Analgesic nephropathy in Hungary: the HANS study.

BACKGROUND: The diagnosis of analgesic nephropathy has improved significantly with modern imaging techniques. We reviewed a large portion of the Hungarian dialysis population to obtain additional insight into the problem. METHODS: Twenty-two participating dialysis units enrolled 1400 patients on renal replacement therapy between 1 January 1995 and 1 January 1998. Patients with no known aetiology (n = 284) were interviewed and studied with renal imaging. We assessed the presence of decreased renal mass combined with either bumpy contours, papillary calcification, or both. The subjects studied were interrogated extensively. RESULTS: Our survey suggested analgesic nephropathy in 47 of 1400 patients (3.3%), 3-fold higher than the EDTA database estimate for Hungary. The analgesics most commonly abused were phenacetin-containing mixtures. The driving symptoms were mainly headache and joint pain. Cardiovascular complications were more common than in the rest of the dialysis population, independent of smoking and lipid values (P<0.01). CONCLUSIONS: Phenacetin should be banned. Our study results support the need for longitudinal cohort and case-control studies in Hungary.     

THE PSYCHOLOGICAL IMPACT OF HIP ARTHROPLASTY

The impact of total hip arthroplasty on psychological functioning was examined in 51 patients; 25 females and 26 males with a mean age of 65 years (range 42–81 years). Assessments of psychological well-being and distress were made with the Mental Health Inventory. Life satisfaction, self-rated health, and pain ratings were also obtained. Assessments were made prior to surgery, immediately after surgery, and at a 2 month follow-up. The operation produced significant improvements in psychological well-being (P < 0.001), psychological distress (P < 0.001). life satisfaction (P < 0.01), self-rated health (P < 0.001), and pain (P < 0.001). It is concluded that the changes in medical and functional status following hip arthroplasty documented in previous research are accompanied by substantial improvements in psychological state, and that the inclusion of psychological factors in hip arthroplasty research will provide a more comprehensive assessment of outcome.     

ARTHROSCOPIC REMOVAL OF ACRYLIC CEMENT FROM UNREDUCED HIP PROSTHESIS

A case is reported in which entrapped polymethylmethacrylate following traumatic dislocation of a total hip replacement prevented complete reduction. A combined arthroscopic and fluoroscopic technique was used to remove the entrapped polymethylmethacrylate. Manipulation of the total hip prosthesis was done after removal of polymethylmethacrylate to minimize mechanical abrasion. This technique allows direct visual assessment of the articulating surfaces as well as the mechanical stability of the prosthesis. The morbidity related to the procedure is minimal and a short rehabilitation period is the major advantage.     

Determination of bone mineral density by dual x-ray absorptiometry in patients with uncemented total hip arthroplasty.

Bone remodeling is an expected sequela with total hip arthroplasty (THA). Although there are several methods of estimating bone response in THA patients from radiographs, there are no accurate and generally accepted methods for quantitative determinations in vivo. In this study, we describe an application of dual x-ray absorptiometry (DXA) for measuring bone mineral content and bone mineral density in the proximal femur following THA. DXA is a noninvasive technique with minimal radiation exposure (< 5 mrem). Various aspects of measurement error (accuracy and reliability) of this application of DXA were determined in a series of studies reported here. Accuracy error (how similar are the measured and actual values) was < 1% determined in bone phantoms of four densities. Precision error (how reproducible are the measurements) was also < 1% at all four densities in the phantoms and was only slightly elevated (0.9-1.5%) in repeated measurements of implanted cadaver femora. Precision error in vivo, determined both from multiple replicates on five patients and from duplicate scans on 30 patients, was further elevated but remained < 5%. Contributions to precision error, rotation of the leg, and interoperator variability were assessed; none was found to elevate precision error appreciably. We suggest that DXA is a feasible method for quantifying bone response following THA, and will allow discrimination of small changes (> 5%) not previously measurable.     

Hormone replacement therapy is associated with increased C-reactive protein in women with Type 2 diabetes in the Diabetes Heart Study.

AIMS: Increased levels of inflammatory biomarkers, especially C-reactive protein (CRP), are associated with increased risk for cardiovascular disease (CVD) events, such as myocardial infarction, stroke, peripheral vascular disease, and sudden cardiac death. Medical interventions that increase CRP levels, such as hormone replacement therapy (HRT) in post-menopausal women, are under increasing scrutiny. The effect of HRT on CRP levels in women with Type 2 diabetes (T2DM) is not well documented, and conflicting conclusions have been reported. The aim of this study was to determine the influence of HRT on women with diabetes in a large cross-sectional study. METHODS: Three hundred and twenty-seven post-menopausal women with T2DM from the Diabetes Heart Study participated. Current use of HRT was determined and serum CRP levels were measured using a high-sensitivity ELISA kit. Generalized estimating equation methods were used to assess the relationship of multiple clinical and lifestyle (e.g. smoking) measures on CRP levels including differences between women taking HRT (HRT+) and not taking HRT (HRT-). RESULTS: Overall serum CRP levels were strongly associated with body mass index (P < 0.0001) and age (P < 0.0001). Of the women, 243 were not using HRT and 84 were using HRT. HRT+ and HRT- women did not differ significantly in measures of clinical traits, with the exception of higher mean low-density lipoprotein cholesterol in HRT- women (P = 0.004). In all models tested, HRT+ women had significantly higher circulating CRP levels, with P-values ranging from 0.0045 to 0.010. CONCLUSIONS: In this study of serum CRP concentration as a function of HRT in women with Type 2 diabetes, there was consistent evidence for increased circulating CRP levels in women receiving oestrogen-containing HRT. Whether HRT-induced increases in CRP can account for the adverse cardiovascular effects of HRT remains to be established; however, based on these data, there is little reason to believe that diabetic women would be spared from such an effect.     

OCM入路微创全髋关节置换术的初步报告

目的介绍OCM入路微创全髋关节置换术(THA)的手术方法。方法2005年1月-2006年1月在对2具尸体、4个髋关节的OCM入路进行相关解剖学研究的基础上开展OCM入路微创THA 20例。手术从臀中肌前间隙进入切开关节囊,分段完成股骨颈截骨,使用特殊的髋臼锉和髋臼打入器安放髋臼假体;股骨侧手术时手术床后下方一半拆卸掉,患髋后伸和外旋且小腿置于消毒袋内,大转子周围关节囊广泛剥离后完成扩髓和股骨假体的安放。结果肥胖指数平均为27．4％的20例患者,皮肤切口长度平均为9．3 cm;术中平均出血130 mL,术后引流量80 mL;患者术后2-3 d下地活动。所有患者获得1-9个月(平均4．3个月)随访,15例已完全脱拐,行走正常;5例不满1个月,仍需扶拐行走。术后随访疼痛采用视觉模拟评分(VAS)由术前平均5．1分分别下降到3．6分(1个月)、1．7分(3个月)和0．8分(6个月)。发生血肿2例,X线检查见髋臼前倾过大2例,股骨假体型号偏小2例。患者髋关节功能Harris评分由术前平均45．4分提高到术后随访时平均88．4分。结论OCM入路微创THA切口小,完整保留臀中肌和关节囊,患者功能恢复快,住院时间短;它需要一个独立学习过程,并需要特殊器械的配合。     

Bone Replacement Materials in Hand Surgery

Abstract Background: In recent years, biomaterials are being found and frequently utilized in bone defects. They have also gained significant precedence in hand surgery. Objectives: The respective requirements for such replacement material will be cited and acknowledged in this article. The individual material groups will also be referred to in this review. An introduction to some of the customary bone replacement materials will be cited and concluded with a corresponding recommendation. Conclusion: The implantation of autologous cancellous bone is still regarded today as the “gold standard”. Nevertheless, the usage of bone replacement material can be an enormous advantage in certain indications. The original article can be found online at There was an error in the author’s affiliation and the address for correspondence was incomplete. Please note the correct institution and complete address: Department of Orthopedics and Traumatology, Hand-, Foot- and Reconstructive Surgery, Kreiskrankenhaus Gummersbach GmbH, Germany. Alexander von Friesen, MD Department of Orthopedics and Traumatology, Hand-, Foot- and Reconstructive Surgery Kreiskrankenhaus Gummersbach GmbH Wilhelm-Breckow-Allee 20 51643 Gummersbach Germany Phone (+49/2261) 171-575, Fax -449 e-mail: Friesen@kkh-gummersbach.de     

低位前外侧入路微创全髋置换术

目的:评价低位前外侧入路微创全髋关节置换术的可行性和早期临床效果.方法:17位患者18例髋关节进行前外侧入路微创全髋关节置换术,仰卧位,自大转子上2 cm为顶向前下切口,纵行切开髂胫束和臀中肌前部着点,由髋关节囊前方分离至髋臼前外缘.不脱位,经股骨颈截骨和取头,处理髋臼植入假体.患髋内收外旋股骨颈基底脱出切口外,股骨扩髓后植入假体.结果:手术切口平均长(10.5±2.1)cm.切口长短与体重正相关,髋臼病理改变和翻修者更长.手术时间平均为(101.7±14.6)min,术中出血量110～600ml,平均(302.2±77.3)ml;双侧髋关节置换1例.术后2～5 d患髋均可负重行走.随访7～22个月,Harris评分平均:术前44;术后6个月85.假体位置理想.无并发症.结论:经低位的前外侧入路行微创全髋关节置换术,需要特殊的髋关节拉钩和牵开技术.有创伤小、不损伤臀上神经、假体位置理想、术中可以处理较复杂病理改变、准确测量两侧下肢体长度、术后外展肌有力、早期康复等优点.     

Challenges in the Diagnosis of the Right Patient for Testosterone Replacement Therapy

Diagnosis of testosterone deficiency is important to identify patients who might benefit from testosterone replacement therapy. Unfortunately, the diagnosis of hypogonadism may be a challenge for many practicing physicians, including endocrinologists and urologists. Signs and symptoms, such as sexual dysfunction, change in body composition, lethargy, and mood changes, are nonspecific and the available questionnaires are generally not useful in clinical practice. The diagnosis of testosterone deficiency is ultimately based on measurement of serum testosterone levels. However, marked variations in the reference ranges of serum testosterone levels among laboratories pose a challenge for physicians when interpreting the results. In addition, initial laboratory assessments usually determine total testosterone levels. About 1–2% of total testosterone is free and a further 30–50% is bound with low affinity to albumin; only these two components are bioavailable to the target tissues. In general, assuming the normal reference range for serum total testosterone in adult men is 300–1000 ng/dl (10–35 nmol/l), levels of < 250 ng/dl (8.7 nmol/l) suggest the patient is likely to be hypogonadal, whereas levels of > 350 ng/dl (12.7 nmol/l) suggest the symptoms may not be due to androgen deficiency. Values between 250 to 350 ng/dl warrant a repeat morning serum testosterone determination with assessment of free or bioavailable testosterone. In men with symptoms suggestive of androgen deficiency and borderline serum testosterone levels, where there are no contraindications to androgen therapy, a short therapeutic trial of testosterone may be justified.