Glucose tolerance test in leprosy

Glucose tolerance test was carried out in 43 cases of leprosy. They included cases of tuberculoid, borderline, lepromatous leprosy and those with lepra reaction. It was observed that normal curve was common in tuberculoid leprosy. Flat glucose tolerance curve was observed in borderline and lepromatous leprosy. However, the diabetic curve was common in Lepra reaction. Fasting blood sugar was low in lepromatous leprosy and it tended to be marginally high in lepra reaction. Normal GTT response was observed in those with duration of disease between 0-6 months, flat curves in those with duration of disease between 7-12 months while diabetic curve was more common in those with disease duration of more than 2 years.     

Effect of knee component alignment on tibial load distribution with clinical correlation

To determine ideal alignment and component placement of total knee prostheses, Kinematic (K) and total condylar (TC) devices were physiologically loaded and interface forces were measured. Laboratory observations were correlated with clinical (roentgenographic) findings. Asymmetric loading of the tibial component has been proposed as causing loosening and radiolucent lines. Misalignment of components is one factor that affects load sharing by bone under the medial and lateral regions of the tibial plateau. Tibial components of K and TC prostheses were inserted without cement into the cut surfaces of artificial tibiae. The mating femoral condylar components were mounted. The tibial and femoral components were individually positioned at 0 degrees (horizontal) and at certain angles of varus and valgus. Pressure-sensitive film was placed between the tibial component and the artificial tibia. A vertical load of 1500 N was used. The experiment was replicated twice. The percentages of the load on the medial and lateral regions of the tibial plateau were calculated from quantitative image analysis of the pressure patterns on the film. Roentgenograms from 532 K and 21 TC patients were examined to determine the orientations of the condylar and tibial components and the presence of radiolucent lines around the tibial component. An even distribution (ideal alignment) of load on the medial and lateral regions of the K tibial component occurred at 9 degrees of valgus tilt of the femoral component and 2 degrees of varus tilt of the tibial component and for the TC at 7 degrees valgus and 0 degrees varus. Misalignment by 5 degrees yielded a 7% change in the load distribution under the K plateau and a 40% change for the TC prosthesis; a 10 degrees misalignment produced changes of 34% and 62% for the K and TC, respectively. Small variations in clinical knee alignment produced the same percentage of radiolucent lines for each alignment group. The location of radiolucent lines was distributed among the medial, lateral, and both tibial plateaus regardless of knee alignment, although there were more medial reactions overall. The smallest incidence (8%) of radiolucent lines occurred with the K prosthesis at 7 degrees of knee valgus, the femoral component placed at 9 degrees valgus, and the tibial component at 2 degrees varus. This correlated with the ideal bench-test findings for the K device.     

Neurological monitoring and sedation protocols in the Liver Intensive Care Unit

Metabolic Brain Disease - Patients with liver disease often have alteration of neurological status which requires admission to an intensive care unit. Patients with acute liver failure (ALF),...     

The effect of wrist surgery on the kinematic consistency of joint axis reconstruction in a static posture

Three‐dimensional analysis of wrist motion is a growing focus in orthopedic research, however, our understanding of its validity (accuracy and reliability) remains limited. Nine human cadavers were tested to estimate wrist joint axes alignment in a postural static pose. The objective was to investigate a rater's ability to reliably align three skin‐ tracked wrist joint coordinate system (WJCS) definitions across baseline and reconstructive wrist states (intact, mid‐carpal arthrodesis, and proximal‐row carpectomy). Two WJCSs (legacy, anatomic) were based on palpated bony landmarks and the third (functional) was based on both landmarks and passive flexion‐extension motion. A coordinate frame based on the anatomic definition was tracked with bone pins and served as a reference. Each WJCS was tested in each wrist state and in three forearm position (45° pronation, neutral, 45° supination). The angular offset about each axis of the WJCS frames were calculated with respect to the reference in flexion‐extension, radial‐ulnar deviation, and pronation‐supination for every iteration. Reliability and root mean square deviation values were analyzed across wrist states. Our data suggest that no WJCS is uniformly more reliable than another. The functional WJCS definition was most consistent across intact and post‐operative states for pronation‐supination offset, but this was dependent on rater interpretation. It still however offers the practical benefit of requiring fewer landmarks. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:1341–1347, 2015.