[From the language of natural sciences to multilingualism].
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Forecasting↗
Biomedical subjects
A Eskola
Publications and source records attributed to A Eskola.
The results of operative resection of the lateral end of the clavicle.
Seventy-three patients had operative resection of the lateral end of the clavicle for the treatment of a painful condition of the acromioclavicular joint. Thirty-two of the patients had had a traumatic separation of the acromioclavicular joint, eight had had a fracture of the lateral end of the clavicle, and thirty-three had primary acromioclavicular osteoarthrosis. An average of sixteen millimeters (range, fine to thirty-three had primary acromioclavicular osteoarthrosis. An average of sixteen millimeters (range, five to thirty-seven millimeters) was resected; the amount was similar in each of the three groups. The patients were evaluated an average of nine years (range, four to sixteen years) after the operation. The result was considered good in twenty-one patients, satisfactory in twenty-nine, and poor in twenty-three. A poor result was more common in the patients who had had a fracture of the lateral end of the clavicle (p<0.01). Forty-six patients reported pain with exertion, and thirteen noted pain at rest. Eighteen patients had a decrease in the strength of the involved upper extremity, and sixteen had some limitation of the mobility of the shoulder. Elevation of the lateral end of the remaining part of the clavicle as compared with the scapula was noted in eighteen patients and was more likely to be associated with pain (p<0.05). The extent of the resection was significantly associated with pain; patients who had had a smaller amount of resection (ten millimeters or less) had less pain than those who had had a larger amount (p<0.03). A good result was more common in the patients in whom less than ten millimeters had been resected and who had had a previous traumatic separation of the acromioclavicular joint or had primary acromioclavicular osteoarthrosis. We recommend that resection of the lateral end of the clavicle be considered with caution for patients who have severe post-traumatic or degenerative osteoarthrosis of the acromioclavicular joint. If resection is performed, it should not exceed ten millimeters.
Acromioclavicular Joint↗
Societal changes and psychological theory: the Russian case.
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History, 20th Century↗
Periosteal and perichondral grafting in reconstructive surgery.
Periosteum consists of multipotent mesodermal cells, and the influence of the environment on differentiation of cells of free periosteal grafts has been demonstrated in experimental studies. Periosteum has the capacity to form all varieties of connective tissue. The periosteum has osteogenic capacity, but it can also be used to promote cartilage formation in a chondrotrophic environment. Free periosteal grafts transplanted to the completely chondrectomized articular surfaces of patellae in experimental animals differentiated into cartilage. Joint motion appeared to be one of the chondrogenesis-promoting factors. The authors are optimistic about the potential clinical results with these types of grafts. Also, periosteal resurfacing of the metatarsal head was found to be suitable in the treatment of hallux rigidus and Freiberg's disease. Findings in growing rabbits showed that spinal fusion can be achieved with free periosteal grafts. This technique has been used to treat lumbar lytic spondylolisthesis in young patients, and the method produced clinical and radiologic results that were comparable with those obtained using bone transplants. This work indicates that some of the adverse effects of lumbar spinal fusion (e.g., postoperative spinal stenosis) can be avoided by using osteoperiosteal fusion. Also, periosteal grafting has proved useful in the treatment of thoracolumbar scoliosis. Free periosteal grafting has been used to treat congenital clefts of the maxilla and tracheal cartilage defects.
Adolescent↗
Revision of cemented hip arthroplasties. 101 hips followed for 5 (4-9) years.
101 hips were revised with cemented Lubinus prostheses after failed primary cemented arthroplasty, and followed for 5 (4-9) years. Radiographically, 41 hips (36 femoral stems and 13 acetabular components) had become loose. The use of an intramedullary plug at the revision did not prevent sinking of the prosthesis. No difference was found between conventional or pressure-injection cementation techniques. In cases where the stem was inserted in varus or the acetabular component was in malposition there was increased loosening. Patients below 50 years of age had oftener more than 5 mm sinking of the stem and more prosthesis loosenings.
Adult↗
Failures after revision hip arthroplasties with threaded cups and structural bone allografts. Loosening of 13/18 cases after 1-4 years.
Uncemented threaded, smooth cup acetabular components and structural deep-frozen bone allografts harvested from femoral heads during arthroplasties were used for reconstruction of the acetabulum in 18 revision hip arthroplasties. Autogenous bone grafts were also used in every case. The mean follow-up time was 2.5 (1-4) years. Loosening of the prosthetic component occurred in 13 cases. In 8 cases revision of the acetabular component has already been performed, and 5 cases remain to be reoperated. The use of uncemented, threaded cups in combination with reconstruction of bone defects with structural allografts cannot be recommended in acetabular revisions.
Acetabulum↗
Inclination of the acetabular cup in erect posture radiographs.
Inclination of the acetabular component was measured in a series of 100 patients who underwent total hip replacement. The radiographs were taken with the patients in erect posture. Two different reference lines were used in the measurements: the ischial reference line, and the true horizontal line perpendicular to a plumb-line used as a vertical reference line. The values measured using these two reference lines correlated well with each other, though there were important differences caused by pelvic tilt. Often an inclination that was within the normal range when measured, using the ischial tuberosity line as a reference, shifted excessively to horizontal or vertical when control measurements were performed using the true horizontal line as the reference. We conclude that inclination of the acetabular cup should be measured in erect posture radiographs, because pelvic tilt increases the degree of inclination on the side of pelvic adduction.
Acetabulum↗
Role of mesenchymal collagenase in the loosening of total hip prosthesis.
Fibroblast-type interstitial collagenase (E.C. 3.4.24.7) was associated with loosening of total hip prostheses in eight patients: there were four cemented stems and one cementless stem with the common type of loosening and two cemented stems and one cementless acetabular component with aggressive granulomatous lesions. The authors used a specific, well-characterized, heterologous, affinity-purified, polyclonal rabbit anti-human fibroblast collagenase antiserum applied in avidin-biotin-peroxidase-complex (ABC) staining. In the aggressive granulomatous type of loosening, collagenase was found in most of the fibroblast- and macrophagelike cells, including multinuclear giant cells and epithelioid cells in periprosthetic tissue. Collagenase-positive cells also were found in the periprosthetic tissue associated with common loosening. Collagenase was also found in capillary and postcapillary venule endothelial cells in the richly vascularized aggressive granulomatous tissue. Collagenase was extracted directly from the tissue samples and incubated with soluble Type I collagen. Collagen degradation products then were analyzed by sodium dodecyl sulfate (SDS)-polyacrylamide gel electrophoresis, and the three-fourths length degradation product quantitated by gel scanning densitometry. In both aggressive granulomatosis and the common type of loosening, extractable collagenase was found in tissue. No significant differences between the sample groups were detected in respect to total measurable collagenase, however. The extractable collagenase was present in a latent form that could be activated by the organomercurial procollagenase activator, phenylmercuric chloride (PMC). It is likely that interstitial collagenase contributes to rapid growth of reactive infiltrative tissue, loosening of the prosthesis associated with aggressive granulomatosis, and the periprosthetic lytic process associated with the common type of hip prosthesis loosening.
Aged↗
Calcitonin treatment in lumbar spinal stenosis: a randomized, placebo-controlled, double-blind, cross-over study with one-year follow-up.
A randomized, placebo-controlled, double-blind, crossover study in 40 lumbar spinal stenosis patients with a 1-year follow-up showed that calcitonin had beneficial effects on the patients' symptoms without producing any notable side effects. Calcitonin had a clear analgesic effect. The mean of walking distance increased, but the crossover trend was not as good as the analgesic effect. Side effects such as erythema and nausea were usually mild and transient. Calcitonin therapy can be used as a conservative treatment in selected cases of lumbar spinal stenosis. When rest pain was mild or the walking distance was under 200-300 m because of neurogenic claudication, the effect of calcitonin seemed to be poor.
Adult↗
Porous-coated anatomic (PCA) knee arthroplasty. 3-year results.
During 1984-1986, the authors used the PCA total knee replacement system on 92 knees in 86 patients who were followed for an average of 3.2 years (range, 2.2-4.5 years). Of the 92 knees, 42 were treated due to rheumatoid arthritis (RA) and 50 due to primary or secondary osteoarthrosis (OA). The average age of the patients was 60 years (range, 32-78 years). Seventy-one of the 92 prostheses were inserted without the use of methyl methacrylate cement. Fixation screws for the tibial plate were used in eight cases. One knee was revised due to ligamentous laxity by inserting a thicker tibia plate. Radiographically, there was radiolucency of more than 2 mm below two tibial plates (both RA), and four patellar components (2 RA, 2 OA; 4.3% of total) showed a radiolucent zone of 1 mm or more. Clinically, there were no evident loosenings. According to the Weinfeld scale, 80 knees (37 RA, 43 OA; P = NS) had an excellent result, 10 (6 OA, 4 RA) good, and 2 (1 OA, 1 RA) satisfactory. In comparison, the Hungerford scale gave 47 excellent, 30 good, 14 satisfactory, and 1 poor result. These results reflect that cementless PCA total knee replacement also appears to provide good fixation in both OA and RA knees.
Adult↗
Proliferative cell response to loosening of total hip replacements: a cytofluorographic cell cycle analysis.
Monocyte/macrophages and fibroblasts are the major reactive cells in the periprosthetic connective tissue in a loose totally replaced hip. Monocyte/macrophages are bone-marrow-derived, hematogenous cells, whereas mesenchymal fibroblasts replenish by local proliferation. The cell-cycle-phase frequency distribution therefore reflects the local mitotic fibroblast response to the loose total hip replacement (THR) implant. In 13 patients who underwent revision of a loose THR implant, most of the local cells were in the resting G0/G1 phase (88.1 +/- 6.3%, mean +/- SD), whereas 8.6 +/- 3.7% were in the S phase of the cycle, and 3.4 +/- 2.9% had already reached the G2/M phase. The highest DNA values were recorded in an osteoarthritic patient undergoing revision 4 years after the primary uncemented THR, while the lowest values were observed in a rheumatoid arthritis patient with a loose cemented prosthesis 15 years after the primary operation. The results suggest that the local proliferative fibroblast response in general is uniform and does not seem to depend on the type of prosthesis or the use of cement. The responses in aggressive granulomatous-type loosening and the common type of loosening were similar.
Aged↗
Results of elbow synovectomy in rheumatoid arthritis.
Synovectomy of the elbow was performed on 54 patients (70 elbows) with rheumatoid arthritis. The mean follow-up time was 7.5 years (range 1.5-22 years). Clinical evaluation showed marked relief of pain in 28 elbows (40%). In 27 cases (38.5%) the pain was moderate but still less than preoperatively. Severe pain was recorded in 15 cases (21.5%) at the time of check up. As to postoperative range of movement, the mean flexion are was 114.5 degrees and the mean rotation are 134.5 degrees. Latitudinal instability was recorded up to 5 degrees in 33 (47%) elbows, up to 10 degrees in 20 (28.5%), up to 15 degrees in 6 (8.5%), and more than 15 degrees in 11 (16%). The mean carrying angle was 10 degrees in valgus. Measurement of strength in flexion and extension showed a reduction of approximately 50% compared to age-matched healthy controls. Reoperations were performed in 10 elbows (14%); the interval between the primary synovectomy and second operation in these cases averaged 8 years.
Adult↗
Methodology for restoring functional leg length in revision total hip arthroplasty.
Functional leg length was measured in 30 patients before and after revision total hip arthroplasty. The authors emphasize the importance of preoperative planning, and determination of adjustment of the leg length should be aimed at a balanced attitude of the entire pelvis and lower back. In order to correct the length inequality, the leg was lengthened in the revision in 25 cases, left unchanged in 2 cases, and shortened in 3 cases. The mean functional leg-length inequality was 13 mm before operation and 4 mm after operation. The mean radiographic inequality between the upper surfaces of the iliac crest was 13 mm before operation and 9 mm after operation. The side operated was more often functionally shorter than the other side before operation, and longer than the other side after operation. The authors emphasize the importance of functional leg length in revision hip arthroplasty. The functional length discrepancy can be corrected in revision, but there appears to be a risk of overlengthening.
Aged↗
Four-year outcome of operative treatment of acute acromioclavicular dislocation.
Seventy of 100 consecutive randomly allocated patients who had been treated for acute total acromioclavicular dislocation with either transfixation with two smooth Kirschner wires (29 cases), two threaded Kirschner wires (20), or one ASIF cortical screw (21) were followed for an average of 4 years. The coracoclavicular ligaments were not sutured. Results were good in 67 of the 70 patients. Using stress radiographs, no redislocation was found in 56 cases. Two complete dislocations were found in patients who had been treated with screw fixation. Osteolysis of the lateral head of the clavicle was found in 13 patients, eight of whom had been treated with screw fixation (p less than 0.01). Our results speak for the use of threaded Kirschner wire fixation for the operative treatment of acute total acromioclavicular dislocation.
Acromioclavicular Joint↗
Immunopathological response to loose cementless acetabular components.
The membranes surrounding seven loose cementless acetabular implants were shown to contain polyethylene particles, birefringent in polarised light. Three of these implants were made of titanium alloy and the membranes around these contained titanium particles as well. There was no metallosis around the four implants made of chromium-cobalt-steel alloy. Both titanium and polyethylene particles caused migration, adherence and phagocytosis of CD11b-positive, peroxidase-negative macrophages. There were no histological signs of activation of the specific immune response; neither interleukin-2 receptor-positive activated T cells nor PCA-1 plasmablasts/plasma cells were present in the tissues. In cases of simple loosening, resident mesenchymal fibroblast-like cells were active. In aggressive granulomatosis, there were many macrophages and multinucleated giant cells but little fibroblast reaction. The clinical relevance of the findings is that the use of cementless prostheses is not a guarantee against adverse tissue reactions.
Adult↗
[Treatment of clavicle fractures].
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Clavicle↗
Flurbiprofen inhibits heterotopic bone formation in total hip arthroplasty.
A double-blind prospective parallel group study comparing slow-release flurbiprofen with placebo in the control of ectopic bone formation was carried out in 68 patients undergoing total hip arthroplasty. Eight weeks after surgery there was evidence, significant at the 1% level, that the incidence and extent of periarticular calcification was lower in the flurbiprofen group. At an early phase, serum calcium level decreased and after 8 weeks serum alkaline phosphatase level increased more in the placebo group than in the flurbiprofen group, indicating an effect of flurbiprofen on bone mineral metabolism. Six patients were withdrawn in each treatment group, four due to side effects in the flurbiprofen group and three due to side effects in the placebo group. Overall, five patients in each group reported side effects, the nature and severity of the side effects being very similar in each group. We conclude that flurbiprofen is an efficient and safe drug in limiting ectopic bone formation following total hip arthroplasty. Heterotopic bone formation is a frequent complication after total hip replacement. Heterotopic bone reduces the extent of hip motion, reduction being more evident in cases with extensive ectopic bone formation around the hip joint. Various treatment regimens have been proposed for discouraging heterotopic bone formation. Anti-inflammatory agents such as indomethacin and ibuprofen have turned out effective. Local irradiation also prevents ectopic bone formation, but diphosphonates seem not be effective in this respect. The aim of the present study was to assess the efficacy of flurbiprofen, a new anti-inflammatory agent, in limiting heterotopic bone formation, and to note the frequency and severity of any side effects of the treatment.
Adult↗
Revision of aggressive granulomatous lesions in hip arthroplasty.
Fourteen patients had revision arthroplasty for aggressive granulomatosis in 16 previously replaced cemented total hips. The revision was performed on average 8 years (range, 6-13 years) after the primary arthroplasty. Twelve patients had multifocal granulomatous lesions. Pain was the first clinical sign of the aggressive granulomatosis, beginning on average 1.7 years (range, 0.8-3.8 years) after the primary operation. One patient had a fracture of the femur due to large granulomas while waiting for revision. The patients were under follow-up evaluation for an average of 5.4 years (range, 4-7 years) after revision. Two patients had recurrence of aggressive granulomatosis at the original sites 4.5 and 6.5 years after revision. Eleven patients had good or excellent results of revision.
Aged↗