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21.
Rafael Walker-Santiago Jason D. Tegethoff William M. Ralston James A. Keeney 《The Journal of arthroplasty》2021,36(2):653-656
BackgroundRevision total knee arthroplasty (rTKA) rates are increasing in younger patients. Few studies have assessed outcomes of initial aseptic rTKA performed for younger patients compared with traditional-aged patients.MethodsA detailed medical record review was performed to identify patient demographics, medical comorbidities, surgical rTKA indications, timing from index TKA to rTKA, subsequent reoperation rates, component rerevision rates, and salvage procedures for 147 young patients (158 knees) aged 55 years and younger and for a traditional older cohort of 276 patients (300 knees) between 60 and 75 years. Univariate analysis was performed to assess differences in these primary variables, and a log-rank test was used to estimate 5-year implant survival based on either reoperation or component revision and salvage procedures.ResultsYounger TKA patients were more likely to undergo initial aseptic rTKA within 2 years of their primary TKA (52.5% vs 29.0%, P < .001) and were more likely to undergo early reoperation (17.7% vs 9.7%, P = .02) or component rerevision (11.4% vs 6.0%, P < .05) after rTKA. Infection and extensor mechanism complications were more commonly noted in younger patients. Estimated 5-year survival was also lower for both reoperation (59.4% vs 65.7%, P = .02) and component rerevision or salvage (65.8% vs 80.1%, P = .02).ConclusionEarly reoperation and component re-rTKA were performed nearly twice as often in younger rTKA than traditional-aged TKA patients. Care should be given to reduce perioperative infection and extensor mechanism failures after rTKA in younger patients. 相似文献
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Stephen J. Gallacher William D. Fraser Fraser C. Logue Frances J. Dryburgh Robert A. Cowan Iain T. Boyle Stuart H. Ralston 《Calcified tissue international》1992,51(6):419-423
Summary In this study we retrospectively reviewed results of the first 9 days of treatment with pamidronate at doses of 30 mg (n=13), 45 mg (n=9), and 90 mg (n=13) in an attempt to see what factors influenced the response of serum calcium to pamidronate.The nadir of serum calcium obtained post treatment was correlated with pretreatment levels of nephrogenous cyclic adenosine monophosphate (NcAMP), the renal tubular threshold for phosphate reabsorption (TmPO4), and the renal tubular threshold for calcium reabsorption (TmCa). Using the post treatment serum calcium levels, patients were divided into good and poor responders depending on whether a normal serum calcium was obtained.Pretreatment NcAMP was significantly correlated with the magnitude of the response of serum calcium (r=0.45, P=0.0001). Pretreatment NcAMP was significantly higher in the poor responders (mean±SEM): 65.0±9.4 nmol/liter GF (poor responders) versus 29.6±6.3 (good responders), P=0.004. NcAMP as a predictor of the acute response of serum calcium showed a sensitivity of 93% and a specificity of 72%. Pretreatment TmPO4 was negatively correlated with the serum calcium response post treatment (r=-0.41, P=0.003). However, though TmPO4 tended to be lower in the poor responders, this was not statistically significant [0.65 mmol/liter GF±0.09 (poor responders) versus 0.76 mmol/liter GF±0.06 (good responders)]. As a predictor of the acute response of serum calcium, TmPO4 was less good with a sensitivity of 70% and specificity of 58%. No significant correlation was present between TmCa and the serum calcium response. A significant negative correlation was evident between NcAMP and TmPO4 (r=-0.35, P=0.003), however, no significant correlation was evident between NcAMP and TmCa or TmPO4 and TmCa.These results suggest that in a hypercalcemic patient where evidence exists for the presence in circulation of a factor with PTH-like activity (i.e., NcAMP is elevated or TmPO4 is low) the response of serum calcium to pamidronate is less good. NcAMP would appear to be a useful predictor of the response of serum calcium, whereas TmPO4 is less discriminating. 相似文献
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Liu JM; Chen YM; Chao Y; Liu SM; Tiu CM; Wu HW; Chiou TC; Hsieh RK; Chen LT; Whang-Peng J 《Japanese journal of clinical oncology》1998,28(7):431-435
BACKGROUND: To evaluate the efficacy and toxicity of cisplatin/etoposide
continuous infusion chemotherapy for cancer of unknown primary site in
Taiwan, a region with a high prevalence of endemic viral infections.
METHOD: Between April 1994 and February 1996, 20 patients with a diagnosis
of CUPS were treated, including 15 males and five females, of average age
63.3 years (range 41-83 years). Continuous intravenous infusion of
etoposide 80 mg/m2 and cisplatin 25 mg/m2 was given for 3 days every 3
weeks. Pretreatment tumor marker and viral serology studies were performed
for baseline evaluation. Nearly two-thirds of the patients had poorly
differentiated carcinoma. The average number of metastatic sites was 2.65
(range 1-4), with liver and lymph node involvement predominating. RESULTS:
The overall response rate was 25% (95% CI 17.7-32.3%); 30.7% for poorly
differentiated cancers and 25% for well differentiated cancers. Median
survival was 4 months (range 1-12 months), 4.8 months for patients
attaining partial response. Toxicity was moderate, grade 3 and 4
neutropenia occurred in 55% and grade 3 and 4 thrombocytopenia in 40%;
other toxicities were mild. CA125 and CA199 were elevated in more than 50%
of patients. Viral serology studies were not significantly different from
those of the indigenous population. CONCLUSION: Etoposide and cisplatin
combination chemotherapy has modest activity in patients with extensive
CUPS and, at the schedule and dosage given, it is associated with moderate
toxicity.
相似文献
28.
Vanderhorst VG Terasawa E Ralston HJ Holstege G 《The Journal of comparative neurology》2000,424(2):233-250
The nucleus retroambiguus (NRA) consists of premotor neurons in the caudal medulla. It is involved in expiration, vomiting, vocalization, and probably reproductive behavior by means of projections to distinct motoneuronal cell groups. Because no information is available about the NRA and its efferent pathways in primates, the present study examines NRA projections to the lumbosacral spinal cord in female rhesus monkeys. To identify the NRA, wheat germ agglutinin-horseradish peroxidase (WGA-HRP) was injected into the lumbosacral cord in three monkeys. To study the distribution of NRA axons in the lumbosacral cord, WGA-HRP injections were made into the NRA in seven monkeys. To identify motoneuronal cell groups receiving input from the NRA, the same seven monkeys also received cholera toxin subunit b (CTb) injections into different hindlimb, axial, and pelvic floor muscles. The results show that NRA neurons projecting to the lumbosacral cord are mainly located between 1 to 4 mm caudal to the obex. They send numerous axons to external oblique and pelvic floor motoneurons, whereas projections to iliopsoas and axial motoneurons are less numerous. The projections are bilateral, but show a clear contralateral predominance in the iliopsoas, axial, and pelvic floor motoneuronal cell groups. At the ultrastructural level, NRA-terminal profiles make asymmetrical contacts with labeled and unlabeled dendrites in these motoneuronal cell groups and contain large amounts of spherical and a few dense core vesicles. It is concluded that the NRA is well developed in the monkey and that there exists a direct pathway from the NRA to lumbosacral motoneurons in this species. The finding that the NRA projects to a somewhat different set of motoneuronal cell groups compared with other species fits the concept that it is not only involved in expiration-related activities but also in species specific receptive and submissive behavior. 相似文献
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Paget’s disease of bone (PDB) has become less common over recent decades but it is unclear if this has impacted on clinical presentation. Here we evaluated the presenting features of PDB in a contemporary cohort of UK patients and conducted a systematic review of studies in which the presenting features had been reported. The case series comprised 88 patients referred to a specialist clinic between 2005 and 2013. Bone pain was the most common presenting feature occurring in 73.8 % of patients. Others included bone deformity (18.1 %), deafness (7.9 %) and pathological fracture (5.7 %). The disease was asymptomatic in 22 % of cases. Antiresorptive treatment was given for pain in 34 cases and 61.7 % of patients responded. Patients with a shorter disease duration were more likely to respond (p = 0.047). In the systematic review, bone pain was the most common presenting feature (52.2 % of cases) followed by deformity (21.5 %), deafness (8.9 %) and fracture (8.5 %). Time trend analysis in subjects of European descent showed that fracture was less common in studies performed during the past 25 years as compared with older studies (5.5 vs. 10.8 % p < 0.001) whereas pain was more common (54.3 vs. 48.3 %, p = 0.003). While changes in the mode of presentation of PDB have occurred over recent years, many patients present with complications such as fracture and deformity. Further research is required to determine if early detection and therapeutic intervention might be of value in preventing the morbidity associated with this common disease. 相似文献