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.     

人工全膝关节置换术治疗膝关节骨关节炎

[目的]评价人工膝关节置换术治疗骨关节炎的临床疗效。[方法]本院自1994年10月～2003年10月采用人工全膝关节置换术治疗膝关节骨关节炎81例（95膝），男10例，女71例；平均年龄65．5岁（50—82岁）；左膝35例，右膝26例，双侧同时置换17例；保留后交叉韧带假体18膝，后方稳定性假体62膝，活动衬垫15膝。[结果]本组平均随访42个月（14—108个月），应用HSS膝关节评分系统进行分析，优：80膝（84．21％），良：10膝（10．53％），可：3膝（3．16％），差：2膝（2．10％）。优良率94．74％。[结论]作者认为人工全膝关节置换术能有效的缓解膝关节骨关节炎的疼痛，改善膝关节功能。正确的选择假体、精细的手术操作和严格的术后康复是保证手术效果的关键。     

Nasal nicotine spray: a rapid nicotine delivery system

Plasma nicotine concentrations following administration by two types of nasal nicotine spray were compared in ten subjects. Absorption was particularly rapid during the first 2.5 min, the average rise in blood nicotine concentrations during this time being 8.6 ng/ml for the two products, followed by a small further rise to an average peak increase of 10.5 ng/ml 5 min after the dose of 2 mg nicotine base (mean 27.8 micrograms/kg). Despite a four-fold Cmax variation between subjects, the levels of individual subjects were fairly consistent across the two products. There were no significant differences between the two products in blood nicotine concentrations or cardiovascular responses, and the correlation between the AUCs from the two products was 0.68 (P = 0.01). Eight subjects reported subjective feelings of light-headedness or slight dizziness, which are not typical after slower absorption from nicotine gum or skin patches. Blood nicotine levels within the smoking range were soon built up with repeated doses, even in the subject with the least efficient nasal absorption. In a second study of ad libitum use under clinical conditions both products appeared sufficiently acceptable for therapeutic use as an aid to smoking cessation. There was no tendency to escalate to excessive use over 4 weeks, and blood nicotine concentrations in nine subjects averaged only 44% of their prior smoking levels. Only one subject had levels equivalent to prior smoking and possible reasons why this was not more common are discussed.     

骨骼肌最大收缩力与最适初长度及其参数的研究

本实验以免载体股直肌为实验模型,研究了该肌在一定脉冲电流刺激下其初长度与收缩力、肌张力及肌力变化的相互关系。同时测定了正常生理状态下兔伸屈膝时股直肌拉长度的变化。结果表明:兔股直肌延长在1.0cm内时,肌力随初长度的延长而增大,超过1.0cm时增大已不明显(p<0.0 1),1.0cm与股直肌的生理最大延长度1.1cm相似。说明兔股直肌的初长度变化不应超过生理最大延长度。而人的骨骼肌与哺乳动物的骨骼肌没有本质的区别,因此,人骨骼肌的初长度变化也不应超过生理最大延长度。肌腱转位后的活动范围应在原位的生理活动范围内,才能发挥最佳收缩效应。     

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.     

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.     

腰椎间盘突出症人工椎间盘置换手术及效果

目的 :观察采用SBCharit啨人工椎间盘置换手术治疗腰椎间盘突出症的临床效果?椒?:左下腹部腹直肌旁切口 ,切断腹直肌鞘及后层 ,钝性分离腹主动脉和静脉 ,并游离到右边用棉垫加以保护。然后作一“H”型切口切开纤维环 ,用刮匙和咬骨钳清除椎间盘组织特别是髓核。将SBCharit啨人工椎间盘植入?峁?:8例中有 7例 (87.5 % )的临床效果为相当好 ,1个病人 (12 .5 % )为一般 ,有背疼或腿部症状需偶尔服药。椎体活动范围平均为 9°。没有发现有假体松动、下沉入椎体。结论 :若适应证选择得当 ,将获得满意效果。     

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     

人工食管植入术后影像学检查的实验研究

目的 探讨影像学检查方法在人工食管实验研究中的应用价值。方法 对10只植入胸段记忆合金组合式人工食管的实验动物模型术后所进行X线平片和食管造影检查结果进行观察分析研究。结果 X线平片清晰显示胸内植入记忆合金组合式人工食管植入的位置原位固定〉9个月3只；2—3月内脱管3只；〉3个月内脱管4只；管体全部滑至胃内，食管造影连续摄片显示重度新生食管狭窄3只；轻度新生食管狭窄4只，同期介入安放食管支架2只．全组仅见1只发生吻合口细小瘘。无发现其它胸内并发症。结论 ①X线检查是进行人工食管动物实验研究简单且实用的检查方法．②食管造影连续摄片检查方法可为已建立植入人工食管的猪实验动物模型术后的观察研究及介入治疗提供多方面的支持帮助。