Revascularization of multiple bypassable extended right coronary arteries

BACKGROUND: Extended right coronary arteries are not uncommon in coronary surgery. They can be revascularized optionally either by conventional single or complete multiple bypassing. However, there are still no objective data showing the superiority or appropriateness of one of these methods over the other. METHODS: Extended right coronary arteries were identified by preoperative angiographic scoring and randomized to multiple-bypassing (group A; n = 32) or single-bypassing (group B; n = 32) groups. Four parameters that show the completeness of right coronary territory revascularization were evaluated and compared between the 2 groups. RESULTS: Although overall perioperative ischemic events seemed to increase in the single-bypass group (P =.0059), half of them were reversible, and there were no statistical differences between the definitive perioperative ischemic event rates, namely, infarction rates, and the remaining 3 parameters of the groups. Logistic regression analysis showed that preoperative left ventricular dysfunction (ejection fraction <50%) was the most significant predictor of these perioperative ischemic events. Hence, the subgroups of patients with left ventricular dysfunction were also evaluated (subgroup A, n =13; subgroup B, n = 12). Overall perioperative ischemic event (P =.001), definitive perioperative ischemic event (infarction; P =.0324), and consequent right ventricular dysfunction (P =.0324) rates were significantly higher in the single-bypass subgroup. Postoperative reperfusion status and graft patency rates of the right coronary territory did not change with the different revascularization methods. CONCLUSIONS: Complete revascularization of extended right coronary arteries did not seem advantageous over its conventional operation in patients with normal ventricular function; however, in patients with poor ventricular function (ejection fraction <50%), it prevented perioperative ischemic events in the right coronary territory and the consequent functional impairment that appeared with conventional operation.     

The role of microvascular injury on steroid and OKT3 response in renal allograft rejection

BACKGROUND: The authors' aim is to understand the influence of human leukocyte antigen-DR positive microvascular (MV)-DR destruction on steroid and OKT3 response in acute rejection (AR). METHODS: Twenty of 40 patients had steroid-resistant AR (group 1) and received OKT3 treatment, and the other 20 patients had AR that responded to steroid treatment (group 2). A renal biopsy specimen was obtained from each subject during the AR episode. The degree of MV-DR destruction and the peritubular capillary (PTC) leukocyte infiltration were recorded in each case, using three-tiered scales. The follow-up biopsy specimens of all cases were evaluated for the development of interstitial fibrosis (IF). RESULTS: Seventy-eight percent of the cases with severe MV destruction and 45% of those with moderate MV destruction did not show response to steroid therapy, whereas 74% of the cases with mild MV destruction responded to steroid therapy. Group 1 patients showed higher frequencies of vascular rejection (80%) and high-grade PTC leukocyte infiltration (85%) than the group 2 cases (P<0.01 for both). Seventy percent of the patients in group 1 responded to OKT3 therapy. The biopsy specimens from the six individuals who were resistant to OKT3 had shown severe MV destruction, vascular rejection, and high-grade PTC leukocyte infiltration. Severity of MV destruction in the initial AR diagnostic biopsy was positively correlated with development of diffuse IF and chronic allograft nephropathy in the follow-up biopsy specimens (P<0.001) CONCLUSIONS: Analysis of MV destruction may be helpful for diagnosing rejection and predicting graft prognosis. This type of assessment may be useful for determining the immune response and thus identifying the most appropriate treatment.     

Sports activities after medial unicompartmental knee arthroplasty Oxford III—What can we expect?

Purpose

Excellent long-term results have been reported for implantation of unicompartmental knee arthroplasty (UKA). In many patients the desire for improvement in function often includes an aspiration to return to sports. The purpose of our study was to evaluate physical activities after medial Oxford-III (Biomet) UKA surgery.

Methods

Patients’ physical activity before and after the surgery was assessed using a self reporting questionnaire. We used the Oxford knee scoring system (OKS), the WOMAC-, the Knee society- (KSS) and the UCLA-score to assess postoperative knee function. The mean follow-up was 4.2 years. The female-to-male ratio was 1.3:1. The mean age at surgery was 65.3 years.

Results

Of the 131 patients studied 78 participated in some kind of sports before surgery (mean age 64.4 years), while 53 patients did not perform any sports (mean age 66.5 years) (p > 0.05). At follow-up the patients in the active group were significantly younger than the patients in the inactive group (p < 0.05). The majority of patients (80.1 %) returned to their level of sports activity after UKA surgery. Six patients took up sports after surgery while 15 patients stopped their sports. Among the active patients we found a shift from high- towards low-impact sports. The active patients had significantly higher scores for the OKS, KSS, WOMAC and UCLA score. The complication rate was comparable in both groups.

Conclusion

Our study demonstrates that a high degree of patient satisfaction in terms of sports activity can be achieved using the Oxford-III UKA for medial osteoarthritis.     

Clinical and cognitive insight in patients with acute-phase psychosis: Association with treatment and neuropsychological functioning

Background: The severity of psychopathology cannot fully explain deficits in the multi-dimensional construct of insight.

Aims: The aim of this study was to evaluate the correlates and associations of clinical and cognitive insight in patients in an acute phase of psychosis and to analyse the impact of acute treatment on these variables.

Methods: This study examined 47 inpatients who were recently hospitalized with acute exacerbation of schizophrenia. All subjects were assessed at both admission and discharge with the Positive and Negative Syndrome Scale (PANSS), Schedule for the Assessment of Insight-Expanded Version (SAI-E), Beck Cognitive Insight Scale (BCIS), and a neurocognition battery.

Results: Patients with schizophrenia gained clinical insight after treatment. Cognitive insight did not change significantly after treatment. Insight showed significant negative correlations with positive symptoms and general psychopathology, but not with negative symptoms. Clinical insight was not associated with neuropsychological functioning in this cohort.

Conclusion: Gaining clinical insight in the acute phase of illness was associated with the remission of positive symptoms, but not with neuropsychological functioning. Some significant correlations between clinical and cognitive insights were detected, which suggests that cognitive insight contributes to clinical insight but is not treatment-dependent. Long-term treatment may be required to understand the contribution of insight to the outcome of patients with schizophrenia.     

Heat distribution of polymerisation temperature of bone cement on the spinal canal during vertebroplasty

Purpose  

In the last 15 years, vertebroplasty and kyphoplasty have become established operative procedures for treating osteoporotic vertebral-body fractures and vertebral bodies afflicted with metastases. These procedures are quickly performed with few personnel and material resources and have a low rate of complications. However, cases of neurological impairment are reported in the scientific literature. We analysed whether potentially harmful heat is radiated/conducted by the polymerisation temperature of polymethylmethacrylate (PMMA) bone cement in the spinal canal.     

Effect of thermocycling on the bond strength of composite resin to bur and laser treated composite resin

The objective of this study was to investigate the effect of two different surface treatments (Er:YAG laser and bur) and three different numbers of thermal cycling (no aging, 1,000, 5,000, and 10,000 cycles) on the micro-shear bond strength of repaired composite resin. Ninety-six composite blocks (4 mm × 4 mm × 1 mm) obtained with a micromatrix hybrid composite were prepared. The composite blocks were then randomly divided into four groups (n = 24), according to the thermal cycling procedure: (1) stored in distilled water at 37°C for 24 h (control group), (2) 1,000 cycles, (3) 5,000 cycles, and (4) 10,000 cycles. After aging, the blocks were further subdivided into two subgroups (n = 12), according to surface treatment. Bur and laser-treated composite surfaces were treated with an etch&rinse adhesive system. In addition, a microhybrid composite resin was bonded to the surfaces via polyethylene tubing. Specimens were subjected to micro-shear bond strength test by a universal testing machine with a crosshead speed of 0 and 5 mm/min. The data were analyzed using one-way analysis of variance and Tukey tests (α = 0.05) for micro-shear bond strengths. After conducting a bond strength test, it was found that the laser and bur-treated specimens had similar results. Aging with 10,000 thermocycles significantly affected the repair bond strength of composite resins.     

Management of stiff hypertrophic nonunions by distraction osteogenesis: a report of 16 cases

OBJECTIVE: Hypertrophic nonunions can be managed successfully with distraction. Hypertrophic changes indicate that the tissue at the nonunion site has a biologic healing potential. The missing component is an appropriate mechanical environment to transform a hypertrophic nonunion into solid bone. DESIGN: At our institution, the records of 10 male and 6 female patients treated for stiff hypertrophic nonunion with the Ilizarov distraction method were retrospectively analyzed. The average age of the patients was 42.3 years (range 15-69 years). The nonunion time ranged from 8-48 months. All patients had at least 1 cm shortening, 3 patients had a deformity in one plane, and 13 had a deformity in two planes. The pathology was localized to the upper extremity in 5 patients, to the lower extremity in 11 patients, with a periarticular localization in 11 patients. An Ilizarov-type circular external fixator was applied in all patients to correct shortening, to correct deformity, and to achieve a solid union. RESULTS: All nonunions healed at an average follow-up of 38.1 months (range 24-95 months). The average time spent in the external fixator was 7.1 months (range 5-10 months). The average preoperative length discrepancy was 2.25 cm (range 1-8 cm), which was eliminated in all patients at the time of frame removal. The average coronal plane angulation of 19.7 degrees (range 15-37 degrees) and sagittal plane angulation of 20.8 degrees (range 5-45 degrees), together with translation in one patient, also were corrected to normal anatomic alignment. Complications included minor pin tract infections and hardware problems; recurrence of deformity was observed in one patient who refused to wear a protective brace after frame removal. CONCLUSIONS: Hypertrophic nonunions can be managed successfully with distraction. The Ilizarov device can address every aspect of a stiff hypertrophic nonunion, including shortening and deformity.     

Influence of number of pregnancies on bone mineral density in postmenopausal women of different age groups

 As data on the relationship between parity and bone mineral density often seem to be controversial, ultimately, a comprehensive research study was thought to be necessary. This study focused on examining the influence of the number of pregnancies on bone mineral density and investigating the relationship between pregnancy and bone mineral density at four sites in postmenopausal women of different age groups. A total of 509 postmenopausal women, varying from 45 to 86 years of age (mean age of 60.85 ± 7.53 years) were considered for the study. A standardized interview was employed to obtain information on demographics, lifestyle, and, reproductive and menstrual histories. Patients were separated into four groups according to the number of pregnancies, i.e., nulliparae (52 patients), one to two parity (66 patients), three to five parity (178 patients), and more than five parity (213 patients). The patients were further classified into two age groups, 40–59 years (233 patients) and 60–80 years (276 patients), respectively. The number of pregnancies was found to range from 0 to 17 (with an overall mean of 5.42 ± 3.68), with 4.29 ± 2.74 (range, 0–16) accounting for live births, while 1.02 ± 1.53 (range, 0–14) were abortions. There were no significant differences among the groups with respect to parameters such as, age, body mass index (BMI), age at menarche, age at menopause, and years since menopause (P > 0.05) in all of the 509 women and in the 40- to 59- and 60- to 80-year groups. When all the patients were considered, the bone mineral density (BMD) values of the spine and the trochanter for the more-than-five-parity group, were found to be significantly lower than those of the other groups (P < 0.05), while the BMD values of the spine and the femur (neck, trochanter) appeared to decrease with increasing parity. In the 40- to 59-year group, the BMD of the spine in both the nulliparae and one-to-two-parity groups was significantly higher than that of the more-than-five-parity group (P < 0.05). No significant differences were found among the groups with respect to the BMD values at any femur sites. The nulliparae patients in the 60- to 80-year group exhibited significantly higher trochanter and Ward's BMD values than those of the more-than-five-parity group (P < 0.05), whereas in the one-to-two-parity group, spine BMD values appeared to be significantly higher than those of the more-than-five-parity group (p < 0.05). Significant correlations were found between the number of pregnancies and BMD values for the spine (r = −0.23; P < 0.01), trochanter (r = −0.16; P < 0.01), and Ward's triangle (r = −0.14; P < 0.05), with no significant correlation for femur neck BMD (r = −0.08; P > 0.05) values. In conclusion, the present study suggests that the number of pregnancies has an effect on the BMD values and that this situation shows a variation in different age groups. In addition, our study indicates that there is a significant correlation between the number of pregnancies and the spine, trochanter, and Ward's triangle BMD, but there is no correlation for the femur neck BMD. Received: April 30, 2002 / Accepted: January 16, 2003 RID="*" ID="*" Offprint requests to: A. Gur