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The Journal of Arthroplasty Oct 2013An accelerated sequential proximal femoral bone loss model was used to measure the initial stability of three noncemented femoral stem designs: fully porous-coated,...
An accelerated sequential proximal femoral bone loss model was used to measure the initial stability of three noncemented femoral stem designs: fully porous-coated, proximally porous-coated, and dual-tapered, diaphyseal press-fit (N=18). Only dual-tapered, diaphyseal press-fit stems remained stable with as much as 105 mm of bone loss, with average cyclic micromotion remaining below 25 μm in ML and below 10 μm in AP planes. In contrast, with proximally coated and fully coated stem designs with circular or oval cross-sections, 60mm of bone loss, resulting in lower than 10 cm of diaphyseal bone contact length, led to gross instability, increasing average cyclic micromotions to greater than 100 μm prior to failure. Therefore, the results provide support for using a dual-tapered stem in revision cases with proximal bone loss.
Topics: Arthroplasty, Replacement, Hip; Bone Resorption; Cementation; Femur; Hip Prosthesis; Humans; Models, Biological; Prosthesis Failure
PubMed: 23523487
DOI: 10.1016/j.arth.2013.01.017 -
Knee Surgery, Sports Traumatology,... Apr 2011A laboratory study was performed to evaluate the histopathological features of the macroscopically intact portion of the Achilles tendon in patients undergoing surgery... (Comparative Study)
Comparative Study
A laboratory study was performed to evaluate the histopathological features of the macroscopically intact portion of the Achilles tendon in patients undergoing surgery for an acute rupture of the Achilles tendon. Tendon samples were harvested from 29 individuals (21 men, 8 women; mean age: 46 ± 12) who underwent repair of an Achilles tendon tear tear, and from 11 male patients who died of cardiovascular events (mean age: 61). Three pieces of tendon were harvested: at the rupture site, 4 cm proximal to the site of rupture, 1 cm proximal to the insertion of the Achilles tendon on the calcaneum. Slides were assessed using a semiquantitative grading scale assessing fiber structure and arrangement, rounding of the nuclei, regional variations in cellularity, increased vascularity, decreased collagen stainability, and hyalinization. Intra-observer reliability of the subscore readings was calculated. The pathological features were significantly more pronounced in the samples taken from the site of rupture than in the samples taken proximally and distal to it (0.008 < P < 0.01). There were no significant differences in the mean pathologic sum-scores in the samples taken proximally and distal to the site of rupture. Unruptured Achilles tendons, even at an advanced age, and ruptured Achilles tendons are clearly part of two distinct populations, with the latter demonstrating histopathological evidence of failed healing response even in areas macroscopically normal.
Topics: Achilles Tendon; Acute Disease; Adult; Biopsy, Needle; Case-Control Studies; Collagen; Female; Humans; Immunohistochemistry; Male; Middle Aged; Plastic Surgery Procedures; Reference Values; Rupture; Statistics, Nonparametric; Tendon Injuries; Tissue and Organ Harvesting; Wound Healing
PubMed: 20563556
DOI: 10.1007/s00167-010-1193-2 -
Neurogastroenterology and Motility Jun 2007Proximal oesophageal acid reflux is increased in gastro-oesophageal reflux disease (GORD) patients with oesophageal and extra-oesophageal symptoms, the latter...
Proximal oesophageal acid reflux is increased in gastro-oesophageal reflux disease (GORD) patients with oesophageal and extra-oesophageal symptoms, the latter particularly in presence of oesophagitis. This study was aimed to assess the proximal extent of reflux, both acid and weakly acidic, in GORD patients with and without oesophagitis and to characterize, using an animal model of GORD, the relationship between acute oesophagitis and proximal extent of reflux. Proximal extent of reflux was evaluated during 24-h pH-impedance monitoring in 17 oesophagitis, 27 non-erosive reflux disease (NERD) patients and 10 asymptomatic controls. In five adult cats, reflux events were simulated by intra-oesophageal retrograde injection of a radiopaque solution. Proximal extent of simulated reflux was fluoroscopically assessed before and after inducing acute oesophagitis. The percentage of proximal reflux was 11% in controls, 22% in NERD and 38% in oesophagitis patients (P < 0.05 vs NERD). Weakly acidic reflux showed higher proximal extent in oesophagitis than in NERD patients but it was less proximally propagated than acid reflux. In cats, proximal reflux was significantly increased during acute oesophagitis. Oesophagitis patients show higher proximal extent of reflux, acid and weakly acidic, when compared with NERD patients and controls. In the experimental model, acute oesophagitis favours proximal migration of simulated reflux.
Topics: Adult; Animals; Cats; Electric Impedance; Esophageal pH Monitoring; Esophagitis, Peptic; Female; Gastroesophageal Reflux; Humans; Male; Middle Aged
PubMed: 17564627
DOI: 10.1111/j.1365-2982.2006.00868.x -
JOP : Journal of the Pancreas Mar 2005Pancreatic stents may be placed during therapeutic ERCP for a variety of indications. One such indication is to prophylax against the development of pancreatitis...
CONTEXT
Pancreatic stents may be placed during therapeutic ERCP for a variety of indications. One such indication is to prophylax against the development of pancreatitis following sphincterotomy of the minor papilla in patients with recurrent acute pancreatitis and pancreas divisum. Increasingly, endoscopists that perform pancreatic ERCP are placing small caliber (3 Fr), unflanged, single pigtail stents into the long axis of the pancreatic duct with the expectation that these stents will only stay in place for a few days and the majority will pass spontaneously on their own without the need for follow-up endoscopic retrieval. As such, these stents are generally regarded as safer and associated with a lower rare of complication than larger (5 and 7 Fr), double flanged pancreatic stents.
CASE REPORT
We present the case of a 3 Fr stent that migrated proximally into the dorsal duct in a patient with recurrent pancreatitis and pancreas divisum. Due to the small size of the patient's dorsal duct, it was difficult to pass appliances alongside the stent to facilitate retrieval and a variety of appliances were used before success was achieved.
DISCUSSION
The medical literature contains series of proximally migrated larger caliber flanged, pancreatic stents but proximal migration of small caliber, unflanged, pigtail stents has not yet been reported. As the use of these small stents increases, we feel that it is important to highlight the potential for this complication and discuss how we successfully treated our patient.
Topics: Acute Disease; Adult; Catheterization; Cholangiopancreatography, Endoscopic Retrograde; Endoscopy, Digestive System; Follow-Up Studies; Foreign-Body Migration; Humans; Male; Pancreas; Pancreatic Ducts; Pancreatitis; Risk Factors; Sphincterotomy, Endoscopic; Stents
PubMed: 15767735
DOI: No ID Found -
Acta Orthopaedica Belgica 1997A 2 to 8 year review of 104 cases of Type III hip revisions with a proximally modular proximal ingrowth non-cemented stem has been carried out. Four re-revisions were...
A 2 to 8 year review of 104 cases of Type III hip revisions with a proximally modular proximal ingrowth non-cemented stem has been carried out. Four re-revisions were required, 1 early for a femur which was too broken up to support an implant, 1 for late sepsis re-activation, 1 for knee pain, and 1 at 4 years for aseptic loosening. Of the remainder, 81.8% had a good or excellent result with most problems being experienced in the acetabular side. 68.8% show no radiolucency and only 3 cases, including the revised one, show complete stem radiolucency. It is concluded that in the medium term, proximal ingrowth implants can be used in revision hip surgery.
Topics: Adult; Aged; Aged, 80 and over; Arthritis, Infectious; Arthroplasty, Replacement, Hip; Cementation; Female; Femoral Fractures; Femur; Hip Prosthesis; Humans; Knee; Male; Middle Aged; Osseointegration; Osteoarthritis; Pain; Prosthesis Design; Prosthesis Failure; Prosthesis-Related Infections; Radiography; Reoperation; Retrospective Studies; Sepsis
PubMed: 9532855
DOI: No ID Found -
The Israel Medical Association Journal... Nov 2017In colon cancer, data regarding proximal and distal metastasis to lymph nodes remains scarce.
BACKGROUND
In colon cancer, data regarding proximal and distal metastasis to lymph nodes remains scarce.
OBJECTIVES
To evaluate lymph node distribution along the longitudinal axis of the colon as related to a tumor to re-examine the common practice of 5 cm proximal and 2 cm distal resection margins.
METHODS
We studied 106 patients (53 males and 53 females, mean age 67.9 ± 10 years) who had undergone left hemicolectomy or sigmoidectomy. Colonic cancer specimens were divided into five zones proximally and distally to the tumor. For each zone, overall lymph node evaluation and ratio was performed.
RESULTS
The mean number of retrieved lymph nodes per patient was 24.3 ± 12, with 54.9% of the nodes concentrated in zone I, 22.1% in zone II, 9.5% in zone III, 10.3% in zone IV, and 3% in zone V. While most positive nodes were found in zone I, significant numbers were also detected in both directions proximally and distally to the tumor.
CONCLUSIONS
It seems that longer colonic segments proximally, and especially distally, should be considered for resection to significantly reduce the chances of finding involved lymph node.
Topics: Aged; Colectomy; Colon; Colonic Neoplasms; Female; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Staging; Patient Selection; Prognosis; Risk Assessment
PubMed: 29185284
DOI: No ID Found -
American Journal of Orthopedics (Belle... Sep 2001Intramedullary nails (IMNs) are the treatment of choice for diaphyseal tibial fractures. Its use has been expanded both distally and proximally to cover metaphyseal...
Intramedullary nails (IMNs) are the treatment of choice for diaphyseal tibial fractures. Its use has been expanded both distally and proximally to cover metaphyseal fractures at both ends of the tibia. Several authors have stated that IMN use in proximal tibial fractures (extra-articular) can become problematic, leading to a significantly increased rate of malunion. Different strategies for solving this problem have been reported in recent years, but no strategy is fault-free. We review the causes of and solutions for increased malunion following use of IMNs for proximal tibial fractures.
Topics: Fracture Fixation, Intramedullary; Fractures, Malunited; Humans; Tibial Fractures
PubMed: 11569848
DOI: No ID Found -
The American Journal of Physiology Feb 1998The human esophagus is composed of striated muscle proximally and of smooth muscle distally with a transition zone between the two. Striated muscle contracts much faster...
The human esophagus is composed of striated muscle proximally and of smooth muscle distally with a transition zone between the two. Striated muscle contracts much faster than smooth muscle. The change in pressure over time (dP/dt) of the contraction amplitude should therefore be higher in proximal than in distal esophagus, reflecting the presence of striated muscle proximally. There were 34 normal esophageal manometries of patients analyzed for swallow amplitude and dP/dt in the pharynx and esophagus. An additional 11 healthy controls were similarly studied. Amplitudes in pharynx and proximal and distal esophagus were not different. The mid-esophagus had a pressure trough (P < 0.001). The dP/dt in the pharynx was much higher than that in the esophagus (P < 0.001). The dP/dt of proximal and distal esophagus were of the same order of magnitude. The manometric behavior of the striated muscle portion of the proximal esophagus differs from that seen in the pharynx and shows similar characteristics to distal esophageal smooth muscle.
Topics: Adult; Aged; Aged, 80 and over; Esophagus; Female; Humans; Male; Manometry; Middle Aged; Muscle Contraction; Muscle, Skeletal; Muscle, Smooth; Pharynx
PubMed: 9486186
DOI: 10.1152/ajpgi.1998.274.2.G325 -
American Journal of Human Biology : the... 1995In 48 normal weight subjects, 25 females and 23 males, body impedance was measured at multiple frequencies. Two different electrode placements were used, one the...
In 48 normal weight subjects, 25 females and 23 males, body impedance was measured at multiple frequencies. Two different electrode placements were used, one the commonly used distal electrode placement, in which the source electrodes are on the dorsal sides of the hand and foot and the sensor electrodes are on ankle and wrist, and a second placement, in which the sensor electrodes are placed more proximally, at the knee and elbow. Theoretically a proximal electrode placement could result in more precise estimates of body water compartments. Total body water (TBW) and extracellular water (ECW) were determined using deuterium oxide dilution and bromide dilution, respectively. The aim of the study was to investigate whether proximal electrode placement results in a more precise estimation of TBW and ECW using multifrequency impedance analysis. Correlation coefficients of impedance and the impedance index stature /impedance) with TBW and ECW were not or were only slightly higher using proximal impedance values, resulting in slight improvement of the estimation error for TBW (0.13 kg) and ECW (0.04 kg). The differences between measured and predicted values (residuals) of TBW and ECW were not correlated with TBW and ECW, but they were correlated with body fat and body water distribution (ECW/TBW). These correlations did not differ between distal and proximal impedance measurements. It is concluded that proximal impedance measurements do not substantially improve the prediction of body water compartments. © 1995 Wiley-Liss, Inc.
PubMed: 28557222
DOI: 10.1002/ajhb.1310070110 -
Clinical Orthopaedics and Related... Oct 1979A modified posterolateral approach is useful for extensive exposure of the elbow and proximal radioulnar joints. The patient is placed prone and the elbow flexed over a...
A modified posterolateral approach is useful for extensive exposure of the elbow and proximal radioulnar joints. The patient is placed prone and the elbow flexed over a padded support: a pneumatic tourniquet is placed proximally on the arm. The laterally curved skin incision extends from the center of the posterior surface of the arm, at the upper limit of the triceps tendon, to the back of the lateral epicondyle and thence to the posterior border of the ulna 3 finger-breadths distal to the tip of the olecranon. The large medial and smaller lateral flaps are secured with sutures. The ulnar nerve is exposed and protected. A distally based tongue of triceps tendon is fashioned and retracted downwards. The anconeus is separated from the extensor carpi ulnaris muscle and retracted medially with the underlying capsule. The common extensor origin and the lateral collateral ligament, with the adjacent capsule, are partially reflected from the humerus. Excellent exposure of the elbow and proximal radioulnar joints is easily achieved and visualization can be increased by putting a varus strain on the elbow.
Topics: Elbow Joint; Humans; Methods; Radius; Ulna
PubMed: 535216
DOI: No ID Found