Maximum loading of carpal bones during movements: a finite element study

European Journal of Orthopaedic Surgery & Traumatology - Maximum stresses show critical points on an object because failure may start from the area close to maximum stress points. However,...     

Should the preservation of residual renal function cost volume overload and its consequence left ventricular hypertrophy in new hemodialysis patients?

BACKGROUND: Left ventricular hypertrophy (LVH) is an important predictor of mortality in dialysis patients. The loss of residual renal function (RRF) appears to occur more rapidly in hemodialysis than continuous ambulatory peritoneal dialysis (CAPD). It is more likely that volume expansion in patients on CAPD may preserve RRF. The aim of this study was to investigate whether there is a cause-effect relationship between volume overload and preserving RRF in new hemodialysis patients. METHODS: Nineteen patients with end-stage renal disease (ESRD) starting hemodialysis therapy were included in the study. At the beginning, their elevated blood pressures (BP) were treated with antihypertensive drugs. Thereafter, until normovolemia and normal BP were obtained, strict volume control was applied. The effects of both treatment modalities on the loss of RRF and LVH were evaluated prospectively. RESULTS: At the initial examination, all of the patients were hypertensive and had markedly increased left ventricular mass index (LVMI). The daily urine production was 1575+/-281 mL. At the end of drug treatment period lasting three months, although BP significantly decreased, daily urine production and LVMI only decreased by 12% and 6%, respectively. At the end of the period in which strict volume control was applied, the body weight significantly decreased (from 60+/-5 to 55+/-8 kg, p<0.0001). This decrease in body weight was accompanied by marked decreases in dilated cardiac chamber size and more importantly daily urine production. At the end of this period, while 7 of 19 patients had no residual urine production, residual urine production was below 200 mL/d in the remaining 12 patients. Although the period of volume control was short, there was significant reduction in the LVMI (decreased from 251+/-59 to 161+/-25 gr/m2, p<0.0001). CONCLUSION: The results of our prospective study have clearly shown that the persistence of residual renal function in patients with ESRD starting hemodialysis therapy may largely depend on volume overload. Equally interesting was the finding that despite significantly reduced BP level with hypotensive drugs, there was no marked regression in LVMI. In the contrary, after the volume control period, LVMI was significantly decreased. Our results support the hypotheses that decrease in volume may be more important than pressure reduction in regressing the left ventricular hypertrophy.     

Congenital radioulnar synostosis: a case report of a probable subtype

We present a case of bilateral congenital radioulnar synostosis in which computed tomography examination revealed osseous outgrowths of the ulna. Their excision resulted in 125° range-of-motion of the forearm rotation.     

The proximal tibiofibular joint: an anatomic study

In the first stage of the current study, 14 fresh specimens from above-the-knee amputations were examined by magnetic resonance imaging arthrography. In the second part of the study, these amputation specimens and 38 embalmed knees from cadavers were dissected. The types of the joint and insertion of the biceps femoris tendon and the other structures were observed. Of 14 fresh specimens from above-the-knee amputations examined by magnetic resonance imaging arthrography, nine had a clear communication between the proximal tibiofibular joint and the knee. It was difficult to distinguish the anterior tibiofibular ligament in 30 specimens as a separate band because it was fused intimately with the biceps femoris tendon. Of these specimens, 24 had an oblique type of joint. Because of this communication, the proximal tibiofibular joint might be construed as the fourth compartment of the knee to explain subtle knee problems.     

Disorders associated with osteopoikilosis: 5 different lesions in a family

Although osteopoikilosis is generally considered an accidental finding, several developmental dysplasias coexisting with this disorder have been reported. However, all authors have mentioned only one coexisting finding, and most of them are case reports. We report a family in whom various members had osteopoikilosis with 5 different associated lesions. We suggest that osteopoikilosis is a bone manifestation of a generalized fibroproliferative or stenosing disease.     

Bilateral trochanteric fractures of the femur in a patient with chronic renal failure

We report a spontaneous intertrochanteric fracture with bilateral avulsion of the greater trochanter in a patient with chronic renal failure.

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Résumé  Nous rapportons une cas de fracture intertrochantérienne spontanée avec avulsion bilatérale du grand trochanter chez un malade insuffisant rénal chronique.

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Accepted: 29 November 1999     

Risk factors for infection and mortality among hemodialysis patients during COVID-19 pandemic

Purpose

The aim of this study was to evaluate risk factors for COVID-19 infection and mortality and to document if any relation exists between 25 (OH) Vitamin D and COVID-19 infection.

Methods

This retrospective study evaluated 151 HD patients. Patients infected with COVID-19 were compared to patients without the infection. Risk factors for intensive care unit (ICU) stay and mortality were analyzed. Deceased infected patients were also compared to patients who died due to other causes.

Results

The mean age of all HD patients was 57.15?±?15.73 years and 51.7% were male. The mean 25 (OH) Vitamin D level of all patients was 16.48?±?8.45 ng/ml. Thirty-five infected patients were significantly older, had a higher Charlson comorbidity index (CCI) score. They also had a higher number of patients with diabetic nephropathy, cerebrovascular accident (CVA) and coronary heart disease (CHD). Patients who needed to stay in ICU had higher CCI score, a higher number of patients with diabetic nephropathy, pulmonary diseases and had statistically significantly higher CRP levels. Deceased infected patients were significantly older, had higher CCI scores and lower PTH than survived infected patients. Deceased infected patients had lower PTH, but had significantly lower leukocyte, lymphocyte counts and urea levels at admission when compared to patients who died due to other causes. Patients with poor prognosis had lower neutrophil and lymphocyte counts before infection and at admission; respectively. 25 (OH) Vitamin D level was not related to the risk of COVID-19 infection, ICU stay or mortality.

Conclusion

Older age, higher CCI scores, diabetic nephropathy, CHD, CVA, pulmonary diseases, and lower neutrophil and lymphocyte counts were found as poor prognostic factors. The comparisons yielded no significant finding for 25 (OH) Vitamin D, acetylsalicylic acid, erythropoietin, intravenous iron, ACEI, ARBs, and dialysis adequacy parameters.

     

The effect of preoperative physiotherapy and education on the outcome of total hip replacement: a prospective randomized controlled trial

OBJECTIVE: To investigate the effects of preoperative physical therapy for patients undergoing total hip replacement. DESIGN: Prospective randomized controlled study. SETTING: Department of Orthopaedics and Traumatology in a university hospital. SUBJECTS: Sixty patients with osteoarthritis of the hip scheduled to receive total hip replacement were randomly assigned into two groups. INTERVENTIONS: Subjects in the study group received preoperative physiotherapy designed to strengthen the muscles of the upper and lower limbs and to improve range of motion of the hip, beginning from eight weeks before the operation. These patients also received an educational programme about living with a prosthesis. The control group received no preoperative physiotherapy or educational programme. MAIN OUTCOME MEASURES: Patients were evaluated at baseline (study group only, eight weeks prior to operation), before surgery, at discharge, three months and two years postoperatively using Harris Hip Score, visual analogue scale and range at hip abduction. RESULTS: Although patients in the study group performed transfer activities earlier than the control group, there were no significant differences between the groups at discharge with regard to the improvement in Harris Hip Score (p < 0.48) and hip adduction (p < 0.97) and visual analogue scale at rest (p < 0.54) and activity (p < 0.89). At the latest follow-up (two years postoperatively) both groups had improved in Harris Hip Score, but rate of improvement between the groups was similar (p < 0.05). CONCLUSIONS: We conclude that the routine use of preoperative physiotherapy and education programme is not useful in total hip replacement surgery.     

Does penile tourniquet application alter bacterial adhesion to rat urethral cells: an in vitro study

Purpose

To investigate the effects of penile tourniquet (PT) application on bacterial adhesion to urothelium.