No abstract

There is a substantial range of drawbacks and complications associated with the use of self-expanding nitinol stents for palliation of malignant esophageal strictures. A covering would be necessary to prevent tumor ingrowth.

The diagnosis of necrotizing fasciitis should be considered for any individual who has unexplained limb pain, especially if that person has diabetes mellitus or chronic liver disease. There was no difference in mortality rates between patients with or without amputation. The primary treatment is early and aggressive debridement of involved skin, subcutaneous fat, and fascia.

Thirty-one female Sprague-Dawley rats were used to determine the effects of subacromial corticosteroid injections on the rotator cuff. The injection technique was tested in 6 animals, which were excluded from the study. The remaining 25 rats were randomly divided into three groups of 8 animals each; a single rat received no injections. Every other week for 8 weeks, one shoulder in each rat was injected with methylprednisolone, betamethasone, or saline in a dosage equivalent to that used in humans. The supraspinatus and infraspinatus tendons were removed 10 days after the last injection and evaluated. There were no pathologic changes in the tendons injected with saline. In 43% of the methylprednisolone-treated rats and 29% of the betamethasone-treated rats, the tendons were abnormally soft and light-colored. In 43% of the methylprednisolone group and 71% of the betamethasone group, fragmentation of collagen bundles and inflammatory cell infiltration were evident. Subacromial injections of methylprednisolone or betamethasone repeated frequently can cause deleterious changes in the normal structure of the rat rotator cuff. In light of these findings, therapy for subacromial impingement syndrome of the shoulder with frequent, repeated steroid injections is potentially harmful.

We performed a prospective, randomized study on 76 patients (82 knees) scheduled for total knee arthroplasty to determine the effect of tourniquet release and hemostasis on the peri-and postoperative blood loss. Patients were randomly divided in two groups. Posterior cruciate retaining tricompartmental total knee prostheses were used in all. In group 1, the tourniquet was deflated intraoperatively after the prosthetic components were settled and hemostasis was done. In group 2, the tourniquet was released after the wound was closed and a compressive bandage was applied. Mean blood drainage was 880.85 ml (320-1,315) in group 1 and 745.36 ml (220-1,175) in group 2 (p=0.03). The mean number of blood transfusions given, hemoglobin and hematocrit values, operation time, and tourniquet time were similar in both groups. Intraoperative tourniquet release and hemostasis does not reduce total blood loss in total knee arthroplasty.RØsumØ Nous avons exØcutØ une Øtude prospective et randomisØe sur 76 malades (82 genoux) programmØ pour arthroplastie du genou total pour dØterminer l'effet de la levØe de garrot-hØmostase sur le perte de sang per-et postopØratoire. Une proth se tricompartmentale du genou, avec conservation du croisØ postØrieur totale a ØtØ utilisØe dans tous les cas. Les malades Øtaient randomisØs et divisØs en deux groupes. Dans le groupe 1 le garrot a ØtØ dØgonflØ en intraopØratoire apr s que les composants prothØtiques aient ØtØ posØs et l'hØmostase a, alors ØtØ faite. Dans le groupe 2 le garrot a ØtØ retirØ apr s la fermeture et la mise en place d'un pansement compressif. La perte moyenne de sang par drainage Øtait 880.85 ml (320-1315) dans le groupe 1 et 745.36 ml (220-1175) dans le groupe 2 (p=0.03). Le nombre moyen de transfusions du sang effectuØes, les valeurs de l'hØmoglobine et de l› hØmatocrite, la durØe opØratoire et la durØe du garrot Øtaient semblables dans les deux groupes.La levØe du garrot pendant l'opØration avec hØmostase ne rØduit pas la perte totale du sang dans l'arthroplastie du genou.