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PubMed1976

Prevention of venous thromboembolism by administration of hydroxychloroquine. A preliminary report.

A placebo or the antimalarial agent hydroxychloroquine (Plaquenil), which inhibits platelet adhesiveness, and, to a lesser extent, platelet aggregation, was given to 100 patients between forty and ninety-five years old (average age, seventy-four years) who had either fractures or orthopaedic operations involving the skeleton between the knee and the pelvis. Medication was started at the time of admission in a blind, randomized way, fifty patients receiving hydroxychloroquine (200 milligrams three times a day) and fifty, a placebo. No untoward bleeding complications were noted in the treated group. Eight instances of thromboembolism were encountered in the control group as compared with one in the hydroxychloroquine-treated group, a statistically significant difference at the 1.5 per cent level.

Adult↗
PubMed1987

Characteristics and sites of infection of Eubacterium nodatum, Eubacterium timidum, Eubacterium brachy, and other asaccharolytic eubacteria.

Three new species, Eubacterium nodatum, Eubacterium timidum, and Eubacterium brachy, were described, primarily from subgingival samples taken from patients with moderate and severe adult periodontitis. Except for the isolation of E. brachy from a pleuropulmonary infection, these species have not been reported from other infected body sites. We report on the isolation of these species and an undescribed group (D-6) of asaccharolytic eubacteria also found in periodontal disease from numerous different sites of infection, mostly the head and neck. A similarity in cellular morphological properties of E. nodatum and Actinomyces sp. was noted previously. Additional similarities, particularly to Actinomyces israelii, that we found are the formation of molar tooth colonies and the isolation from cases of lumpy jaw and from the genital tract of women in association with the use of an intrauterine contraceptive device. E. timidum and E. brachy did not occur more often from any particular site outside of the head, neck, and respiratory tract. The group D-6 strains came from a variety of sites in the trunk and pelvis. These species are all obligately anaerobic, asaccharolytic, and generally nonreactive, and they grow poorly and slowly on media commonly used to isolate anaerobic bacteria. L-Lysine (0.5%) markedly stimulated the growth of E. nodatum and, to a lesser extent, another acetate- and butyrate-producing group, Eubacterium sp. group D-6, but we did not find comparable stimulants for the other species. We found the production of phenyl acetate to be a helpful marker in the identification of E. timidum and Eubacterium sp. group D-6. Although the isolation and identification of most of these species remain somewhat difficult, the evidence from dental infections and the present report suggests that these species are potential pathogens that are likely to be overlooked in infected clinical material without special attention to more prolonged incubation and use of enriched isolation media.

Bacterial Infections↗
PubMedDate not supplied

Fracture of the lesser trochanter.

Isolated fracture or detachment of the lesser trochanter is an infrequent occurrence. In most cases the event is part of a complex of fractures involving the femoral neck and the greater trochanter. Isolated fracture caused by direct trauma is rare because of the anatomical location of the lesser trochanter which is protected anteriorly and posteriorly by large muscular masses, superiorly by the head and the neck of the femur, laterally by the femur itself, and medially by the ilio- and ischio-public branches of the pelvis. Trauma is usually indirect, caused by sudden traction by the iliopsoas muscle on the femoral tendinous insertion. The highest frequency is observed in young patients who are still growing where there is an imbalance between muscular strength and resistance of the osteochondral plate of the tendinous insertion. Particularly affected are adolescent athletes of male sex aged from 13 to 17 years. Similar overloading of traction in an adult would probably produce only muscular stretching. Diagnosis is based on radiographic ascertainment, obtained with the thigh in extra-rotation, supported by rather typical clinical findings such as acute pain in the inguinal region and in Scarpa's triangle, limping, passive movement of the hip in all directions with pain in maximum extension and relief when seated. Nonsurgical treatment with the limb resting in flexion, further confirmed by the case presented in this study, still remains the treatment of choice in most cases, obtaining excellent functional results. The authors believe that it was of interest to report this clinical case because of the rareness of the pathology observed and because of the specific features of its etiology.

Adolescent↗
PubMed1978

Biomechanical aspects of Salter osteotomy.

A mathematical model of a Salter osteotomy in an adult male pelvis reveals that during innominate osteotomy, the center of the hip joint moves distally, posteriorly, and medially. The acetabulum extends by an angle roughly equivalent to the angle of osteotomy opening. Adduction of the acetabulum takes place to a lesser extent. Hip abductors and flexors tighten minmally following innominate osteotomy. Augmentation of abduction occurs as a result of medial acetabular displacement rather than gross alteration of the abductor muscles themselves. Theoretical considerations suggest that the surgeon should strive to obtain maximum correction at the osteotomy site while avoiding levering at the greater sciatic notch.

Adult↗
PubMed1991

Transitional cell carcinoma of the upper urinary tract: evaluation of prognostic factors by histopathology and flow cytometric analysis.

Prognostic factors in transitional cell carcinoma of the upper urinary tract were assessed with histopathological examination and flow cytometric analysis in a series of 127 patients operated upon between 1976 and 1988. In particular, we evaluated the usefulness of flow cytometry to identify patients who require adjuvant treatment among those with low grade and low stage disease (51% in this series). A multivariate analysis was done on 92 cases, considering patient age and sex, stage, grade and number of lesions (unifocal versus multifocal), site (renal pelvis versus ureter), presence of vesical tumors, recurrences along the urinary tract or in the bladder, type of operation and nuclear deoxyribonucleic acid (DNA) ploidy (diploid versus tetraploid/aneuploid tumors). Only the stage (p = 0.001), grade (p = 0.001) and, to a lesser extent, the DNA pattern (p = 0.031), as well as the number of lesions (p = 0.061) were determinant for prognosis. In regard to the subgroup of 41 patients with grade 2 or less, stage P1 or less tumors, no significant difference in survival was demonstrated between diploid and nondiploid tumor patients. However, 7 of 10 patients from the latter group are still under observation. Therefore, our conclusions may have to be modified in the future.

Adult↗
PubMed1981

A surgical technique for hip disarticulation.

Hip disarticulation is usually elected for malignant bony and soft tissue tumors below the lesser trochanter of the femur. The operation is performed with the patient in a posterolateral position; in the first phase of the procedure the surgeon stands anterior to the patient. After incision of the skin and division of the femoral vessels and nerve, muscles of the anterior thigh are transected off the pelvic bone from lateral to medial starting with the sartorius and finishing with the adductor magnus. Muscles are divided at their origin except for the iliopsoas and obturator externus which are divided at their insertion on the lesser trochanter of the femur. The quadratus femoris muscle is identified and preserved, then the flexor muscles are transected at their site of origin from the ischial tuberosity. During the next phase the surgeon is posterior to the patient, and the pelvis is rotated from the posterolateral to the anterolateral position. After completion of the skin incision, the gluteal fascia, tensor fascia lata, and the gluteus maximus muscles are divided and dissected free of their posterior attachments to expose the muscles inserting by way of a common tendon onto the greater trochanter. These muscles are then transected at their insertion on the bone. The posterior aspect of the joint capsule is then exposed and transected. Finally, the sciatic nerve is divided and allowed to retract beneath the piriformis muscle. To close the wound the preserved muscles are approximated over the joint capsule and the gluteal fascia secured to the inguinal ligament over suction drains. The skin is closed with interrupted sutures.

Disarticulation↗
PubMed1990

[Y-shaped cartilage in the development of the normal pelvis and in congenital hip dislocation].

The authors use a radiographic approach to demonstrate the primary role of the triradiate cartilage in hip development in the normal child and in congenital dislocation of the hip. The orientation of this cartilage with respect to the dysplasia gives an indication as to the prognosis of the CDH. The acetabular angle is of lesser interest with respect to the orientation of the triradiate cartilage on the pelvic radiographic examination.

Cartilage↗
PubMedDate not supplied

[Purine metabolism in ankylosing spondylitis: clinical study].

We undertook a prospective study of 23 male patients with Ankylosing Spondylitis (AS) (New York Criteria), 18 HLA-B27 positive and 5 HLA-B27 negative, five of them had hyperuricemia. The following data of evolution were taken into consideration: age at onset of disease, time course of the disease, presence of urolithiasis, heart disease, flares of uveitis. Clinical activity and degree of disability were evaluated every one to 3 months; on each visit, every patient had determinations of serum and urinary uric acid levels, serum and phosphorus, erythrocyte sedimentation rate (ESR), serum protein electrophoresis, as well as X-ray films of the vertebral spine and pelvis. Three groups of patients were detected, all of them with equal age at onset, duration of disease, frequency of B27, peripheral arthritis, and leukocytosis. One group had hyperuricemia (5 of 23 patients, 80% of them HLA-B27 positive) and a lesser degree of clinical activity of the disease (p less than .001, a higher frequency of uveitis (40%, lower levels of serum gammaglobulins (p less than 0.05) and ESR (p less than 0.05), a lesser degree of ankylosis of the spine, and a better functional prognosis than the other groups. Another group (8 of 23 patients, 75% of them were HLA-B27 positive) had normouricemia and hyperuricosuria, and showed a higher frequency of fever (50%), an abnormal urinalysis, and urolithiasis (25%).

Adolescent↗
PubMed1995

[Traumatic loosening of apophyses in the pelvic area and the proximal femur].

Avulsion fractures of the pelvis and the proximal femur are relatively rare injuries in the adolescent age group of 11 to 17 years. The overall prognosis for spontaneous healing is good. The injury most frequently involves the apophysis of the anterior inferior iliac spine and of the lesser trochanter, followed by anterior superior iliac spine. In our experience the avulsion fractures involving the ischial tuberosity and the greater trochanter are extremely rare. The latter can have dire consequences.

Adolescent↗
PubMed1998

Postural adjustments accompanying fast pointing movements in standing, sitting and lying adults.

The present study evaluated the effect of different positions, which varied in the amount of bodily support, on postural control during fast pointing movements. Fourteen adult subjects were studied in standing, various sitting and lying positions. Multiple surface electromyograms (EMGs) of arm, neck, trunk and upper leg muscles and kinematics were recorded during a standard series of unilateral arm movements. Two additional series, consisting of bilateral arm movements and unilateral arm movements with an additional weight, were performed to assess whether additional task-load affected postural adjustments differently in a sitting and standing position. Two pointing strategies were used--despite identical instructions. Seven subjects showed an elbow extension throughout the movements. They used the deltoid (DE) as the prime mover (DE group). The other seven subjects performed the movement with a slight elbow flexion and used the biceps brachii (BB) as the prime mover (BB group). The two strategies had a differential effect on the postural adjustments: postural activity was less and substantially later in the BB-group than in the DE group. Anticipatory postural muscle activity was only present in the DE group during stance. In all positions and task-load conditions the dorsal postural muscles were activated before their ventral antagonists. The activation rate, the timing and--to a lesser extent the amplitude of the dorsal muscle activity was position dependent. The position dependency was mainly found in the caudally located lumbar extensor (LE) and hamstrings (HAM) muscles. The EMG amplitude of LE and HAM was also affected by body geometry (trunk and pelvis position). Position and body geometry had only a minor effect on the activity of the neck and thoracic extensor muscles. This difference in behaviour of lower and upper postural muscles suggests that they could serve different postural tasks: the lower muscles being more involved in keeping the centre of mass within the limits of the support surface, and the upper ones in counteracting the reaction forces generated by movement onset. Increasing task-load by performing bilateral movements and--to a minor extent--during loaded unilateral movements affected the temporal and quantitative characteristics of the postural adjustments during standing and sitting in a similar way. The effect was present mainly during the early part of the response (within 100 ms after prime mover onset). This suggests that feedforward or anticipatory mechanisms play a major role in the task-specific modulation of postural adjustments.

Adaptation, Physiological↗
PubMed1999

Observations on the effect of abolishing analgesic abuse and reducing smoking on cancers of the kidney and bladder in New South Wales, Australia, 1972-1995.

OBJECTIVES: We have assessed the effect on the rates of cancers of the kidney and bladder of measures undertaken by the government in 1979-1983 to limit smoking and analgesic abuse in New South Wales (NSW). Sale of phenacetin-containing analgesics, previously available without restriction and regularly taken by 11-13% of women and 4-9% of men in NSW, was prohibited from 1979. The prevalence of current smokers among adult Australian men had fallen from 72% in 1945 to 43% in 1980 and to 28% in 1992. In women the corresponding figures were 26%, 31% and 24%. METHODS: Incidence and mortality data from the New South Wales Central Cancer Registry for the period 1972 to 1995 were analyzed, by sex and age, for trends over time. Relative survival was calculated for cases diagnosed in the period 1980-94 and followed until the end of 1996. RESULTS: Significant trends evident from these data were: throughout the period of review a rising incidence of, and to a lesser extent mortality from, renal parenchymal cancer for which relative survival has steadily improved; falling mortality from bladder cancer throughout the period of review, but more rapid after 1985; a reversal of the earlier increasing incidence of, and mortality from, cancer of the renal pelvis; and relative survival for bladder and renal pelvic cancers which was worse in women than men. Changes in registration practice in 1985 and 1993 introduced artifacts into the trends in incidence of bladder cancer. CONCLUSIONS: Improvements in the trends of incidence and mortality of cancers of the renal pelvis and bladder in the mid-1980s are interpreted, in the light of registration and clinical practice, to indicate a beneficial effect of regulations which virtually abolished analgesic abuse and, less certainly, a contribution from measures restricting smoking, in New South Wales. However, renal parenchymal cancer continues to increase, although there has been some apparent benefit of earlier detection.

Adult↗
PubMed1980

CT of acute pancreatitis: interim assessment.

a retrospective review of 102 ptients with the clinical diagnosis of acute pancreatitis undergoing computed tomographic (CT) evaluation during a 9 month period revealed 32 patients with abnormal CT scans. All 32 had enlargement of the pancreas. The extent of inflammatory process on these patients was examined. Twenty patients exhibited a phlegmonous mass extending into the region of the lesser sac. There was involvement of the left anterior pararenal space in 13 (the right in three and both in four). Eight patients demonstrated involvement of the posterior pararenal space, and in seven of these the inflammatory process extended down the psoas muscle into the pelvis. Five patients had involvement of the transverse mesocolon and small bowel mesentery. Eight patients developed a pseudocyst during the acute phase of the disease, 11 developed a pancreatic abscess, and two showed evidence of pancretic hemorrhage. This experience prompted a prospective study of the clinical course of acute pancreatitis relative to the extent of disease as recognized by CT.

Abscess↗
PubMed1992

Preoperative templating for the equalization of leg lengths in total hip arthroplasty.

The method and results of preoperative templating for the re-establishment of leg length equality during total hip replacement (THR) are reported. The method is a modification of the technique of Müller and requires an anteroposterior radiograph of the pelvis that includes the proximal third of both femora, appropriate acetabular and femoral templates, and tracing paper. To obtain equalization of leg lengths and tissue tension, a composite drawing is made of the operative plan, with all component sizes and important measurements clearly marked. During THR, the lesser trochanter is identified and the femoral neck is osteotomized after a direct measurement is made. These principles were followed in a prospective, consecutive series of 42 primary THR procedures performed by one surgeon. All the radiographic measurements were performed by a single observer. The leg length discrepancy on the postoperative radiograph averaged 3mm (standard deviation = 3mm, range: -9 to +9mm). The postoperative clinical leg length discrepancy averaged 0mm (range: -10 to +10mm). None of the patients complained of leg length inequality. Preoperative templating allows different alternatives to be traced on paper prior to the actual surgical procedure. This method also helps determine the requirements for special prosthetic implants. Acceptable results for postoperative leg length equality may be reliably achieved using this method.

Bone Lengthening↗
PubMed1999

New observations on carrying angle.

Based on experiments on fresh cadaveric and accidentally amputated 8 upper limbs of children, study of ulnae for presence and absence of non articular strip on the trochlear notch, measurements of carrying angle, length of forearm bones, pronation-supination, height and weight in 2250 infants, children and adults of various age groups and clinical observations on 800 cases of injuries around elbow many new facts have been observed about the development of the carrying angle and its significance in the etiopathogenesis of various types of fractures seen around the elbow. The carrying angle develops in response to pronation of the forearm and is dependent on length of the forearm bones. Lesser the length of forearm bones greater is the carrying angle. So the carrying angle is more in shorter persons as compared to taller persons. It is abduction at the shoulder and not the carrying angle which keeps the swinging upper limbs away from the side of the pelvis during walking. Carrying angle is not a secondary sex character. The type of fracture a child sustains after fall on outstretched hand is also determined by the value of the carrying angle. A new type of fracture hitherto undescribed in the literature, T-Y fracture of the distal humeral epiphysis is also reported.

Adolescent↗
PubMed1972

Effect of tetracyclines and 4-epiderivatives on the ureter.

1. The effect of tetracyclines on the isolated dog ureter is dependent on: (a) the tetracyclines used-mepicycline and doxycycline antagonizing, and tetracycline and rolitetracycline increasing the contractor action of barium chloride; (b) the percentage of 4-epiderivatives in the tetracyclines used-the higher the epiderivative concentration, the smaller the effect of mepicycline or doxycycline, and the greater the action of tetracycline or rolitetracycline.2. In vivo the addition of the antibiotics into the renal pelvis shows no significant differences between the various tetracyclines or different 4-epiderivative concentrations on the intra-ureteral flow of the dog or guinea-pig.3. Intravenous injection of mepicycline or doxycycline does not induce a significant change in the intra-ureteral flow, while intravenous administration of tetracycline or rolitetracycline produces a triphasic response: (a) a marked decrease of the intra-ureteral flow for a few minutes; (b) a return to the control condition for 30-60 min; and (c) a lesser but persistent decrease in flow for 60-120 minutes. In the first phase the ureteral smooth muscle is directly affected by the antibiotics circulating in the blood, while in the third phase the tetracyclines act via the intra-ureteral mucosa.4. Neurogenic effects on the ureter-bladder junction in vivo are not affected by the tetracyclines tested.

Animals↗
PubMed1988

Malnutrition and the role of nutritional support for radiation therapy patients.

The nutritional status of a tumor patient can be negatively influenced by the local and systemic effects of the malignant tumor (tumor cachexia, anorexia, difficult oral food intake), by the effects of the various antitumoral therapy modalities (surgery, radiotherapy, chemotherapy), and by the complications associated with such modalities (anorexia, nausea, vomiting, mucositis, xerostomia, alterations of the smell and taste sensations, odynophagia, dysphagia, maldigestion, malabsorption, diarrhea, steatorrhea, conditioned aversions, radiogenic late effects), as well as by the psychological reactions of the patient to the real or feared existence of his tumor. The radiation-induced nutritional disorders depend on the tumor localization, the region irradiated, the dose and length of radiotherapy, the fractionation, the volume irradiated, and the combination with other therapeutic modalities ("combined modality therapy"). The acute radiation-induced reactions are usually of limited duration and for this reason tend to interfere with the nutritional status to a lesser extent than the permanent chronic consequences of irradiation. Weight loss and malnutrition tend to develop particularly in patients in whom segments of the gastrointestinal tract are subjected to irradiation. The incidence and severity of deficient nutrition depend not only on the region irradiated (head-neck region, thorax, abdomen, pelvis) but also, and most particularly, on the volume of the digestive tract irradiated. Chemotherapy and radiotherapy combined act very strongly on rapidly proliferating cell populations (skin, mucosa, epithelium of the gastrointestinal tract). In this context, actinomycin D and adriamycin act like real sensitizers, whereas the majority of the other drugs are likely to produce only an additive effect. The first named cytostatics give rise to the so-called recall phenomenon, i.e., the reactivation of latent radiation effects in response to the subsequent administration of the drug. Malnutrition impairs organ function and ultimately results in increased morbidity and mortality. For this reason it has proven mandatory and reasonable that the organism of all tumor patients suffering from malnutrition is provided with the missing essential nutrients (especially amino acids for protein synthesis). This tends to clearly improve the Karnofsky performance status, with a positive effect on response rates, toxicity, and survival rates in retrospective studies.(ABSTRACT TRUNCATED AT 400 WORDS)

Abdominal Neoplasms↗
PubMed1994

Use of proliferative markers Ki-67 (MIB-1) and proliferating cell nuclear antigen (PC10) in transitional cell carcinoma of the renal pelvis.

Segmental renal resection and improved endourological techniques have resulted in conservative treatment options for transitional cell carcinoma of the renal pelvis. These techniques have increased the need for more objective measures of biological behavior. We applied two immunohistochemical markers of cellular proliferation, proliferating cell nuclear antigen (PCNA; PC10) and Ki-67 (MIB-1), to 58 archival cases of renal pelvic transitional cell carcinomas and correlated the percentage of positive cells to grade, stage, and survival, and to one another; mitotic counts (mitoses/10 high-power fields) were also performed. Expression of PCNA showed a significant difference between grades 1, 2, and 3 tumors (P = 0.05) and between superficial (Ta, T1) and invasive tumors (T2-4) (P = 0.02). There was a significant overlap, however, in the percentage of cells staining between the grades as well as the stages. PCNA staining did not correlate with survival and did not identify a subset of patients with low-stage, low-grade tumors with a poorer prognosis. The Ki-67 score exhibited a stronger correlation with grade (P = 0.001), and there was a trend of increasing Ki-67 expression with higher stage tumors, but this did not reach statistical significance (P = 0.10). Ki-67 showed comparable findings to PCNA with regard to survival and overlap in staining between the grades and stages. Mitotic counts did correlate with grade (P = 0.003) but not stage or survival. This study demonstrates that cellular proliferation, as determined by the immunohistochemical markers, Ki-67 and PCNA, is related to grade and, to a lesser extent, stage, but the use of these markers as measures of biological behavior in clinical practice may be limited.

Adult↗
PubMed1991

Bowel opacification for abdominal computed tomography in children: a clinical trial of oral Telebrix 38.

Computed tomography (CT) of the abdomen is an important diagnostic tool for detecting abnormalities of the solid organs and, to a lesser extent, the gastrointestinal tract. For an optimal CT study, the gastrointestinal and urinary tracts should be opacified with oral and intravenous radiopaque contrast agents. The authors tested the effectiveness of dilute oral meglumine and sodium ioxithalamate (Telebrix 38, Mallinckrodt Canada Inc., Pointe-Claire, Que.) as a bowel marker in 50 CT examinations of the abdomen and pelvis. The study objective was assessment of patient acceptance, safety of the product, degree of bowel opacification and image quality. Of children who were capable of answering the question, 93% said they would be willing to take the 2% oral solution of Telebrix again if required. No adverse effect attributable to the contrast medium was noted. Opacification of the gastrointestinal tract was excellent in the majority of cases, and the diagnostic quality of the CT images was good. The authors concluded that 2% Telebrix is an effective and safe bowel opacification agent for abdominal and pelvic CT scanning.

Administration, Oral↗