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991.
Jun Endo Satoshi Yamaguchi Masahito Saito Takashi Itabashi Kouji Kita Wataru Koizumi Yoshikuni Kawaguchi Tomomi Asaka Osamu Saegusa 《Journal of orthopaedic science》2013,18(2):250-255
Background
Preoperative traction for hip fractures is of no benefit in semi-urgent surgery. However, its efficacy has not been assessed in cases in which emergency surgery was not possible. We evaluated the efficacy of preoperative skin traction for hip fractures in a level II trauma center in Japan where many patients undergo delayed surgery.Methods
We undertook a randomized controlled trial. Eighty-one patients were randomized to be treated with skin traction (41 patients), or bed rest (40 patients). Preoperative pain was assessed by use of a visual analogue scale and the number of analgesics required. Fracture reduction was measured on the basis of leg-length and neck–shaft angle discrepancies on the radiograph on admission, a day before surgery, and after surgery.Results
The mean time from admission to surgery was 7.5 days. Pain decreased markedly on the day after admission in both the traction and no-traction groups. No significant difference was found during the preoperative waiting period between the groups in either pain score or number of analgesics taken. No significant difference was found in radiographic data either before or after surgery, and satisfactory reduction was achieved after surgery irrespective of the use of skin traction.Conclusions
In our single-institution prospective randomized controlled trial, preoperative skin traction for patients with hip fracture had no effect on pain relief before surgery or reduction of fracture displacement during surgery, irrespective of preoperative waiting time. 相似文献992.
Noboru Hanaoka MD Ryu Ishihara MD Yoji Takeuchi MD Motoyuki Suzuki MD Hirokazu Uemura MD Takashi Fujii MD Kunitoshi Yoshino MD Noriya Uedo MD Koji Higashino MD Takashi Ohta MD Hiromitsu Kanzaki MD Masao Hanafusa MD Kengo Nagai MD Fumi Matsui MD Hiroyasu Iishi MD Masaharu Tatsuta MD Yasuhiko Tomita MD 《Head & neck》2013,35(9):1248-1254
993.
Hirotaka Koyanagi Keisuke Ae Hidetsugu Maehara Masato Yuasa Tomokazu Masaoka Tsuyoshi Yamada Takashi Taniyama Masanori Saito Yuki Funauchi Toshitaka Yoshii Atsushi Okawa Shinichi Sotome 《Journal of orthopaedic research》2013,31(8):1308-1316
994.
Norihiro Sakai Takaya Inoue Yasuo Kunugiza Tetsuya Tomita Takashi Mashimo 《The Journal of arthroplasty》2013
We conducted the prospective randomized controlled trial to test that continuous femoral nerve block (CFNB) improves attainment of 120° knee flexion compared to continuous epidural analgesia (CEA). Sixty-six patients scheduled for unilateral total knee arthroplasty were randomized into two groups; infusion of ropivacaine 0.15% into CEA or CFNB to third postoperative days. We studied the time required to attain 120° knee flexion, variations in thigh and calf circumferences around the treated knee, pain scores, rehabilitation milestones, the need for adjuvant analgesics, and side effects. CFNB patients attained earlier knee flexion to 120°, lower variations in thigh and calf circumferences, less pain during rehabilitation, and less need for adjuvant analgesics. CFNB is a better pain management strategy that accelerates knee flexion rehabilitation. 相似文献
995.
996.
Bungo Otsuki Mitsuru Takemoto Keiichi Kawanabe Yasunari Awa Haruhiko Akiyama Shunsuke Fujibayashi Takashi Nakamura Shuichi Matsuda 《International orthopaedics》2013,37(6):1033-1038
Purpose
Curved peri-acetabular osteotomy (CPO) produces excellent clinical results, but the surgical procedure is technically demanding, and severe complications related to the osteotomy have been reported. To provide a safe, accurate surgical procedure, we have developed a novel method for setting the cutting line and direction. We have designed and made a custom cutting guide for individual patients. The purpose of the study was to evaluate the efficacy of this new method and cutting guide.Methods
The cutting line was designed on a full-scale three-dimensional plaster model made from computed tomography (CT) data for each case. The surface of each plaster model was colour-coded according to the distance from the centre of the femoral head. A custom cutting guide was designed based on this cutting line on the workstation. A titanium custom cutting guide was fabricated using rapid prototyping technology. The cutting guide directed the cutting direction of the osteotome. We evaluated the outcomes for seven consecutive hips in seven patients who underwent CPO using the system between April and December 2011. All peri-operative complications were recorded. The accuracy of the cutting line was evaluated using CT data obtained two weeks after the operation.Results
There were no major complications related to the osteotomy such as posterior column fracture or intra-articular osteotomy. The actual cutting line corresponded almost exactly to the planned cutting line in all cases.Conclusions
The colour-coded plaster model and the custom cutting guide were effective for avoiding severe complications associated with a CPO. 相似文献997.
Takashi Sugawara Masaru Aoyagi Youji Tanaka Masashi Tamaki Daisuke Kobayashi Kikuo Ohno 《Neurosurgical review》2013,36(3):395-402
The diagnosis and treatment of pituitary macroadenomas with entire hematoma fluid accumulation are problematic. Such lesions are often difficult to completely resect, and recurrence is not uncommon. We present five cases of pituitary macroadenomas entirely composed of hematoma fluid and investigated their histopathology to clarify the mechanism of the hematoma fluid accumulation. Five patients with pituitary adenoma and significant intra-tumor hematoma underwent transsphenoidal resection and were retrospectively reviewed for their clinical status, findings on magnetic resonance imaging (MRI), intraoperative findings, and histopathology. The specific surgical techniques used to address these cases were also reviewed. All patients were diagnosed with nonfunctioning pituitary adenomas by histopathological examination. MRI showed all tumors extended to the cavernous sinus. Histopathology showed tumor tissues were located between the thick granulation tissue and the pseudocapsule of the tumor. The thick granulation tissues were composed of collagenous layers, neovascular vessels, and necrotic red blood cells, indicating repeat hemorrhage from the granulation tissues. The boundary between adenoma and normal pituitary gland was identified during surgical removal in four patients and was not identified in the other patient who showed a recurrence 2 years later. Clinical and histopathological findings indicate hematoma fluid accumulation in the present cases is caused by repeat hemorrhage from the reactive granulation tissues and can be regarded as a chronic encapsulated expanding hematoma. In these cases, the boundary between adenoma and normal pituitary gland should be identified before puncturing the hematoma fluid to minimize the risk of tumor recurrence. 相似文献
998.
Satsuki Miyata Masashi Urabe Akira Gomi Mutsumi Nagai Takashi Yamaguchi Tomonori Tsukahara Hiroaki Mizukami Akihiro Kume Keiya Ozawa Eiju Watanabe 《Neurologia medico-chirurgica》2013,53(10):645-654
Cytosolic isocitrate dehydrogenase 1 (IDH1) with an R132H mutation in brain tumors loses its enzymatic activity for catalyzing isocitrate to α-ketoglutarate (α-KG) and acquires new activity whereby it converts α-KG to 2-hydroxyglutarate. The IDH1 mutation induces down-regulation of tricarboxylic acid cycle intermediates and up-regulation of lipid metabolism. Sterol regulatory element-binding proteins (SREBPs) regulate not only the synthesis of cholesterol and fatty acids but also acyclin-dependent kinase inhibitor p21 that halts the cell cycle at G1. Here we show that SREBPs were up-regulated in U87 human glioblastoma cells transfected with an IDH1R132H-expression plasmid. Small interfering ribonucleic acid (siRNA) for SREBP1 specifically decreased p21 messenger RNA (mRNA) levels independent of the p53 pathway. In IDH1R132H-expressing U87 cells, phosphorylation of Retinoblastoma (Rb) protein also decreased. We propose that metabolic changes induced by the IDH1 mutation enhance p21 expression via SREBP1 and inhibit phosphorylation of Rb, which slows progressionof the cell cycle and may be associated with non-aggressive features of gliomas with an IDH1 mutation. 相似文献
999.