RESUMEN
PURPOSE: To update brachytherapy recommendations for pretreatment evaluation, treatment, and dosimetric issues for thoracic brachytherapy for lung cancer. METHODS AND MATERIALS: Members of the American Brachytherapy Society with expertise in thoracic brachytherapy updated recommendations for thoracic brachytherapy based on literature review and clinical experience. RESULTS: The American Brachytherapy Society consensus guidelines recommend the use of endobronchial brachytherapy for disease palliation in patients with central obstructing lesions, particularly in patients who have previously received external beam radiotherapy. The use of interstitial implants after incomplete resection may improve outcomes and provide enhanced palliation. Early reports support the use of CT-guided intratumoral volume implants within clinical studies. The use of brachytherapy routinely after sublobar resection is not generally recommended, unless within the confines of a clinical trial or a registry. CONCLUSIONS: American Brachytherapy Society recommendations for thoracic brachytherapy are provided. Practitioners are encouraged to follow these guidelines and to develop further clinical trials to examine this treatment modality to increase the evidence base for its use.
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Braquiterapia , Consenso , Neoplasias Pulmonares/radioterapia , Cuidados Paliativos , Braquiterapia/métodos , Humanos , Selección de Paciente , Radioterapia Adyuvante , Estados UnidosRESUMEN
Diastasis of the pubic symphysis is a well documented injury typically associated with high energy trauma. Three cases in horse riders are here described, emphasising the appropriate modern investigation, including computed tomography, and orthopaedic and urological management.
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Traumatismos en Atletas/etiología , Luxaciones Articulares/etiología , Sínfisis Pubiana/lesiones , Equipo Deportivo/efectos adversos , Anciano , Animales , Traumatismos en Atletas/terapia , Fijadores Externos , Caballos , Humanos , Fijadores Internos , Luxaciones Articulares/terapia , Masculino , Persona de Mediana Edad , Sínfisis Pubiana/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
PURPOSE: A practical method to achieve prostate immobilization and daily target localization for external beam radiation treatment is described. METHODS AND MATERIALS: Ten patients who underwent prostate brachytherapy using permanent radioactive source placement were selected for study. To quantify prostate motion both with and without the presence of a specially designed inflatable intrarectal balloon, the computerized tomography-based coordinates of all intraprostatic radioactive sources were compared over 3 consecutive measurements at 1-min intervals. RESULTS: The placement and inflation of the intrarectal balloon were well tolerated by all patients. The mean (range) displacement of the prostate gland when the intrarectal balloon was present vs. absent was 1.3 (0-2.2) mm vs. 1.8 (0-9.1) mm (p = 0.03) at 2 min respectively. The maximum displacement in any direction (anterior-posterior, superior-inferior, or right-left) when the intrarectal balloon was inflated vs. absent was reduced to < or =1 mm from 4 mm. CONCLUSIONS: Both prostate gland immobilization and target verification are possible using a specially designed inflatable intrarectal balloon. Using this device, the posterior margin necessary on the lateral fields to ensure dosimetric coverage of the entire prostate gland could be safely reduced to 5 mm and treatment could be set up and verified using a lateral portal image.
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Braquiterapia , Neoplasias de la Próstata/radioterapia , Humanos , Inmovilización , Masculino , Dosificación RadioterapéuticaRESUMEN
PURPOSE: When irradiating a tumor that abuts or displaces any normal structures, the dose constraints to those structures (if lower than the prescribed dose) may cause dose inhomogeneity in the tumor volume at the tumor-critical structure interface. The low-dose region in the tumor volume may be one of the reasons for local failure. The aim of this study is to quantitate the effect of tumor dose inhomogeneity on local control and recurrence-free survival in patients with skull base chordoma. METHODS AND MATERIALS: 132 patients with skull base chordoma were treated with combined photon and proton irradiation between 1978 and 1993. This study reviews 115 patients whose dose-volume data and follow-up data are available. The prescribed doses ranged from 66.6 Cobalt-Gray-Equivalent (CGE) to 79.2 CGE (median of 68.9 CGE). The dose to the optic structures (optic nerves and chiasm), the brain stem surface, and the brain stem center was limited to 60, 64, and 53 CGE, respectively. We used the dose-volume histogram data derived with the three-dimensional treatment planning system to evaluate several dose-volume parameters including the Equivalent Uniform Dose (EUD). We also analyzed several other patient and treatment factors in relation to local control and recurrence-free survival. RESULTS: Local failure developed in 42 of 115 patients, with the actuarial local control rates at 5 and 10 years being 59% and 44%. Gender was a significant predictor for local control with the prognosis in males being significantly better than that in females (P = 0.004, hazard ratio = 2.3). In a Cox univariate analysis, with stratification by gender, the significant predictors for local control (at the probability level of 0.05) were EUD, the target volume, the minimum dose, and the D5cc dose. The prescribed dose, histology, age, the maximum dose, the mean dose, the median dose, the D90% dose, and the overall treatment time were not significant factors. In a Cox multivariate analysis, the models including gender and EUD, or gender and the target volume, or gender and the minimum target dose were significant. The more biologically meaningful of these models is that of gender and EUD. CONCLUSION: This study suggests that the probability of recurrence of skull base chordomas depends on gender, target volume, and the level of target dose inhomogeneity. EUD was shown to be a useful parameter to evaluate dose distribution for the target volume.
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Cordoma/radioterapia , Neoplasias de la Base del Cráneo/radioterapia , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Supervivencia sin Enfermedad , Relación Dosis-Respuesta en la Radiación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fotones/uso terapéutico , Modelos de Riesgos Proporcionales , Terapia de Protones , Dosificación Radioterapéutica , Factores SexualesRESUMEN
OBJECTIVES: to assess the efficacy of recombinant human manganese superoxide dismutase (rhMnSOD) in prevention of early and late skeletal muscle ischaemia-reperfusion injury mediated by superoxide (O2-). Design : randomised controlled trial. MATERIALS: seventy-two Sprague-Dawley rats (250-350 g) randomised to receive either 7.5 mg/kg of rhMnSOD or saline. Four hours of ischaemia was induced in the cremaster muscle by dissecting free and clamping its vascular supply. Cremaster muscle contractile function was assessed following 90 minutes, 24, 48 hours and one week of reperfusion. Electrophysiological muscle function was assessed using electrical field stimulation in an organ bath system. RESULTS: muscle function in the untreated groups following ischaemia reperfusion was significantly reduced at 90 minutes, 24, 48 hours and one week of reperfusion (p <0.05). rhMnSOD significantly protected and maintained normal muscle function at 24 and 48 hours (p <0.001). However at one week of reperfusion there was a reduction in function of the treated muscle, such that there was no significant difference between treated and untreated muscle at this point in time. CONCLUSIONS: these data demonstrate that skeletal muscle dysfunction after ischaemia reperfusion injury is attenuated at 24 and 48 hrs of reperfusion by the superoxide scavenger rhMnSOD. This protective effect is not maintained after seven days of reperfusion.
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Músculo Esquelético/irrigación sanguínea , Daño por Reperfusión/fisiopatología , Superóxido Dismutasa/farmacología , Animales , Humanos , Contracción Isométrica/efectos de los fármacos , Contracción Isométrica/fisiología , Masculino , Microcirculación/efectos de los fármacos , Microcirculación/fisiopatología , Ratas , Ratas Sprague-Dawley , Proteínas Recombinantes/farmacología , Procesamiento de Señales Asistido por Computador , Superóxidos/metabolismoRESUMEN
To determine the changes in capillary perfusion, which occur with elevated tissue pressure, and to highlight the relationship between systemic blood pressure and compartment pressure, we designed an experiment that allowed direct observation of the microcirculation of skeletal muscle under normal and increased compartment pressures. In each of 10 anesthetized rats, the cremaster muscle was exposed and suspended in a transparent pressure chamber. In vivo videomicroscopy was then performed and blood pressure was monitored via left carotid artery cannulation. Two sets of data for each animal were obtained: deltaP (mean arterial pressure compartment pressure) at which the muscle capillary blood flow was completely arrested, and the number of capillaries per 10,000 square micrometers of skeletal muscle with blood flowing at compartment pressures of 0, 15, 30, 45, and 60 mm Hg. Capillary blood flow stopped at a deltaP of 25.5 mm Hg +/- 14.3 SD. We found that capillary blood flow, as measured by the number of capillaries with blood flow per 10,000 square micrometers, decreased significantly (P < 0.05) as compartment pressure reached 15, 30, 45, and 60 mm Hg, when compared to 0 mm Hg; there was no vessel collapse at these pressures. These data show that increasing compartment pressure reduces the number of perfused capillaries per unit area, and that there is complete cessation of muscle capillary blood flow when the compartment pressure is within about 25 mm Hg of the mean arterial pressure.
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Capilares/fisiopatología , Síndromes Compartimentales/fisiopatología , Músculo Esquelético/irrigación sanguínea , Animales , Presión Sanguínea , Modelos Animales de Enfermedad , Masculino , Presión , Ratas , Ratas Sprague-Dawley , Flujo Sanguíneo RegionalRESUMEN
PURPOSE: To determine the temporal lobe (TL) damage rate in 96 patients treated with high-dose proton and photon irradiation for chordomas and chondrosarcomas of the base of the skull. METHODS AND MATERIALS: The records of 96 consecutive patients treated at Massachusetts General Hospital (MGH) and Harvard Cyclotron Laboratory (HCL) between June 1984 and 1993, for chordomas and chondrosarcomas of the base of the skull were reviewed. All the patients had undergone some degree of resection of the tumor prior to radiation therapy. Seventy-five patients were classified as "primary tumors" and 21 as recurrent or regrowing tumors after one or more surgical procedures. All the patients were randomized to receive 66.6 or 72 cobalt Gray equivalent (CGE) on a prospective dose-searching study by proton and photon irradiation (Radiation Therapy Oncology Group #85-26) with conventional fractionation (1.8 CGE/day, 5 fractions/week). All treatments were planned using the three-dimensional (3D) planning system developed at the Massachusetts General Hospital, and the dose was delivered using opposed lateral fields for the photon component and a noncoplanar isocentric technique for the proton component. Clinical symptoms of TL damage were classified into 4 grades. Computerized tomography (CT) and magnetic resonance imaging (MRI) scans were evaluated for white matter changes. Abnormalities associated with persistent or recurrent tumor were distinguished from radiation-induced changes. TLs were delineated on the original scans of the 10 patients with damage and those of a group of 33 patients with no clinical or MRI evidence of injury. Dose distributions were calculated and dose-volume histograms were obtained for these patients. RESULTS: Of the patients, 10 developed TL damage, with bilateral injury in 2 and unilateral injury in 8. The cumulative TL damage incidence at 2 and 5 years was 7.6 and 13.2%, respectively. The MRI areas suggestive of TL damage were always separated from the tumor bed. Symptoms were severe to moderate in 8 patients. Several baseline factors, tumor- or host-related, were analyzed to evaluate their predictivity for TL damage: age, gender, tumor site, histology, type of presentation, type and number of surgical procedures, primary tumor volume, prescribed dose, normal tissue involvement, and volume of TL receiving doses ranging between 10 and 50 CGE or more. Only gender, in a univariate analysis (log rank) was a significant predictor of damage (0.0155), with male patients being at significantly higher risk of TL injury. In a stepwise Cox regression that included gender as a variable, no other baseline variable improved the prediction of damage. CONCLUSIONS: The 2- and 5-year cumulative TL damage rates were 7.6 and 13.2%, respectively. Despite the different TL damage rates related to age, tumor volume, number of surgical procedures prior to radiation therapy, and prescribed doses to the tumor, only gender was a significant predictor of damage (p = 0.0155) using a univariate (log rank) test. Chordomas and chondrosarcomas of the base of the skull may represent an interesting model to evaluate the TL damage rates because of their extradural origin, displacing the white matter instead of infiltrating it as gliomas do, because of their longer local recurrence-free survival other than gliomas and other brain tumors and because of the high doses of irradiation delivered to the target volume to obtain local control.
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Condrosarcoma/radioterapia , Cordoma/radioterapia , Recurrencia Local de Neoplasia/radioterapia , Fotones/efectos adversos , Protones/efectos adversos , Traumatismos por Radiación/patología , Neoplasias de la Base del Cráneo/radioterapia , Lóbulo Temporal/efectos de la radiación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Condrosarcoma/cirugía , Cordoma/cirugía , Terapia Combinada , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Fotones/uso terapéutico , Estudios Prospectivos , Terapia de Protones , Traumatismos por Radiación/etiología , Dosificación Radioterapéutica , Neoplasias de la Base del Cráneo/cirugíaRESUMEN
STUDY DESIGN: A case of intrapelvic aneurysm is reported. It is as an example of one of the many extraspinal causes of sciatica. OBJECTIVE: To demonstrate the importance of clinical examination in the assessment of patients with sciatic, despite continuing improvements in methods for imaging the spine. SUMMARY OF BACKGROUND DATA: Extraspinal conditions cause sciatic in a rare but recognized group of patients. Their clinical symptoms can be very similar to those of patients with sciatic from lumbar disc protrusion. METHODS: The clinical appearance, investigation, and treatment of a patient with an internal iliac artery aneurysm causing sciatic are discussed. RESULTS: Surgical treatment of the patient's aneurysm resulted in relief of the symptoms of sciatica. CONCLUSIONS: Although these cases are unusual in isolation, together they represent an important group. When a patient has sciatica, the clinician looks first to the spine for the origin of symptoms. Extraspinal causes are often not considered in the differential diagnosis. This oversight may be compounded by observation of asymptomatic disc protrusions on computed tomographic and magnetic resonance studies. The importance of clinical history and examination in the diagnosis of these lesions cannot be overemphasized.
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Aneurisma/complicaciones , Pelvis/irrigación sanguínea , Ciática/etiología , Aneurisma/diagnóstico , Aneurisma/cirugía , Humanos , Masculino , Persona de Mediana Edad , Examen Físico , Tomografía Computarizada por Rayos XRESUMEN
A review of 105 consecutive cases of chymopapain chemonucleolysis for single level lumbar disc herniation was undertaken. Mean follow-up was 12.2 years (range 10-15.3). Patients were assessed using the Oswestry Disability Questionnaire. Eighty-seven patients were available for follow-up. An excellent or good response occurred in 58 patients (67%); four patients (4.5%) had a moderate response but were only minimally disabled. The treatment failed in 25 patients (28.5%) and 21 of these went on to surgery within a mean of 5.2 months (range 3 weeks-12 months). In 15 patients (71%) disc sequestration or lateral recess stenosis was found. Five of the remaining six cases had a large disc herniation at surgery. Surgery resulted in a significant improvement in nine cases. Discitis following chemonucleolysis occurred in six patients (5.7%). Chymopapain chemonucleolysis has a useful role in the management of lumbar intervertebral disc prolapse. However, its efficacy is dependent on careful clinical and radiological patient selection.
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Quimopapaína/uso terapéutico , Quimiólisis del Disco Intervertebral , Desplazamiento del Disco Intervertebral/tratamiento farmacológico , Vértebras Lumbares , Adulto , Anciano , Evaluación de la Discapacidad , Femenino , Estudios de Seguimiento , Humanos , Desplazamiento del Disco Intervertebral/cirugía , Masculino , Persona de Mediana EdadRESUMEN
We have reviewed 59 patients with injury to the spinal cord to assess the predictive value of the sparing of sensation to pin prick in determining motor recovery in segments which initially had MRC grade-0 power. There were 35 tetraplegics (18 complete, 17 incomplete) and 24 paraplegics (19 complete, 5 incomplete), and the mean follow-up was 29.6 months. A total of 114 motor segments initially had grade-0 power but sparing of sensation to pin prick in the corresponding dermatome. Of these, 97 (85%) had return of functional power (> or = grade 3) at follow-up. There were 479 motor segments with grade-0 power but no sparing of sensation to pin prick and of these only six (1.3%) had return of functional power. Both of the above associations were statistically significant (chi-squared test, p < 0.0001). After injury to the spinal cord, the preservation of sensation to pin prick in a motor segment with grade-0 power indicated an 85% chance of motor recovery to at least grade 3.
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Neuronas Motoras/fisiología , Dolor/fisiopatología , Paraplejía/fisiopatología , Cuadriplejía/fisiopatología , Piel/inervación , Traumatismos de la Médula Espinal/fisiopatología , Tacto/fisiología , Distribución de Chi-Cuadrado , Estudios de Seguimiento , Predicción , Humanos , Músculo Esquelético/inervación , Examen Neurológico , Paraplejía/tratamiento farmacológico , Paraplejía/rehabilitación , Paraplejía/cirugía , Admisión del Paciente , Transferencia de Pacientes , Valor Predictivo de las Pruebas , Pronóstico , Cuadriplejía/tratamiento farmacológico , Cuadriplejía/rehabilitación , Cuadriplejía/cirugía , Traumatismos de la Médula Espinal/tratamiento farmacológico , Traumatismos de la Médula Espinal/rehabilitación , Traumatismos de la Médula Espinal/cirugía , Cicatrización de HeridasAsunto(s)
Aneurisma Falso/etiología , Articulación del Tobillo , Artroscopía/efectos adversos , Endoscopía/efectos adversos , Enfermedad Iatrogénica , Arterias Tibiales , Adulto , Articulación del Tobillo/diagnóstico por imagen , Anticoagulantes/efectos adversos , Exostosis/cirugía , Humanos , Masculino , RadiografíaRESUMEN
A series of pelvic and acetabular injuries caused by horse riding accidents is reported. The importance of wearing appropriate protective clothing when riding is emphasised.
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Acetábulo/lesiones , Traumatismos en Atletas/etiología , Fracturas Óseas/etiología , Caballos , Huesos Pélvicos/lesiones , Accidentes por Caídas , Acetábulo/cirugía , Adolescente , Adulto , Anciano , Animales , Traumatismos en Atletas/cirugía , Femenino , Estudios de Seguimiento , Fijación Interna de Fracturas , Fracturas Óseas/cirugía , Dispositivos de Protección de la Cabeza , Hospitalización , Humanos , Ilion/lesiones , Ilion/cirugía , Tiempo de Internación , Masculino , Persona de Mediana Edad , Huesos Pélvicos/cirugía , Ropa de Protección , Hueso Púbico/lesiones , Hueso Púbico/cirugía , Articulación Sacroiliaca/lesiones , Articulación Sacroiliaca/cirugíaRESUMEN
Roller blading is a new and increasingly popular leisure activity in many countries. We reviewed 110 consecutive patients with roller-blade injuries between 1 January and 30 June 1996. The patients ranged from 4 to 14 years in age (mean 6.5 years). Eighty-three (75.4%) sustained injuries to the upper limb and 27 (24.5%) injured the lower limb. Fifty-six patients, were girls and 54 were boys. Of the 110 patients, 79 (72.7%) sustained fractures, 28 (25.4%) soft tissue injuries and 3 (2.7%) dislocations. Eighty-three (75.4%) of the patients wore no protective equipment on the limbs. Four months following injury 103 (93.6%) patients were fully recovered. The mean duration of school absence was 3 days. Subsequently 101 children returned to using roller-blades following injury. Seventy-three (66.3%) of these now use protective equipment. We found that injuries were unrelated to age or duration of roller-blading experience or to the brand-name of roller blades used, and that most of our patients wore no protective equipment at the time of injury.
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Traumatismos del Brazo/etiología , Traumatismos de la Pierna/etiología , Patinación/lesiones , Adolescente , Traumatismos del Brazo/epidemiología , Traumatismos del Brazo/rehabilitación , Niño , Preescolar , Femenino , Estudios de Seguimiento , Fracturas Óseas/epidemiología , Fracturas Óseas/etiología , Fracturas Óseas/rehabilitación , Humanos , Luxaciones Articulares/epidemiología , Luxaciones Articulares/etiología , Luxaciones Articulares/rehabilitación , Traumatismos de la Pierna/epidemiología , Traumatismos de la Pierna/rehabilitación , Masculino , Estudios Prospectivos , Equipos de Seguridad , Patinación/estadística & datos numéricos , Traumatismos de los Tejidos BlandosRESUMEN
We studied the electrophysiological effects of E 4031, given in a dose ascending manner (1.5, 3.0, and 6.0 micrograms/kg over 5 min followed by 0.1, 0.2, and 0.4 microgram/kg per min for 60 min, respectively) to 19 volunteers. There were significant, dose related linear increase in QT and QTc intervals, in atrial functional and effective refractory periods (ERPs) at a paced cycle length of 400 ms, and in ventricular functional and ERPs at a paced cycle length of 600 ms. There was no significant change in the AH and HV intervals or QRS duration. No significant proarrhythmic or other side effects were encountered during the administration of the drug. E 4031 prolongs atrial and ventricular refractoriness without significantly affecting AV or intraventricular conduction, consistent with selective Class III properties. At the doses used in the present study, intravenous infusion of E 4031 appears to be safe and well tolerated.
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Antiarrítmicos/farmacología , Sistema de Conducción Cardíaco/efectos de los fármacos , Piperidinas/farmacología , Piridinas/farmacología , Adolescente , Adulto , Anciano , Antiarrítmicos/efectos adversos , Antiarrítmicos/farmacocinética , Función Atrial , Nodo Atrioventricular/efectos de los fármacos , Nodo Atrioventricular/fisiología , Estimulación Cardíaca Artificial , Relación Dosis-Respuesta a Droga , Electrocardiografía , Electrofisiología , Femenino , Atrios Cardíacos/efectos de los fármacos , Sistema de Conducción Cardíaco/fisiología , Humanos , Masculino , Persona de Mediana Edad , Piperidinas/efectos adversos , Piperidinas/farmacocinética , Piridinas/efectos adversos , Piridinas/farmacocinéticaRESUMEN
We reviewed 71 consecutive spinal cord injuries to determine the factors influencing neurological recovery. Sixty-three (35 tetraplegics and 28 paraplegics) were available for follow-up at a mean of 29.6 months. The American Spinal Injury Association (ASIA) scoring system was used on admission and at follow-up to determine change in neurological status. Treatment with corticosteroids or surgical intervention had no significant effect on outcome. Tetraplegics, both complete and incomplete, had a significantly better outcome than paraplegics (p < 0.02). Incomplete cord injury carried a better prognosis of motor recovery (p < 0.0001). Pattern of injury was an important determinant of recovery in the complete tetraplegia group. We conclude that many factors influence recovery following spinal cord injury and the effect of treatment may be difficult to demonstrate.
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Movimiento , Sensación , Traumatismos de la Médula Espinal/fisiopatología , Adolescente , Adulto , Anciano , Antiinflamatorios/uso terapéutico , Estudios de Seguimiento , Humanos , Metilprednisolona/uso terapéutico , Persona de Mediana Edad , Paraplejía/complicaciones , Pronóstico , Cuadriplejía/complicaciones , Traumatismos de la Médula Espinal/psicología , Traumatismos de la Médula Espinal/terapia , Resultado del TratamientoRESUMEN
Thirty-three patients with single and multiple digital amputations were fitted with a total of 50 prosthetic silicone fingers over a mean period of 4 years. The prosthetic fingers were custom made using a special method which has been modified at our institution. This study provides a detailed analysis of patients' occupational and cosmetic usage of and satisfaction with their prostheses, as well as describing the fabrication technique.
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Dedos , Prótesis e Implantes , Siliconas , Adulto , Anciano , Anciano de 80 o más Años , Amputación Quirúrgica/rehabilitación , Femenino , Dedos/cirugía , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Diseño de PrótesisRESUMEN
Twenty-four Sprague-Dawley rats underwent exploration and exposure of the sciatic nerve, followed by sham isolation, irrigation, and subsequent wound closure (Group 1); barrier vein wrapping of the nerve using glutaraldehyde-preserved allograft inferior vena cava (Group 2); or barrier vein wrapping of the nerve with femoral vein autograft from the contralateral extremity (Group 3). Four months later, the rats were sacrificed and the nerves fixed in situ in buffered glutaraldehyde. Sections proximal, mid-portion, and distal to the barrier and vein wrap were fixed with osmium tetroxide, epon embedded, stained with toluidine blue, and studied under x200 and x400 light microscopy. Epineural scar formation increased 10 times in Group 2, compared to Group 3 (p < 0.0001). Epineural thickness and the number of degenerating axons did not differ significantly among all groups. Inflammatory cells in Group 2 increased 100 times, compared to Group 3 (p < 0.0001). Continuing with the underlying epineural layer was apparent grossly and microscopically with all allografts, but with no autografts. Thus, glutaraldehyde-preserved allograft vein wraps appear to incite a marked inflammatory response, with epineural scarring and adherence to the underlying nerve, while autograft vein wraps do not.
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Nervio Ciático/cirugía , Animales , Bioprótesis , Vena Femoral/trasplante , Métodos , Ratas , Ratas Sprague-Dawley , Nervio Ciático/patología , Trasplante Autólogo , Trasplante Homólogo , Vena Cava Inferior/trasplanteRESUMEN
Cardiac transplantation has become the treatment of choice for end stage heart disease. In 1990 2,000 transplants were performed worldwide. Orthopaedic Surgeons will be asked with increasing frequency to evaluate and treat bone and soft tissue problems with these patients. Orthopaedic service at the Mater Hospital has been involved in the follow-up treatment of orthopaedic complications in 46 transplant patients over a six year period. Thirty eight were male and eight were female. The ages were between 12 years and 65 years (mean 44.3). Nine (20%) of these patients developed thirteen orthopaedic complications: A vascular Necrosis of the hip (AVN) (4), Soft tissue infections (3), Osteoporosis (2), Stress Fractures (2), Osteomyelitis (1) and Ostomalacia (1). The mode of presentation, investigation and management of orthopaedic problems particular to these patients is described. Most patients who develop bony complications have had increased doses of steroids for episodes of rejection. This study highlights the special features of this patient population that require modification of the treatment approach such as the need to avoid the drug Erythromycin and the increased risk of AVN of the hip in patients who require high dose steroids.
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Trasplante de Corazón , Enfermedades Musculoesqueléticas/etiología , Complicaciones Posoperatorias/fisiopatología , Adolescente , Adulto , Anciano , Niño , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Musculoesqueléticas/fisiopatología , Enfermedades Musculoesqueléticas/terapia , Ortopedia , Complicaciones Posoperatorias/terapia , Estudios RetrospectivosRESUMEN
A growing body of experimental data indicates that the "no-reflow" phenomenon is a type of reperfusion injury in skeletal muscle which may, in part, be mediated by oxygen free radicals, and thus may be attenuated by using agents that scavenge or inhibit formation of these reactive oxygen metabolites. This study was undertaken to assess the efficacy of recombinant human manganese superoxide dismutase (rhMnSOD) in reducing reperfusion injury in skeletal muscle. The specific advantage of this agent over other SOD types is a much longer plasma half-life (5 to 7 hr), allowing better equilibration between extra- and intracellular compartments. The rat cremaster model was used to study "no-reflow" in skeletal muscle. Reperfusion injury in the muscle was assessed by fluorescein dye perfusion, myocyte creatine phosphokinase (CPK) release, and contractile function in response to electrical field stimulation. Compared with untreated saline control animals, those treated with rhMnSOD after 5 hr of cremasteric ischemia, had a significantly higher percentage area of blood reflow (78 percent +/- 6 percent of normal), a greater percentage tetanic (66 percent +/- 9 percent of normal) and twitch (56 percent +/- 9 percent of normal) contractile strength, and less CPK release (21.5 percent higher than pre-reperfusion baseline CPK levels) (p < 0.05). Untreated saline control CPK release (21.5 percent higher than the prereperfusion level. Animals treated with allopurinol also had a significantly higher percentage twitch contraction (47 percent +/- 14 percent of normal) and a lower CPK release (11.1 percent of the prereperfusion value) 45 min after reperfusion than untreated saline controls.(ABSTRACT TRUNCATED AT 250 WORDS)