),疗程9～12个月。随诊通过观察结核症状、化验指标和放射学的影像变化以评价疗效并调整用药,通过视觉模拟评分(VAS)评价疼痛程度。结果:36例均获随访,时间8～24个月,平均15个月。其中31例患者化疗9～12个月结核病灶治愈,血沉及CRP恢复正常;4例(对利福平或异烟肼耐药)选用左氧氟沙星、对氨基水杨酸等抗结核药物化疗15个月后痊愈;1例患者结核症状加重,经手术治疗3个月后缓解,血沉及CRP恢复正常。影像学变化:治疗后X线及CT示椎体骨质硬化、融合,未见明显后凸畸形,1例手术患者植骨融合,未见内固定松动。治疗前及末次随访时Cobb角分别为(17.6±2.3)°、(18.1±2.7)°(P>0.05);MRI示椎旁脓肿吸收,椎体炎症消退。VAS评分治疗前为6.5±1.7,末次随访时为1.4±0.5(P<0.05)。7例患者出现药物不良反应,通过暂时停药并配以对症药物治疗后恢复正常。结论:对于早期老年脊柱结核病例,在严格的督导下单纯应用抗结核药物行规范的个体化保守治疗可获得满意的效果。     

Fractalkine reduces N-methyl-d-aspartate-induced calcium flux and apoptosis in human neurons through extracellular signal-regulated kinase activation

Our purpose was to investigate in human neurons the neuroprotective pathways induced by Fractalkine (FKN) against glutamate receptor-induced excitotoxicity. CX(3)CR1 and FKN are expressed constitutively in the tested human embryonic primary neurons and SK-N-SH, a human neuroblastoma cell line. Microfluorometry assay demonstrated that CX(3)CR1 was functional in 44% of primary neurons and in 70% of SK-N-SH. Fractalkine induced ERK1/2 phosphorylation within 1 min and Akt phosphorylation after 10 min, and both phosphorylation decreased after 20 min. No p38 and SAPK/JNK activation was observed after FKN treatment. Application of FKN triggered a 53% reduction of the NMDA-induced neuronal calcium influx, which was insensitive to pertussis toxin and LY294002 an inhibitor of Akt pathway, but abolished by PD98059, an ERK1/2 pathway inhibitor. Moreover, FKN significantly reduced neuronal NMDA-induced apoptosis, which was pertussis toxin insensitive and abolished in presence of PD98059 and LY294002. In conclusion, FKN protected human neurons from NMDA-mediated excitotoxicity in at least two ways with different kinetics: (i) an early ERK1/2 activation which reduced NMDA-mediated calcium flux; and (ii), a late Akt activation associated with the previously induced ERK1/2 activation.