RESUMEN
Prophylaxis against venous thromboembolism after elective total hip replacement is routinely recommended. Our preference has been to use mechanical prophylaxis without anticoagulant drugs. A randomised controlled trial was performed to evaluate whether the incidence of post-operative venous thromboembolism was reduced by using pharmacological anticoagulation with either fondaparinux or enoxaparin in addition to our prophylactic mechanical regimen. A total of 255 Japanese patients who underwent primary unilateral cementless total hip replacement were randomly assigned to one of three postoperative regimens, namely injection of placebo (saline), fondaparinux or enoxaparin. There were 85 patients in each group. All also received the same mechanical prophylaxis during and after the operation, regardless of their assigned group. The primary measurement of efficacy was the presence of a venous thromboembolic event by day 11, defined as deep-vein thrombosis detected by ultrasonography, documented symptomatic deep-vein thrombosis or documented symptomatic pulmonary embolism. The duration of follow-up was 12 weeks. The rate of venous thromboembolism was 7.2% with the placebo, 7.1% with fondaparinux and 6.0% with enoxaparin (p = 0.95 for the comparison of all three groups). Our study confirmed the effectiveness and safety of mechanical thromboprophylaxis without the use of anticoagulant drugs after total hip replacement in Japanese patients.
Asunto(s)
Anticoagulantes/uso terapéutico , Artroplastia de Reemplazo de Cadera , Complicaciones Posoperatorias/prevención & control , Tromboembolia Venosa/prevención & control , Anciano , Terapia Combinada , Vendajes de Compresión , Enoxaparina/uso terapéutico , Femenino , Fondaparinux , Humanos , Aparatos de Compresión Neumática Intermitente , Masculino , Persona de Mediana Edad , Polisacáridos/uso terapéutico , Cuidados Posoperatorios/métodos , Complicaciones Posoperatorias/diagnóstico por imagen , Ultrasonografía Doppler Dúplex , Procedimientos Innecesarios , Tromboembolia Venosa/diagnóstico por imagenRESUMEN
There are many published reports demonstrating the accuracy of CT-based navigation systems. However, the use of such systems often subjects patients to a high level of radiation exposure. CT scans acquired using thinner slices are considered to lead to more accurate results, but also increase radiation exposure. We took the postoperative CT scans for 56 cases of total hip arthroplasty performed using a CT-based navigation system and analyzed the accuracy of the cup and stem positioning. Of these cases, 41 were performed using 3-mm CT slices and 15 were performed using 1-mm slices, enabling us to compare the accuracy of the system and the radiation exposure using the different slice thicknesses. CT-based navigation appears to be very accurate with regard to cup anteversion and leg length, but inaccurate with regard to stem anteversion. As for the varus/valgus angle of the stem, the navigated approach seems to be very accurate in terms of the numerical value, but this does not satisfy us: Stem anteversion is still inaccurate with this system, while cup inclination is sufficiently accurate with both navigation and manual methods. Use of 1-mm CT slices results in twice the radiation exposure associated with 3-mm CT slices, but there is little difference with respect to accuracy. It is therefore recommended to use a CT-based navigation system with 3-mm CT slices for accurate and safe total hip arthroplasty.
Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Cirugía Asistida por Computador/métodos , Tomografía Computarizada por Rayos X/métodos , Artroplastia de Reemplazo de Cadera/instrumentación , Femenino , Humanos , Imagenología Tridimensional/instrumentación , Imagenología Tridimensional/métodos , Masculino , Periodo Posoperatorio , Efectos de la Radiación , Programas Informáticos , Estadísticas no Paramétricas , Cirugía Asistida por Computador/instrumentación , Tomografía Computarizada por Rayos X/instrumentaciónRESUMEN
In a neuropathological study of consecutive autopsies, prevalence and cause of dementia in a Japanese leprosarium were investigated, where more than 95% of inpatients with a mean age of 70 years are now free from active leprosy. In 10 years (1983-1992), clinically overt dementia at death was 35/136 (25.7%) in the age group over 65 years (mean age 79.4). Autopsy was performed in 85 cases (mean age 81 years), and clinically overt dementia was seen in 25 subjects (29.4%). Neuropathologically, Alzheimer's disease (AD) was seen in 9 cases (10.6%), vascular dementia (VD) in 9 cases (10.6%), mixed type in 3 cases (3.5%) and unclassified in 4 cases (4.7%). In the age group of 65-84 years, AD was 5/58 (8.6%), VD was 4/58 (6.9%), mixed type was 2/58 (3.4%), and unclassified was 1/58 (1.7%). Compared with previous Japanese general population-based data, where VD was more frequent than AD, the rate of dementia in our leprosarium was high, and pathologically confirmed AD was as common as VD. Recently, a prophylactic effect of the antileprosy and anti-inflammatory drug DDS (dapsone, 4,4'-diaminodiphenyl sulfone) has been suggested. Lepromatous patients take more DDS (51.9%) than tuberculoid patients (11.5%), however, as the dementia rate of tuberculoid leprosy (17.9%) in those 65-84 years old is similar to lepromatous leprosy (15.9%) in our study, we do not support their viewpoint.
Asunto(s)
Demencia/epidemiología , Hospitales Especializados/estadística & datos numéricos , Lepra/epidemiología , Factores de Edad , Anciano , Enfermedad de Alzheimer/epidemiología , Enfermedad de Alzheimer/patología , Autopsia , Encéfalo/patología , Comorbilidad , Dapsona/uso terapéutico , Demencia/patología , Demencia Vascular/epidemiología , Demencia Vascular/patología , Estudios de Seguimiento , Humanos , Japón , Lepra/tratamiento farmacológico , Lepra/patología , PrevalenciaRESUMEN
A case of acinar cell carcinoma of the pancreas with elevated serum alpha-fetoprotein (AFP) is presented. The diagnosis was reached using histopathological techniques. AFP was positive in the tumor specimen, immunohistochemically. Serum AFP had fallen temporarily after surgery and chemotherapy. The patient survived 6.5 months after the onset of symptoms.
Asunto(s)
Carcinoma/sangre , Neoplasias Pancreáticas/sangre , alfa-Fetoproteínas/análisis , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma/patología , Carcinoma/cirugía , Histocitoquímica , Humanos , Inmunoquímica , Masculino , Recurrencia Local de Neoplasia , Neoplasias Pancreáticas/patología , Neoplasias Pancreáticas/cirugíaRESUMEN
Two cases of colon carcinoma coexisting with tuberculosis are reported. Both carcinoma were adjacent to scarring areas of ulcerative tuberculosis, these areas were covered by regenerated mucosa, the muscularis mucosae were lacking and there was occurrence of atypical regenerative tubules and adenomatous glands. These findings suggest that ulcerative lesions of tuberculosis may be precursors of the carcinomas. It is interesting that such carcinomas derived from a chronic inflammatory process with repetition of erosion, ulcer and consequent regeneration.