Techniques of exposure for the stiff total knee

Primary and revision total knee arthroplasty have become common orthopaedic procedures. The operating surgeon, at times, may be faced with a difficult surgical case due to soft tissue contractures or bone deformities. A review of multiple surgical techniques using soft tissue releases and osteotomies are presented including their potential complications. Although these techniques are aimed at the atypical operative case, the operating surgeon may utilize them for ‘routine’ exposures as well. Importance is focused on the functional integrity of the knee extensor mechanism.     

Immunohistological demonstration of lymphocyte surface antigens in postmortem lymphoid tissues

Summary The postmortem stability of cell antigens has hardly been studied. Using monoclonal antibodies (mabs) we examined the postmortem detectability of lymphocyte surface antigens in different lymphoid organs by comparing two sensitive, immunohistological staining procedures.To quantify the probable degree of autolysis of the tissues a score system was applied by taking into consideration the postmortem age as well as the core temperature of the corpses.The antigens examined generally proved to be very resistant to autolytic influences. Differences were found when comparing different mabs and with regard to the type of lymphoid tissue. The loss of immunohistological reactions was most extensive in the spleen whereas tonsils showed almost no qualitative alterations in staining patterns. Reactivity of mabs with postmortem tissues decreased in the following order: Dako CD22 and anti-Leu 4, anti-Leu 3a, anti-Leu 7, Dako T8. The mabs anti-Leu 7 and Dako-T8 frequently failed to demonstrate their respective antigens but no correlation between the loss of staining and the degree of autolytic decomposition (our score) could be detected.In general, postmortem tissues as well as tissues shock frozen after delay are suitable for qualitative immunohistology of those cells characterized by the mabs applied.The APAAP-method proved unequivocally to be the superior staining technique.     

甲硝唑口颊片的工艺研究

采用正交试验设计,考察处方工艺中羧甲基纤维素钠的用量、筛网的大小和片剂的硬度对甲硝唑口颊片的质量影响,从而优选甲硝唑口颊片的最佳处方和制备工艺。制备的甲硝唑口颊片各项指标均符合质量标准,20、50和90min的释放度分别为33．4％、54．3％和74．1％。     

小巨核细胞免疫酶标染色在鉴别骨髓增生异常综合征和巨幼细胞贫血中的意义

①目的探讨小巨核细胞免疫酶标染色在鉴别骨髓增生异常综合征(MDS)和巨幼细胞贫血(MegA)中的意义.②方法采用碱性磷酸酶-抗碱性磷酸酶桥联免疫酶标(APAAP)法,对30例MDS和34例MegA病人骨髓涂片染色,观察巨核细胞阳性率并计数,并与33例正常骨髓进行比较.③结果小巨核细胞在MDS中的阳性率为93.3%,在MegA中的阳性率为23.8%,差异有极显著意义(x2=31.56,P＜0.01);二者均明显高于正常对照组(12.3%),差异有显著性(x2=48.94,13.69,P＜0.01).MDS中小巨核细胞数量为每片34个,MegA中小巨核细胞数量为每片4.8个,两者比较,差异有显著性(u=78.24,P＜0.01);两组与正常对照组(每片0.3个)比较,差异均有极显著性(u=648.56,432.78,P＜0.01).MDS中的小巨核细胞以淋巴样小巨核细胞、单圆核小巨核细胞为主;MegA中的小巨核细胞为单圆核、多核小巨核细胞,未见淋巴样小巨核细胞.④结论小巨核细胞免疫酶标染色在MDS和MegA的鉴别诊断中有重要意义.     

Arthrodesis of the first metatarsophalangeal joint: The “when and how”

Arthrodesis of the first metatarsophalangeal (MTP) joint has been established as the “gold standard” for the treatment of several first ray disorders, due to its perceived efficacy and the consistently reported good results in the literature. Arthrodesis is a commonly performed procedure for the treatment of end stage arthritis, rheumatoid arthritis with severe deformity, selected cases of severe hallux valgus (with or without signs of degenerative joint disease), as well as a salvage procedure after failed previous operation of the first ray. The goals of a successful 1^st MTP arthrodesis are pain alleviation and deformity correction in order to restore a comfortable gait pattern and to improve shoe wear. Several techniques have been reported with several proposals regarding the preparation of the articular surfaces and the method of definitive fixation. As with any given surgical procedure, various complications may occur after arthrodesis of the 1^st MTP joint, namely delayed union, nonunion, malunion, irritating hardware, etc.      

Continuous blockade of the lumbar plexus after knee surgery: a comparison of the plasma concentrations and analgesic effect of bupivacaine 0.250% and 0.125%

In 20 patients a continuous block of the lumbar plexus was administered after knee-joint surgery, and the analgesic effect of two different concentrations of bupivacaine was compared. The same volume of bupivacaine was given to both groups of patients: a bolus dose of 0.4 ml/kg, 0.5% or 0.25%, followed by infusion of 0.14 ml/kg/h, 0.25% or 0.125%, respectively, via a catheter placed in the neurovascular fascial sheath of the femoral nerve according to the "3-in-1 block" technique. The median morphine consumption during the first 16 h postoperatively was 6.0 mg when bupivacaine 0.5/0.25% was used and 9.5 mg when 0.25/0.125% was used. This difference is not significant. The visual analogue pain scores were also similar in the two groups (P greater than 0.05). All plasma concentrations were below 4 micrograms/ml, the highest concentration measured being 3.6 micrograms/ml. It is concluded that when used for a continuous block of the lumbar plexus after knee-joint surgery, bupivacaine in a concentration of 0.125% offers the same pain relief as a concentration of 0.25%, and the risk of toxic reactions is reduced.     

Effect of locus of control and consideration of future consequences on time tradeoff utilities for current health

Comments from subjects undergoing utility assessment suggest that personality traits may affect responses. We sought to describe the association between time-tradeoff utility for current health and measures of two personality traits: (1) perceived control over one's life and (2) concern over immediate vs. future outcomes. One hundred subjects were recruited from the cafeteria of a large tertiary care hospital. Time-tradeoff utilities were assessed for current health relative to perfect health and death. Subjects also completed two previously validated scales, the Locus of Control (LOC), and Consideration of Future Consequences (CFC) instruments. The interview failure rate was less than 3%. The correlation between LOC score and utility for current health was modest (Spearman's =0.196, p=0.071), but increased substantially when subjects unwilling to trade were excluded (Spearman's =0.33, p=0.0043). The CFC scale was weakly correlated with utility for current health (Spearman's =0.12, p=0.2676). The Consideration of Future Consequences scale explains little of the variation in time-tradeoff utilities. In contrast, Locus of Control appears to partially explain the variation in time-tradeoff utilities for current health, even after controlling for health status.     

Intrapleural analgesia in a child with a mediastinal tumour

A case is presented of an eight-year-old child with a mediastinal tumour, who had developed acute renal failure following the institution of steroid therapy. Intrapleural analgesia was successfully used for the insertion of a peritoneal dialysis catheter so that the considerable risks of general anaesthesia were avoided. Subsequent dialysis allowed chemotherapy to commence and, as a result of the shrinkage in tumour size, general anaesthesia was administered safely two days later. The purpose of this report is to highlight the use of intrapleural analgesia in children as an alternative to general anaesthesia, when the latter is contraindicated. The mechanism of action of intra-pleural analgesia and the risks of anaesthesia in the presence of a mediastinal tumour are discussed.     

Comparison of transarterial and multiple nerve stimulation techniques for axillary block using a high dose of mepivacaine with adrenaline

BACKGROUND: High-dose transarterial (TA) technique results in high effectiveness of the axillary block. The technique is fast and simple, but does not produce a satisfactory success rate when using the manufacturer's recommended dose of mepivacaine. The multiple nerve stimulation (MNS) technique requires more time and experience. This double-blind study compared effectiveness, safety and the time used to obtain an effective analgesia in 101 patients, having an axillary block by either TA or MNS techniques. METHODS: Mepivacaine with adrenaline (MEPA), 850 mg, was used for the initial block. Five millilitres of 1% solution was injected subcutaneously. In the TA group, 20 mL of 2% solution was injected deep to, and 20 mL superficial to the axillary artery. In the MNS group, four terminal motor nerves were electrolocated in the axilla, and injected with 10 mL each. Analgesia was assessed every 10 min and, when needed, supplemented after 30 min. The block was effective when analgesia was present in all sensory nerve areas distal to the elbow. RESULTS: The MNS group required median 11 min for block performance compared with 8 min for the TA group (P < 0.001). Latency of the initial block was shorter and the frequency of supplemental analgesia lower in the MNS group (median 10 min and 6%) than in the TA group (30 min and 36%, respectively), P < 0.001. All incomplete blocks were successfully supplemented. However, the total time to obtain an effective block was shorter in the MNS group (23 min) than in the TA group (37 min), P < 0.001. Two patients in each group had signs and symptoms of systemic toxicity, the most serious being atrial fibrillation and temporary loss of consciousness in a cardiovascularly medicated patient. The local adverse effects (intravascular injections and haematomas) were fewer in the MNS group, P < 0.001. CONCLUSION: The MNS technique of axillary block by four injections of 10 mL of 2% MEPA produces faster and more extensive block than the TA technique by two injections of 20 mL. Therefore, the MNS technique requires fewer supplementary blocks and results in faster patient readiness for surgery. However, high doses of MEPA may result in dangerous systemic toxic reactions.     

The effect of intravenous tenoxicam on pruritus in patients receiving epidural fentanyl

In this prospective randomised study, pruritus and pain were evaluated in patients undergoing abdominal surgery during which epidural fentanyl was administered. All patients had an epidural catheter inserted at the time of surgery. Epidural fentanyl 100 micrograms was administered intra-operatively and infused at a concentration of 2 micrograms.ml-1 for 48 h postoperatively. All patients received a standard anaesthetic and, in addition, the study group had a 20 mg bolus of tenoxicam intravenously, intra-operatively. Patients receiving tenoxicam demonstrated significantly lower pruritus and pain scores at 30 min, 2, 4, 8 and 24 h postoperatively as well as reduced pethidine requirements for breakthrough pain in the first 24 h. In conclusion, tenoxicam 20 mg significantly reduces the incidence and severity of postoperative pruritus in patients who received peri-operative epidural fentanyl. In addition, it significantly reduces pain and further analgesic requirements postoperatively.