The relation of the coracoclavicular ligament insertion to the acromioclavicular jointA cadaver study of relevance to lateral clavicle resection

Resection of the lateral end of the clavicle is a common procedure for arthrosis of the acromioclavicular joint (AC-joint). However, no anatomical data on the distance between the insertions of the coracoclavicular ligaments and the AC-joint have been reported. In 36 cadaver shoulders (18 male), we studied the relation between the AC-joint and the insertions of the joint capsule, trapezoid and conoid ligaments. The distance from the AC-joint to the medial end of its capsule was, on average, 0.7 cm (0.4-0.9) cm in women and 0.8 (0.4-1.2) cm in men. In women, the trapezoid ligament began, on average, at 0.9 (0.4-1.6) cm and ended at 2.4 (2.0-2.8) cm and in men, it began at 1.1 (0.8-1.6) cm and ended at 2.9 (2.1-3.8) cm medial to the AC joint. The corresponding figures for the conoid ligament were 2.6 (2.0-3.7) cm and 4.7 (3.9-6.2) cm. A resection of 1 cm of the lateral clavicle detaches 8%, a resection of 2 cm 60% and a resection of 2.5 cm 90% of the trapezoid ligament. We recommend a maximum resection of 1 cm of the lateral clavicle because a resection of 2 cm or more may cause postoperative AC-joint instability and related pain.     

Assessment of functional ability in younger and older patients with ankylosing spondylitis: performance of the bath ankylosing spondylitis functional index

OBJECTIVE: To determine whether the Bath Ankylosing Spondylitis Functional Index (BASFI) is applicable in older patients with ankylosing spondylitis and whether it shows major differences between younger and older patients with ankylosing spondylitis. DESIGN: BASFI total scores and every BASFI item of 202 patients with ankylosing spondylitis aged >or=60 yr (group A) and 267 patients with ankylosing spondylitis aged 相似文献   

Long-term benefits of radon spa therapy in rheumatic diseases: results of the randomised, multi-centre IMuRa trial

In chronic rheumatic diseases, recent treatment regimens comprise multimodal concepts including pharmacologic, physical/exercise, occupational and psychological therapies. Rehabilitation programmes are used for long-term management of disease. Spa therapy is often integrated in various middle and south European and Asian countries. Here, we investigated radon spa therapy as applied in health resorts compared to a control intervention in rheumatic out-patients. Randomised, blinded trial enroling 681 patients [mean age 58.3 (standard deviation 11.1); female 59.7 %] in 7 health resorts in Germany and Austria with chronic back pain (n ₁ = 437), osteoarthritis (OA) (n ₂ = 230), rheumatoid arthritis (n ₃ = 98), and/or ankylosing spondylitis (n ₄ = 39); multiple nominations in 146 cases). Outcomes were pain (primary), quality of life, functional capacity, and medication measured before start, after end of treatment, and 3 times thereafter in 3 monthly intervals. Adverse events were documented. To analyse between-group differences, repeated-measures analysis of covariance was performed in metric endpoints and Fisher’s exact test in rates. Two-sided significance level of 5 % was chosen. Until end of follow-up, superiority of radon therapy was found regarding pain relief (p = 0.032) and analgesic drug consumption (p = 0.007), but not regarding quality of life. Functional capacity was assessed specific to the underlying indication. Significant benefits were found in radon-treated OA patients until 6-month follow-up (p = 0.05), but not until end of study (p = 0.096). Neither the back pain sub-population nor the two smaller patient populations with inflammatory indications benefited significantly in functional capacity. Results suggest beneficial analgesic effects of radon spa therapy in rheumatic diseases until 9 months post-intervention.     

Suppository administration of chemotherapeutic drugs with concomitant radiation for rectal cancer

PURPOSE: Preoperative radiation with combined chemotherapy is effective in shrinking advanced rectal cancer locally and facilitating subsequent surgery. Suppository delivery of 5-fluorouracil is associated with less toxicity and higher rectal tissue concentrations than intravenous administration. This prompted us to evaluate suppository and intravenous administration of 5-fluorouracil and mitomycin C with concomitant radiation to determine associated toxicity. METHODS: Rectal, liver, lymph node, and lung tissue and systemic and portal blood were collected serially from male Sprague Dawley rats to determine drug concentrations following suppository or intravenous delivery of 5-fluorouracil or mitomycin C. Thirty-six animals were randomly assigned to treatment groups and received 5-fluorouracil suppositories, mitomycin C suppositories, or an equivalent intravenous dose of 5-fluorouracil or mitomycin C 30 minutes before radiation therapy. Before and 3, 6, 10, and 15 days following this treatment, blood was collected, colonoscopy was performed, and rectal tissue was harvested for histologic examination. RESULTS: Mitomycin C suppository was significantly less toxic compared with intravenous delivery, and higher rectal tissue concentrations were observed from 10 to 30 minutes ( P < 0.05). Compared with intravenous 5-fluorouracil administration and radiation, 5-fluorouracil suppository and radiation resulted in additive myelosuppression at day 6 ( P <0.05) with rapid recovery. CONCLUSIONS: 5-Fluorouracil and mitomycin C suppository delivery combined with radiation causes less systemic toxicity and is more effective than intravenous administration.Supported in part by a grant from the Mason and Mary Rudd Foundation Endowment of Jewish Hospital, Louisville, Kentucky. Dr. Pokomy was supported by a grant from the American Cancer Society.Poster presentation at the meeting. of The American Society of Colon and Rectal Surgeons, Seattle, Washington, June 9 to 14, 1996.     

Changes in knee adduction moment,pain, and functionality with a variable‐stiffness walking shoe after 6 months

This study tested the effects of variable‐stiffness shoes on knee adduction moment, pain, and function in subjects with symptoms of medial compartment knee osteoarthritis over 6 months. Patients were randomly and blindly assigned to a variable‐stiffness intervention or constant‐stiffness control shoe. The Western Ontario and McMaster Universities (WOMAC) score served as the primary outcome measure. Joint loading, the secondary outcome measure, was assessed using the external knee adduction moment. Peak external knee adduction moment, total WOMAC, and WOMAC pain scores were assessed at baseline and after 6 months. The total WOMAC and WOMAC pain scores for the intervention group were reduced from baseline to 6 months (p = 0.017 and p = 0.002, respectively), with no significant reductions for the control group. There was no difference between groups in magnitude of the reduction in total WOMAC (p = 0.50) or WOMAC pain scores (p = 0.31). The proportion of patients achieving a clinically important improvement in pain was greater in the intervention group than in the control group (p = 0.012). The variable‐stiffness shoes reduced the peak knee adduction moment (?6.6% vs. control, p < 0.001) in the 34 intervention subjects at 6 months. The adduction moment reduction significantly improved (p = 0.03) from the baseline reduction. The constant‐stiffness control shoe increased the peak knee adduction moment (+6.3% vs. personal, p = 0.004) in the 26 control subjects at 6 months. The results of this study showed that wearing the variable‐stiffness shoe lowered the adduction moment, reduced pain, and improved functionality after 6 months of wear. The lower adduction moment associated with wearing this shoe may slow the rate of progression of osteoarthritis after long‐term use. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 28:873–879, 2010     

Fish oil supplementation in the parenteral nutrition of critically ill medical patients: a randomised controlled trial

OBJECTIVE: To test whether supplementation of parenteral nutrition with fish oil - aimed at increasing the n-3:n-6 ratio of polyunsaturated fatty acids (PUFA) to 1:2 - affects systemic inflammation and clinical outcome compared to standard parenteral nutrition with an n-3/n-6 ratio of 1:7 in medical intensive care unit (ICU) patients. DESIGN: Single-centre, placebo-controlled, double-blind, randomised clinical trial. SETTING: Twelve-bed medical ICU of a university hospital. PATIENTS: A total of 166 consecutive patients anticipated to need parenteral nutrition for more than 6 days. Patients were stratified for the presence of systemic inflammatory response syndrome (SIRS) at baseline (115 SIRS, 51 non-SIRS). INTERVENTION: Patients were randomly assigned to receive either a 1:1-mixture of medium-chain triglycerides (MCT) and long-chain triglycerides (LCT) with an n-3/n-6 PUFA ratio of 1:7, or the same MCT/LCT emulsion supplemented with fish oil (resulting in an n-3/n-6 ratio of 1:2). MEASUREMENTS AND RESULTS: Primary endpoints were changes in interleukin 6 (IL-6) and monocyte HLA-DR expression relative to baseline. Secondary endpoints were incidence of nosocomial infections, duration of mechanical ventilation, length of ICU stay, and 28-day mortality. Bleeding complications were recorded as a possible side effect of fish oil. Between standard and intervention groups, overall as well as stratified for SIRS or non-SIRS, no significant difference was detected in any of the endpoints or frequency and severity of bleeding events. CONCLUSIONS: In unselected critically ill medical patients, fish oil supplementation that increased the n-3/n-6 PUFA ratio to 1:2 did not affect inflammation or clinical outcome, compared to parenteral lipid nutrition with an MCT/LCT emulsion.     

Relationship Between Anticancer Activity and Stereochemistry of Saldach Ligands and their Iron(III) Complexes

(R,R)-, (S,S)- and (R,S)-N,N′-bis(salicylidene)-1,2-diaminocyclohexane (saldach) and their iron(III) complexes were screened for anticancer activity against MCF-7 and MDA-MB 231 breast cancer as well as HT-29 colon carcinoma cells. Antiproliferative effects depended on the presence of the central atom iron but were independent on the configuration at the saldach ligand. While the free ligands were inactive, the iron(III) derivatives displayed anticancer activity within a concentration range of 1 to 5 μM irrespective of the used cell line. At 5 μM they were even more active than cis-platin. A mode of action comparable to cis-platin can be excluded because it is very likely that the DNA is not the primary target of [Fe^III (saldach)] complexes.