RESUMEN
Adenosine (Ado) and non-adenosine (non-Ado) nucleosides such as inosine (Ino), guanosine (Guo) and uridine (Urd) may have regionally different roles in the regulation of physiological and pathophysiological processes in the central nervous system (CNS) such as epilepsy. It was demonstrated previously that Ino and Guo decreased quinolinic acid (QA)-induced seizures and Urd reduced penicillin-, bicuculline- and pentylenetetrazole (PTZ)-induced seizures. It has also been demonstrated that Ino and Urd may exert their effects through GABAergic system by altering the function of GABA(A) type of gamma-aminobutyric acid receptors (GABAA receptors) whereas Guo decreases glutamate-induced excitability through glutamatergic system, which systems (GABAergic and glutamatergic) are involved in pathomechanisms of absence epilepsy. Thus, we hypothesized that Ino and Guo, similarly to the previously described effect of Urd, might also decrease absence epileptic activity. We investigated in the present study whether intraperitoneal (i.p.) application of Ino (500 and 1000mg/kg), Guo (20 and 50mg/kg), Urd (500 and 1000mg/kg), GABA(A) receptor agonist muscimol (1 and 3mg/kg), GABA(A) receptor antagonist bicuculline (2 and 4mg/kg), non-selective Ado receptor antagonist theophylline (5 and 10mg/kg) and non-competitive N-methyl-d-aspartate (NMDA) receptor antagonist (+)-5-methyl-10,11-dihydro-5H-dibenzo (a,d) cyclohepten-5,10-imine maleate (MK-801, 0.0625 and 0.1250mg/kg) alone and in combination have modulatory effects on absence epileptic activity in Wistar Albino Glaxo Rijswijk (WAG/Rij) rats. We found that Guo decreased the number of spike-wave discharges (SWDs) whereas Ino increased it dose-dependently. We strengthened that Urd can decrease absence epileptic activity. Our results suggest that Guo, Urd and their analogs could be potentially effective drugs for treatment of human absence epilepsy.
Asunto(s)
Anticonvulsivantes/farmacología , Encéfalo/efectos de los fármacos , Epilepsia Tipo Ausencia/tratamiento farmacológico , Guanosina/farmacología , Inosina/farmacología , Uridina/farmacología , Animales , Encéfalo/fisiopatología , Modelos Animales de Enfermedad , Relación Dosis-Respuesta a Droga , Electrocorticografía , Epilepsia Tipo Ausencia/fisiopatología , Masculino , Ratas Wistar , Receptores de GABA-A/metabolismo , Receptores de N-Metil-D-Aspartato/metabolismo , Receptores Purinérgicos P1/metabolismoRESUMEN
OBJECTIVE: To prospectively compare the results, function, and complications of antegrade and retrograde femoral nailing for femoral shaft fractures. DESIGN: Prospective, randomized. SETTING: Urban Level 1 trauma center. PATIENTS: One hundred consecutive femoral shaft fractures. Fifty-four nails inserted retrograde and forty-six inserted antegrade. INTERVENTION: Ten-millimeter antegrade or retrograde nail inserted for a femoral shaft fracture after reaming. OUTCOME MEASUREMENTS: A comparison of the outcomes after antegrade and retrograde nailing of the femur. Data were collected for analysis on comminution, set-up and starting point times, open grade, location of fracture, injury severity score, body mass index, time to union, knee pain and motion, hip and thigh pain, and nail to intramedullary canal diameter difference. A linear regression model was employed. RESULTS: Knee motion was 120 degrees in all but one knee in each group. The antegrade nailed femurs healed faster than those treated retrograde (A = 14.4, R = 18.1 weeks, p = 0.0496). More patients required dynamization for union in the retrograde insertion group (17 percent versus 5 percent, p = 0.10, NS). In a linear regression model, a nail-to-canal-diameter difference and retrograde nailing had an association with an increased time to union. Knee pain was equal in both groups; however, thigh pain was higher in the antegrade group (p = 0.0108). All of the antegrade nailed femurs healed (100 percent), and 98 percent (one nonunion) of the retrograde femurs healed after secondary procedures. CONCLUSIONS: Both antegrade and retrograde nailing yielded high union rates. Each insertion technique has its own advantages and disadvantages. The two insertion modes appear to be relatively equal for the treatment of femoral shaft fractures.
Asunto(s)
Fracturas del Fémur/cirugía , Fijación Intramedular de Fracturas/métodos , Adulto , Femenino , Fracturas del Fémur/diagnóstico por imagen , Fracturas del Fémur/patología , Fracturas del Fémur/fisiopatología , Humanos , Masculino , Estudios Prospectivos , Radiografía , Distribución Aleatoria , Resultado del TratamientoRESUMEN
OBJECTIVES: To prospectively evaluate the results of retrograde intramedullary nailing of femoral shaft fractures. DESIGN: Prospective, consecutive series. PATIENTS AND SETTING: All patients with a femoral shaft fracture admitted at an urban Level 1 trauma center from December 1995 to December 1996 were treated with a retrograde femoral intramedullary nail. INTERVENTION: Retrograde femoral intramedullary nailing was performed on a radiolucent operating room table. Through a three-centimeter medial parapatellar incision, a reamed ten-millimeter retrograde nail was inserted. METHODS: From the time of injury until union, the following parameters were assessed: operative time, blood loss, extent of comminution, open grade, associated injuries, Injury Severity Score, body mass index, time to union, secondary procedures, range of motion in the knee. and complications. RESULTS: Fifty-seven patients with sixty-one fractures were available for follow-up, which averaged 43.1 weeks. Fifty-two percent of fractures demonstrated Winquist Type 3 or 4 comminution. Twenty-six percent of the fractures were open. Fifty-two fractures healed after the initial nailing, five of seven dynamized nails healed, and one patient with bone loss requiring bone graft united yielding a final union rate of 95 percent. Of the three nonunions (5 percent), two healed with exchange nailing and one remains asymptomatic at seventy-one weeks. One patient developed a late septic knee that resolved with treatment. Excellent range of motion in the knee was obtained by those patients who did not have other ipsilateral limb injuries. CONCLUSIONS: This consecutive series had a 95 percent union rate after nailing and dynamization as necessary. No knee problems were associated with the retrograde femoral intramedullary nailing technique. The one septic knee raises concerns about the use of retrograde nailing in severe open femoral shaft fractures. Retrograde femoral nailing should be given serious consideration as an alternative to antegrade femoral nailing.
Asunto(s)
Fracturas del Fémur/cirugía , Fijación Intramedular de Fracturas , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Fracturas del Fémur/rehabilitación , Fijación Intramedular de Fracturas/métodos , Fracturas Conminutas/rehabilitación , Fracturas Conminutas/cirugía , Fracturas Abiertas/rehabilitación , Fracturas Abiertas/cirugía , Humanos , Masculino , Persona de Mediana Edad , Terapia Pasiva Continua de Movimiento , Estudios Prospectivos , Resultado del TratamientoRESUMEN
A prospective study of 100 consecutive unilateral fractures of the shaft of the femur was performed to delineate the incidence of, and the factors predisposing to, heterotopic ossification about the hip after intramedullary nailing. Bone debris from reaming of the endosteal canal is deposited in the soft tissues surrounding the site of insertion of the nail, and we postulated that this debris may stimulate the formation of heterotopic bone and that decreasing the amount of debris left in the tissues after nailing may decrease the amount of heterotopic ossification. To test this theory, the patients were treated with routine intramedullary nailing and were randomly divided into two groups. In Group I, the operative incision was irrigated with 250 milliliters of normal saline solution with use of a bulb syringe before the wound was closed, and in Group II, the incision was irrigated with 3000 milliliters of normal saline solution with use of pulsatile lavage. The two groups were similar in all other respects. Eighty patients (eighty fractures; forty in Group I and forty in Group II) were available for follow-up and were evaluated in a blind fashion after the fracture had united. A grading system that was based on the length of the heterotopic ossification, as measured on antero-posterior radiographs of the hip, was used. In thirty-two of the patients (40 per cent), no heterotopic ossification developed, whereas minimum or mild ossification developed in twenty-seven patients (34 per cent). Moderate ossification developed in twelve patients (15 per cent) and severe ossification, in nine patients (11 per cent).(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Fracturas del Fémur/cirugía , Fijación Intramedular de Fracturas/efectos adversos , Articulación de la Cadera , Osificación Heterotópica/etiología , Adolescente , Adulto , Clavos Ortopédicos/efectos adversos , Traumatismos Craneocerebrales/complicaciones , Femenino , Fracturas del Fémur/complicaciones , Estudios de Seguimiento , Articulación de la Cadera/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Traumatismo Múltiple/complicaciones , Osificación Heterotópica/diagnóstico por imagen , Estudios Prospectivos , Radiografía , Distribución AleatoriaRESUMEN
The cases of eighty-six patients in whom eighty-nine open fractures of the femoral shaft had been treated by intramedullary nailing with reaming were retrospectively reviewed. Twenty-seven fractures were classified as grade-I open fractures; sixteen, as grade-II open fractures; and forty-six, as grade-III open fractures. Immediate intramedullary nailing was done for fifty-six fractures, and delayed stabilization (five to seven days after delayed closure of the wound) was done for thirty-three fractures. A prerequisite for immediate intramedullary nailing was that irrigation and debridement of the open wound be done within eight hours after injury. All fractures healed in an average of 5.2 months. No infections occurred in the sixty-two grade-I, grade-II, or grade-IIIA open fractures, regardless of whether immediate or delayed intramedullary nailing was performed. Of the twenty-seven grade-IIIB fractures, infection developed in three: in one after immediate intramedullary nailing and in two after delayed intramedullary nailing. We concluded that, if a thorough and timely debridement can be accomplished, immediate intramedullary nailing of grade-I and grade-II open fractures of the femoral shaft does not increase the risk of postoperative infection. Selected patients who have a grade-III open fracture may be candidates for immediate intramedullary stabilization, depending on the degree of the patient's associated injuries and the extent of disruption and contamination of the soft tissues of the thigh.
Asunto(s)
Clavos Ortopédicos , Fracturas del Fémur/cirugía , Fijación Intramedular de Fracturas/instrumentación , Fracturas Abiertas/cirugía , Adolescente , Adulto , Anciano , Desbridamiento , Femenino , Fracturas del Fémur/diagnóstico por imagen , Fracturas del Fémur/fisiopatología , Fracturas Abiertas/clasificación , Fracturas Abiertas/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Estudios Retrospectivos , Irrigación Terapéutica , Factores de Tiempo , Cicatrización de HeridasRESUMEN
Twenty-one compartment syndromes of the thigh in seventeen patients were identified for retrospective review. Ten of the compartment syndromes were associated with an ipsilateral femoral fracture; five of these femoral fractures were open. In five patients, the syndrome followed femoral intramedullary stabilization. The remaining eleven syndromes followed blunt trauma to the thigh, prolonged compression by body weight, or vascular injury. The patients who were awake and alert at the time of the examination complained of intense pain in the thigh, and they had neuromuscular deficits. For the patients who could not cooperate with a subjective physical examination because they were under general anesthesia or because of associated injuries, the measurement of compartment pressure assumed a more important diagnostic role. All of the patients had tense swelling of the involved thigh. The predisposing risk factors for the development of compartment syndromes of the thigh, which are common in the multiply injured population, include: systemic hypotension, a history of external compression of the thigh, the use of military antishock trousers, coagulopathy, vascular injury, and trauma to the thigh, with or without a fracture of the femur. In approximately one-half of these patients, a crush syndrome developed, with myoglobinuria, renal failure, and collapse of multiple organ systems. Eight patients (47 per cent) died as a result of multiple injuries. Of the nine patients (ten compartment syndromes) who survived, infection developed at the site of the fasciotomy in six. Follow-up examination revealed marked morbidity, including sensory deficit and motor weakness of the lower extremity.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Síndromes Compartimentales/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Síndromes Compartimentales/etiología , Síndromes Compartimentales/mortalidad , Síndromes Compartimentales/cirugía , Susceptibilidad a Enfermedades , Fasciotomía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Traumatismo Múltiple/complicaciones , Traumatismo Múltiple/mortalidad , Estudios Retrospectivos , Factores de Riesgo , Infección de la Herida Quirúrgica/epidemiología , MusloRESUMEN
Fifty-three high-energy tibial fractures treated with early prophylactic posterolateral bone grafting were retrospectively reviewed. The bone-grafting procedures were performed at a mean of ten weeks following injury and at a mean of eight weeks following soft-tissue coverage. Ninety-six percent of the fractures had associated injuries with a mean injury severity score of 20.9. Seventy-nine percent of the fractures were classified as Grade III open fractures, and 40% had bone loss greater than 50% of the cortical circumference. Ninety-six percent of the fractures healed at a mean time of 43 weeks after injury. Segmental bone loss and soft-tissue injury requiring flap coverage were the best predictors of prolonged time to union. Comparison with a matched historical control group of tibial fractures not receiving early bone grafts revealed a mean reduction in time to union of 11.7 weeks (p = 0.03). The incidence of chronic osteomyelitis was 1.9%. These results are attributed to early and repeated aggressive debridement, immediate rigid external fixation, early soft-tissue coverage, and early posterolateral bone grafting. Recommendations include posterolateral cancellous bone grafting two weeks following wound closure by delayed primary closure, split-thickness skin graft, or local rotational myoplasty. A six-week delay following freely vascularized soft-tissue coverage prior to bone grafting is suggested.
Asunto(s)
Trasplante Óseo , Fracturas Abiertas/cirugía , Fracturas de la Tibia/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Traumatismo Múltiple/complicaciones , Dispositivos de Fijación Ortopédica , Radiografía , Estudios Retrospectivos , Colgajos Quirúrgicos , Fracturas de la Tibia/complicaciones , Fracturas de la Tibia/diagnóstico por imagen , Factores de Tiempo , Cicatrización de HeridasRESUMEN
Dynamic intramedullary fixation depends on the configuration of the fracture for postoperative stability. Unanticipated loss of reduction of the fracture after dynamic intramedullary nailing of the femur may result from errors in surgical decision-making, specifically the failure to insert both proximal and distal interlocking screws. Of 133 dynamic femoral intramedullary nailings that were performed after interlocking techniques became routinely available, fourteen (10.5 per cent) were complicated by loss of postoperative fixation and reduction. Thirteen of the fourteen femora shortened an average of 2.0 centimeters; the remaining femur shortened slightly, with clinical loss of rotational stability. Eight of fourteen patients elected some form of surgical revision, most commonly closed osteoclasis with restoration of femoral length, followed by the insertion of a statically locked nail. Errors in surgical judgment were attributed to inadequate preoperative analysis of the pattern of the fracture; undetected intraoperative comminution during reaming or insertion of the nail, or both; or postoperative failure to recognize an increase in comminution and instability of the fracture. We suggest using high-quality preoperative radiographs to detect non-displaced comminution of the major fracture fragments. Any increase in comminution of the fracture that occurs with reaming of the canal or insertion of the nail is an indication for static interlocking fixation. Radiographs that are made immediately postoperatively should be analyzed while the patient is under anesthesia, and any previously undetected instability of the fracture should be treated by static interlocking fixation. Dynamic intramedullary stabilization of the femur should be reserved for transverse or short oblique fractures at the femoral isthmus that have type-I or type-II comminution.
Asunto(s)
Fracturas del Fémur/cirugía , Fijación Intramedular de Fracturas/métodos , Adolescente , Adulto , Anciano , Clavos Ortopédicos , Tornillos Óseos , Femenino , Fracturas del Fémur/diagnóstico por imagen , Humanos , Diferencia de Longitud de las Piernas/etiología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Radiografía , ReoperaciónRESUMEN
A consecutive, prospective series of ninety-seven patients who had 100 fractures of the femoral shaft that were treated with static interlocking nailing was analyzed to determine the incidence of union of the fracture without planned conversion from static to dynamic intramedullary fixation as a technique to stimulate healing of the fracture. Eighty-four patients (eighty-seven fractures) were studied through union of the fracture (average follow-up, fourteen months). Eighty-five (98 per cent) of the eighty-seven fractures healed with static interlocking fixation. Two patients needed conversion from static to dynamic interlocking fixation because of inadequate fracture-healing; both progressed to uneventful union. The time to full weight-bearing (average, eleven weeks) was individualized for each patient and depended on the cortical contact of the major fragments, the presence of bridging callus as seen on radiographs, and the extent of other injuries of the ipsilateral lower extremity. No deformation or failure of the static interlocking device developed after early walking with weight-bearing, but fatigue failure of one nail occurred in a non-ambulatory patient who had an intracranial injury. Pain related to soft-tissue irritation by the prominent heads of the interlocking screws, clinically presenting as bursitis or snapping of the iliotibial band, was severe enough in six patients to necessitate removal of either the proximal or the distal screw after union of the fracture. We concluded that static interlocking of intramedullary nails in femoral shaft fractures does not appreciably inhibit the process of healing of the fracture, and that routine conversion to dynamic intramedullary fixation, although occasionally necessary, need not be performed.