Septic joint replacement: an orthopedic perspective.
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Arthroplasty, Replacement, Knee↗
Biomedical subjects
E Salvati
Publications and source records attributed to E Salvati.
Randomized trial of hypotensive epidural anesthesia in older adults.
BACKGROUND: Data are sparse on the incidence of postoperative cognitive, cardiac, and renal complications after deliberate hypotensive anesthesia in elderly patients. METHODS: This randomized, controlled clinical trial included 235 older adults with comorbid medical illnesses undergoing elective primary total hip replacement with epidural anesthesia. The patients were randomly assigned to one of two levels of intraoperative mean arterial blood pressure management: either to a markedly hypotensive mean arterial blood pressure range of 45-55 mmHg or to a less hypotensive range of 55-70 mmHg. Cognitive outcome was assessed by within-patient change on 10 neuropsychologic tests assessing memory, psychomotor, and language skills from before surgery to 1 week and 4 months after surgery. Prospective standardized surveillance was performed for cardiovascular and renal outcomes, delirium, thromboembolism, and blood loss and replacement. RESULTS: The two groups were similar at baseline in terms of age (mean, 72 yr), sex (50% women), comorbid conditions, and cognitive function. After operation, no significant differences in the incidence of early or long-term cognitive dysfunction were observed between the two blood pressure management groups. There were no significant differences in the rates of other adverse consequences, including cardiac, renal, and thromboembolic complications. In addition, no differences occurred in the duration of surgery, intraoperative estimated blood loss, or transfusion rates. CONCLUSIONS: Elderly patients can safely receive controlled hypotensive epidural anesthesia with this protocol. There was no evidence of greater risks, or early benefits, with the use of the more markedly hypotensive range.
Aged↗
Nonconsolidated polyethylene particles and oxidation in Charnley acetabular cups.
Nonconsolidated particles of ultra high molecular weight polyethylene are believed to be defects that adversely can affect the wear performance of total joint prostheses. The present study was done to determine the number, size, and distribution of these particles and to determine if their presence correlated with wear performance, as well as with other clinical and implant parameters. Forty retrieved and 7 new, never-implanted acetabular components were examined using light microscopy on thin cross sections. Particles were found in 92% of retrieved components and in all the new components. Particles in the retrieved components were either randomly distributed (32 components) or banded (with particles localized in regions approximately 1 mm below the outer surface of the component). No correlations were found between the number or area of particles and the wear performance or any of the clinical or implant variables. The presence of particles in the new implants was found to correlate with the length of time since the components had been radiation sterilized. For retrieved components, the density (and, therefore, the level of oxidative degradation) was high in the areas of banded particles. For new components, the density was higher the longer the time since sterilization. Nonconsolidated polyethylene particles are prevalent in total replacements but their source and cause are unknown. The results of this study show that they do not appear to affect or correlate with the length of implantation of acetabular cups. However, they still may be expected to adversely affect performance in cases where large numbers of particles are banded together near articulating surfaces of high stress environments such as found in the knee.
Acetabulum↗
Titanium wear debris in failed cemented total hip arthroplasty. An analysis of 71 cases.
Seventy-one cemented total hip arthroplasties (THAs) were reviewed following removal of the all-titanium alloy femoral stem. Fifty-one hips were primary arthroplasties that failed due to aseptic loosening, 8 were previous revisions with aseptic loosening, and 12 were removed for infection. The average duration of service for the three groups was 4.5 years, 5.0 years, and 3.7 years, respectively. Femoral bone loss in aseptically loose, primary THA was graded as severe in 51%, moderate in 24%, and mild in 20%. Femoral endosteolysis was present in 94%, while acetabular osteolysis was seen in 6%. Histological evaluation of tissues from failed primary arthroplasties revealed polymethyl methacrylate debris in 75% of cases, polyethylene debris in 80%, metal debris in 75%, and chronic inflammatory cells in all cases. Metallic debris was not seen in the failed revision cases and in only 17% of the infected cases. Examination of retrieved femoral components revealed burnishing of the head in all cases, while 71% of stems with aseptic loosening were abraded from the cement. Metal levels from 12 cases averaged 2,111 mg/g of dry tissue (range, 60-11,823); synovial fluid levels from 8 other cases averaged 106 mg/l (range, 22-340). While it is not certain whether metallic particles are a primary cause of loosening or are generated secondarily, their presence seems to accelerate bone loss and loosening.
Adult↗
Circadian rhythm in plasma noradrenaline of healthy sleep-deprived subjects.
Under normal sleep-wake conditions, noradrenaline (NA) secretions in supine subjects exhibit a weak circadian variation with a peak that occurs around noon; the sleep span is characterized by reduced NA secretion. Some investigators have reported that the circadian NA rhythm is completely obliterated during sleep deprivation. In our laboratory, plasma NA was assayed every hour for 24 h in nine healthy men 20-23 years of age. All men were deprived of sleep and were required to eat and walk around every hour to prevent sleep. However, subjects remained supine for 20 min before blood samples were collected to eliminate the effect of activity. Persistence of a slight decrease in the night concentration in several subjects, despite sleep deprivation, suggests that NA secretion may be influenced by a biological clock whose activity becomes visible when the influence of posture is removed.
Adult↗
5-Methoxypsoralen as a specific stimulating agent of melatonin secretion in humans.
The endocrine effects of the linear furocoumarin, 5-methoxypsoralen (Bergapten), were investigated in 11 normal adults according to a cross-over design with 2 conditions: a 1-week trial with 5-methoxypsoralen (5MOP) administered daily (40 mg/orally) at 0900 h, and after a 1-week period of washout, a similar 1-week trial with daily administrations of 5MOP at 2100 h. The subjects were living under normal nychtohemeral conditions. The plasma levels of melatonin, cortisol, TSH, PRL, and GH were evaluated by hourly blood samples over 24-h periods on the preceding day and on the last day of each condition. Our main finding is that 5MOP specifically stimulates melatonin secretion in humans, with a pronounced effect when administered during the dark phase of the day (at 2100 h). The other endocrine rhythms were unaffected by 5MOP administration. Melatonin has been shown to interact with the regulation of the human circadian system; this specific stimulation may, therefore, be of great interest in disorders associated with abnormalities of circadian rhythms.
5-Methoxypsoralen↗
5-Methoxypsoralen increases the sensitivity of the retina to light in humans.
The acute effect of 5-methoxypsoralen (5-MOP) on the sensitivity of the retina to visible light in humans has been studied in 11 healthy volunteers 2 h after administration of 5-MOP or placebo given at 09.00 h. Retinal sensitivity was evaluated by electroretinography at 11.00 h. 5-MOP significantly increased the sensitivity of the retina to light under photopic conditions and in the early stages of the dark adaptation period, as observed under scotopic conditions. The findings suggest that melatonin is involved in these changes.
5-Methoxypsoralen↗
5-Methoxypsoralen increases evening sleepiness in humans: possible involvement of the melatonin secretion.
The acute and short-term effect of 5-methoxypsoralen (5-MOP) on daytime sleepiness was investigated in 12 healthy subjects according to a double-blind cross-over design. 5-MOP (40 mg/day) or placebo was orally administered (one week each) at 16.00 h. 5-MOP significantly increases daytime sleepiness 4 to 5 h after administration without affecting the subsequent sleep efficiency and duration. We found a positive correlation between sleepiness and melatonin levels. Our findings suggest that the melatonin secretion may play a role in the effect of 5-MOP on sleepiness in humans.
5-Methoxypsoralen↗
Circadian rhythms in depression and recovery: evidence for blunted amplitude as the main chronobiological abnormality.
Circadian rhythms of body temperature, plasma cortisol, norepinephrine (NE), thyroid stimulating hormone (TSH), and melatonin were compared in 16 endogenously depressed, 15 recovered (after 3 weeks of anti-depressant treatment), and 16 normal subjects. The depressed patients showed clear circadian rhythm abnormalities, consisting mainly in amplitude reduction. This amplitude reduction was significantly correlated with the patients' Hamilton depression scores. Normal circadian profiles were restored after recovery when amplitude, in particular, was increased. Features of the circadian rhythms observed in remission may be associated with antidepressant drug effects, whereas those observed in depression resemble the circadian rhythms observed in normal subjects living under conditions of temporal isolation and those of blind subjects. Our findings suggest that depression may be related both to a weakening of the coupling processes between internal pacemakers and to an abnormal sensitivity to environmental information.
Adult↗
Abnormal melatonin response to 5-methoxypsoralen in dementia.
The authors investigated the melatonin response to 5-methoxypsoralen in 39 healthy adult and elderly subjects and in 13 demented, 13 depressed, and 13 schizophrenic inpatients. Subjects' plasma melatonin levels were evaluated before they took single, oral 40-mg doses of 5-methoxypsoralen and 3 hours afterward. The preliminary results indicate that the melatonin response of the pineal gland to 5-methoxypsoralen is reduced in demented patients compared to that in healthy elderly subjects. Depressed and schizophrenic patients had a normal melatonin response to the drug. This finding suggests that the pineal gland may be functionally impaired in dementia but not in depression.
Adult↗
Antidepressant effect of 5-methoxypsoralen: a preliminary report.
5-Methoxypsoralen (5 MOP) administered daily (40 mg at 9 p.m.) was compared with placebo in the treatment of severe depression. The clinical response was evaluated using the Hamilton Depression Rating Scale after 1 week of treatment. Our preliminary data indicate that patients receiving 5 MOP improved significantly after 1 week, whereas patients treated with placebo did not. The stimulating effect of 5 MOP on the melatonin secretion may be involved in this clinical effect.
5-Methoxypsoralen↗
Effect of recovery on the cortisol circadian rhythm of depressed patients.
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Adult↗
Psoralen and the suppression of melatonin secretion by bright light.
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Adult↗
Twenty-four-hour profiles of body temperature and plasma TSH in bipolar patients during depression and during remission and in normal control subjects.
The 24-hour patterns of body temperature and plasma thyrotropin (TSH) were measured in eight bipolar patients in both depressed and recovered (after 3 weeks of treatment) states and in eight normal control subjects. Clear circadian patterns were detected for both temperature and TSH. Nocturnal body temperature was increased and the nocturnal surge of TSH was blunted during depression; these abnormalities were corrected after recovery. The inverse relationship between changes in body temperature and TSH levels at night suggests that changes in thermoregulation may be responsible for the neuroendocrine disturbance and may play a role in the pathophysiology of depression.
Bipolar Disorder↗
[The concept of biological rhythm in psychopathology].
The chronobiological hypotheses of depression are based on epidemiological, biological as well as therapeutical pieces of evidence. The seasonal pattern of depression and suicide rates tend to link affective disorders and the daylight duration. Disturbances of circadian rhythms have been reported in endogenous depression. Treatments of depression, such as manipulations of the sleep/wake cycle, phototherapy or tricyclics, may involve chronobiological mechanisms on endogenous pacemakers. Beside the phase advance hypothesis of depression, present data seem to involve a disturbance of the mechanisms of entrainment of the internal clocks by external synchronizers. Other psychiatric illnesses may thus be linked to chronobiological abnormalities.
Chronobiology Phenomena↗
5-Methoxypsoralen increases the plasma melatonin levels in humans.
The aim of this study was to evaluate the acute effects of 5-methoxypsoralen (5-MOP) on the melatonin secretion in humans. Eleven normal volunteers were investigated before (drug-free) and after 6-day periods of treatment with oral 5-MOP, first administered daily at 9 A.M. and after a 1-week free interval administered daily at 9 P.M. Under nyctohemeral conditions, the plasma melatonin levels were evaluated over a 24-h period in each session by hourly blood samples and radioimmunoassay. The sensitivity of the retina to light was also evaluated by means of electroretinography performed at 11 A.M. before and after a morning administration of 5-MOP. Plasma levels of melatonin were significantly increased from the second hour after 5-MOP administration. The hourly mean levels were significantly higher after 5-MOP administration compared to baseline values. This increased secretion was more pronounced after evening than after morning administration. Also, 5-MOP increases the sensitivity of the retina to light under photopic conditions and in the early stages of the dark adaptation period, as observed under scotopic conditions.
5-Methoxypsoralen↗
24-hour profile of plasma norepinephrine in affective disorders.
The circadian rhythm of plasma norepinephrine (NE) was investigated in the depressed (major affective disorder, DSM III; n = 12), recovered (after 3 weeks of treatment using usual antidepressant drugs; n = 12) and normal (volunteers, age and sex matched; n = 10) states. Data analysis (based on the evaluation of circadian parameters, on the chronogram method and on the chronobiological analysis) revealed a clear NE circadian rhythm in normal subjects, a rhythm which was disturbed in depression, with amplitude reduction and abnormal phase position. These abnormalities tended to disappear during recovery since circadian parameters were similar to those of controls. These circadian abnormalities could be linked to the impairment of the peripheral and central catecholaminergic systems. They may also support the chronobiological hypothesis of affective disorders.
Adult↗
The circadian rhythm of plasma thyrotropin in depression and recovery.
The 24-hr patterns of plasma thyrotropin have been observed in 12 endogenous depressed patients in both depressed and recovered states and in 13 normal subjects. A clear circadian rhythm was detected in controls with high values at night. In depression, the circadian rhythm was altered with amplitude reduction and blunted nocturnal secretion, abnormalities particularly relevant in bipolar patients. This flattened profile could be linked to the blunted response of TSH to TRH administration reported in depressed patients. Normal nyctohemeral patterns have been restored after recovery. These chronobiological abnormalities as well as their normalization under antidepressant drugs seem to be similar to those reported for various parameters (e.g. temperature, cortisol, etc) in depression which could support the chronobiological hypothesis for affective disorders.
Antidepressive Agents↗