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[Effects of an oxacephem antibiotic on liver function in orthopedic surgery].

The subjects were 531 patients who underwent orthopedic surgery. Flomoxef was administered, and liver function was examined before and after administration. Abnormal liver function after administration of flomoxef was found in 14.3% of patients. In male patients, a high rate of 18.8% was observed. A particularly high rate of 37.0% was obtained among patients who showed GOT values of more than 40 U/L before treatment with flomoxef. The prevalence of abnormal GOT and GPT values after administration of flomoxef was 3.6% and 13.2%, respectively. These values were significantly higher than those obtained with other cephem antibiotics. These rates of occurrence of abnormally high GOT and GPT are obviously higher than those submitted at the time of approval and reported in the drug use investigation. The prevalence of abnormal liver function values was high in patients receiving flomoxef, and particularly high in male patients and patients whose GOT was high before administration of flomoxef. Therefore, sufficient check of liver function appears important when administration of flomoxef to these types of patients is intended.

Adult↗

[The alcohol dependence in the patients of the Department of Orthopedics and the Department of Endocrinology of the clinical hospital in Białystok].

The authors analyse problem of alcohol dependence in the patients of the traumatic department (orthopedics) and the internal department (endocrinology). The evaluation of the dependence was made by the help of MAST. This test is easy to perform by the patients themselves. As authors predicted, the probability of alcohol dependence was higher among the patients of the orthopaedics department. Although the difference was not statistically significant, the authors confirm that the alcohol dependence may be related to physical traumas, especially in men.

Adolescent↗

[Clinical experiences and problems with home medical treatment in an orthopedic clinic].

Twenty-five patients who received home medical treatment were reviewed. There were 11 males and 14 females, with a mean age of 77 years. In an orthopedic clinic, it is difficult to secure the time for to visit a patient's home. Another problem for doctor is that the medical fee for home treatment is very low. To promote home treatment by orthopedists, it is important to secure the time to visit a patient's home, to improve the fees for home treatment, and to establish a connection with a visiting nurse care station and visiting rehabilitation workers.

Aged↗

[Use of autoblood and its components in orthopedics and traumatology].

The results of the autoblood donation in 304 patients with complex surgical operations in orthopedics and traumatology are analyzed. The method of the intraoperation blood loss compensation with own red cells is offered. It should be noted that the red cells must be prepared 2 days and less before the operation. The use of modern methods of autoblood donation allowed to reduce 3 times the requirement in homologous blood.

Blood Component Transfusion↗

[Analgesia after orthopedic interventions].

The efficacy of application of tramadol and naclofen for analgesia after performance of orthopedic operations was studied up. There were examined 112 patients, to whom were done total endoprosthesis of coxofemoral joint, 19--total endoprosthesis of the knee joint, 54--the knee joint arthroscopy. The analgesia efficacy was estimated according to visual-analogue scale and to the sensations index. High efficacy of the tramadol application for postoperative analgesia was established. In patients, to whom tramadol and naclofen were administered, maximal analgetic effect was noted.

Analgesics, Opioid↗

Finding the right fit: effective thrombosis risk stratification in orthopedic patients.

Patients undergoing orthopedic surgery are at increased risk of venous thromboembolic events. Proven prophylactic measures are available but are generally underused. However, even one of the most effective therapies available, low-molecular-weight heparin, fails to prevent deep vein thrombosis in approximately 15% of patients undergoing total hip replacement. Clinical outcomes and cost-effectiveness of venous thromboembolism prophylaxis may be optimized by tailoring the treatment to the level of risk of each patient. Overall thromboembolic risk depends on the interactions among multiple factors, such as those that relate to the current clinical status and underlying susceptibility of the patient. Presently, risk assessment models that consider these factors may be of practical assistance in stratifying patients. Improving identification of patients with additional risk factors is a goal of future models. Novel therapies, such as the recombinant hirudin desirudin, or strategies, such as prolonged postoperative prophylaxis, may provide improved protection in these patients and should be considered in the future.

Anticoagulants↗

Orthopedic rehabilitation using the "Rutgers ankle" interface.

A novel ankle rehabilitation device is being developed for home use, allowing remote monitoring by therapists. The system will allow patients to perform a variety of exercises while interacting with a virtual environment (VE). These game-like VEs created with WorldToolKit run on a host PC that controls the movement and output forces of the device via an RS232 connection. Patients will develop strength, flexibility, coordination, and balance as they interact with the VEs. The device will also perform diagnostic functions, measuring the ankle's range of motion, force exertion capabilities and coordination. The host PC transparently records patient progress for remote evaluation by therapists via our existing telerehabilitation system. The "Rutgers Ankle" Orthopedic Rehabilitation Interface uses double-acting pneumatic cylinders, linear potentiometers, and a 6 degree-of-freedom (DOF) force sensor. The controller contains a Pentium single-board computer and pneumatic control valves. Based on the Stewart platform, the device can move and supply forces and torques in 6 DOFs. A proof-of-concept trial conducted at the University of Medicine and Dentistry of New Jersey (UMDNJ) provided therapist and patient feedback. The system measured the range of motion and maximum force output of a group of four patients (male and female). Future medical trials are required to establish clinical efficacy in rehabilitation.

Adult↗

Pediatric analgesia and sedation for the management of orthopedic conditions.

Orthopedic injuries are common in the emergency department; this is especially true in children. The orthopedist must often supervise sedation and analgesia for the injured child. While the techniques of conscious sedation have improved, the therapeutic index between adequate and excessive sedation is much narrower in children than adults, especially for painful procedures. The purpose of this review is to outline a reasonable approach to sedation and analgesia in the pediatric patient. In addition, current monitoring guidelines are reviewed, as well as the basic pharmacology of the most commonly used drugs.

Adult↗

[Biological experimental models in orthopedics].

Experimental research in orthopedics is conducted on different experimental models. Animal models have to be characterized by high similarity and consistence of the animal bone tissue with human metabolism and must undergo similar biomechanical changes. This paper presents the advantages and disadvantages of the most commonly used animal models, with particular attention given to sheep.

Animals↗

Orthopedic infections: A prospective study of 378 clean procedures.

Six hundred twenty orthopedic surgery patients were evaluated in a prospective study of postoperative infection. The wound infection rate among the 378 elective clean procedures was 5.8 per cent (3.2 per cent major plus 2.6 per cent minor infections). Staphylococcus aureus was the single most common pathogen recovered in both major and minor infections. Gram-negative rods predominated in major infections, but were rarely found in minor infections. In the clean procedure group, infection rates increased with age and duration of operation. Preoperative consideration should be given to all A "profile sheet" or checklist of several such factors is presented for this purpose.

Age Factors↗

[A procedure of detecting and measuring pelvic bone displacement by an original orthopedic grid-plate].

An original orthopedic grid plate made of transparent organic glass with horizontal and vertical lines marked on it, which are projected on the most important diagnostic parts of the pelvic ring when the plate is applied to the X-ray film of the latter. Asymmetry detected in different portions of the pelvic ring and its values expressed in millimeters was successful in detecting insidious and hardly noticeable ring displacements and in measuring the latter.

Adolescent↗

Coralline hydroxyapatite as bone substitute in orthopedic oncology.

We retrospectively reviewed the results of 71 consecutive patients managed with coralline hydroxyapatite (Pro-Osteon 500; Interpore Cross International) for bone defects produced as a result of surgical extirpation of bone tumors. All patients underwent a thorough physical examination and a radiographic evaluation at baseline and follow-up by the same senior surgeon (R.B.I.). Seventy-one patients were followed up for an average of 2.4 years (range, 8.1 months to 3.5 years); mean age of female patients was 39.8 years and that of male patients was 30 years. The functional status of patients at follow-up was evaluated based on comparison with preoperative functional status. Radiographic evaluation was performed and graded as follows: stage I (obvious margins), stage II (hazy margins), and stage III (obvious incorporation). The average time of return of preoperative function was 7.6 weeks. There were 3 major and 9 minor complications. We conclude that coralline hydroxyapatite graft in the form of Pro-Osteon 500 is a viable option for the management of bone defects in orthopedic oncology.

Adolescent↗

[History of orthopedics].

Functional Jaws Orthopedics has become of great importance and development, because of the evolution of orthodontics, not only treating dental malpositions but also referring these anomalies to the rest of the body, in an anatomic-functional whole.

Dentistry↗

History of medicine and prehistoric orthopedics.

Increasing efforts have been recently made to apply medical technologies to history of medicine of ancient time. Despite the use of molecular biology techniques, the most reliable results have been obtained by the paleopathological study on disease which may be recognized by the observation of stigmata of bones: the datation of skeletal lesions and the findings of cranial and orthopedic lesions indicate that the attempts of cure of bones are typical of early medical activity, dating from the prehistoric antiquity.

History, Ancient↗

A population based assessment of the use of orthopedic surgery in patients with rheumatoid arthritis.

OBJECTIVE: To describe the use of orthopedic surgery, including joint replacement surgery, in a well defined population based cohort of patients with rheumatoid arthritis (RA) and to identify characteristics that predict such use. METHODS: A retrospective medical record review was performed of cases of RA incident in Rochester, MN, during the years 1955-85. Patients were followed until 1998. All joint surgeries were recorded, including joint reconstructive surgeries, total joint arthroplasty (TJA), and other joint reconstructive procedures (JRP) such as tendon transfers and resections, joint fusions, and surgeries for fractures and infections involving joints. RESULTS: Of the total 424 RA incident cases, 148 (34.9%) patients underwent one or more (maximum of 20/patient) surgical procedures involving joints during their followup (median 14.8 yrs, range 0.2-42.8 yrs). Overall, this RA cohort had 9.7 surgeries per 100 person-yrs of followup. The estimated cumulative incidence of surgical procedures for RA at 30 yrs was 52.7% +/- SE 4.2. Surgeries for arthritis related joint disease of RA included: primary TJA 76 patients (31.3 +/- 4.1); JRP joint fusion 78 patients (29.4 +/- 3.5); JRP soft tissue 92 patients (29.8 +/- 3.3); and cervical spine fusion one patient. Non-RA (trauma and other) joint surgeries included TJA 26 patients (13.5 +/- 3.4) and arthrotomy for septic arthritis 8 patients (2.4 +/- 0.9). Based on Cox proportional hazards regression, the risk of having a disease related joint surgery for RA is increased in patients who are younger (p < 0.001), have positive rheumatoid factor (p = 0.01), and those with rheumatoid nodules (p < 0.001). There was a borderline significant increase in the risk of first joint surgery in women (p = 0.09). Women also had significantly more joint surgeries (11.5/100 person-yrs) than men (4.9/100 person-yrs; p < 0.001). Survival of patients who had surgery for RA related joint disease was similar to those who did not. CONCLUSION: This is the first population based assessment of joint surgeries performed in patients with RA. Reconstructive surgeries were common, and women had significantly more surgeries than men. Survivorship among patients with RA undergoing surgeries was similar to that of the RA patient population at large.

Adult↗

[Corporality in an orthopedics clinic scenario].

The study features the author's lived experience of phenomenological enlightenment in which she pursued to operate Polak's (1996) concepts of Nursing and Care, which have corporality as a reference. It describes the living experiences of four clients hospitalized in an Orthopedics and Trauma Unit of an School Hospital of Curitiba's metropolitan area, according to Polak's caring process moments, which are: perception; discovery and dialogue; building of new knowledge; and implementation of caring actions. It was noticed that the concepts are feasible on practical situations.

Humans↗

[How was the referral sheet interpreted? Questionnaire on priority assessment of patients referred to orthopedic surgeons showed great differences between reviewers].

A questionnaire containing 15 simulated referrals for orthopedic specialist treatment was distributed to physicians in charge of determining priority. They were asked to consider each referral in a normal way and grade them in order of priority. The results overall showed great divergence; units with longer waiting lists assigned the patients lower priority than did units with short waiting lists. There is a pressing need for national guidelines in order to improve the referral sheet as an instrument of communication.

Bone Diseases↗

Genes and orthopedics: from gene to clinic and vice versa.

Recent advances in molecular biology have greatly helped in understanding the mechanisms involved in normal skeletal morphogenesis. Multiple genes involved in normal skeletal development have been identified, but several others still await discovery. Mutations in these genes are often responsible for the congenital skeletal malformations that we see in the orthopedic clinics. In this overview we would like to emphasize the importance of the interaction between orthopaedic surgeons, molecular biologists and geneticists.

Bone Diseases, Developmental↗