Injury
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Cranial CT scans are often repeated to observe the progress of an intracranial injury. This prospective observational study analyses the effect of repeat CT scans with the aim of formulating a guideline for their use. ⋯ When a head injured patient shows clinical deterioration, it is necessary to repeat the CT scan to pick up a surgically treatable lesion; which is likely in a significant number of patients. Repeat CT scan as a matter of "routine" follow-up when the patient is clinically status-quo or improving, is unlikely to yield any further information necessitating change in treatment. This guideline may be useful in settings where CT scan facility is not easily available or expenditure is an issue.
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The acute respiratory distress syndrome (ARDS) is often caused by fat tissue embolism. One of the most common animal models of ARDS is produced by direct administration of oleic acid (OA). Activated leukocytes are critically involved in the pathological mechanism in this model. Human urinary trypsin inhibitor (UTI) is known to inhibit production of tumor necrosis factor (TNF)-alpha, which potently stimulates leukocyte activation. The purpose of this study was to clarify whether UTI improves OA-induced lung injury in rats by inhibiting activated leukocytes via TNF-alpha production. ⋯ Leukocytes play a critical role in the development of OA-induced lung injury. It was suggested that UTI contributed to the reduction in the OA-induced lung injury by inhibiting TNF-alpha and thereby suppressing leukocyte.
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Complex regional pain syndrome is a disabling disorder with an unknown mechanism which is extremely resistant to conventional pharmaceutical and therapeutic therapies. In this paper we present the underlying theories of this disorder. We present spinal cord stimulation as an alternative to conventional interventions in the management of this disabling condition spinal cord stimulation significantly improves pain, reduces narcotic intake and improves activity levels and overall quality of life. There is now a significant body of evidence to support the utilization of spinal cord stimulation in the management of complex regional pain syndrome.
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Comparative Study
Periprosthetic femoral fractures--a comparison between cemented and uncemented hemiarthroplasties.
Over a 2-year period, 244 patients underwent hemiarthroplasty for a displaced intracapsular femoral neck fracture. Seventy patients had a cementless Austin-Moore prosthesis (AMP) inserted and 174 patients were treated using a cemented Thompson hemiarthroplasty. All the AMPs were inserted by or under the supervision of an orthopaedic consultant. ⋯ There was no significant difference in age or gender between those who sustained a periprosthetic fracture and those who did not. These findings suggest that due to the increased risk of periprosthetic femoral fracture, cemented hemiarthroplasty is preferable. Furthermore, with modern cementing techniques, elderly frail patients appear to tolerate bone cement, which may serve to reinforce an osteoporotic proximal femur.
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A systematic review was performed to assess the relative merits of reamed and unreamed antegrade femoral nailing. To be included, a study had to be prospective, randomised or pseudorandomised, comparing reamed and unreamed antegrade femoral nailing in adults. Where more than one study from the same institution was available, only the study with longest follow-up was included. ⋯ Unreamed nailing was quicker and associated with significantly less blood loss (P < 0.00001). Reaming significantly reduced the time to union (P = 0.00001), non-union (P = 0.002), delayed union (P = 0.005), technical problems (P = 0.01) and reoperation rate (P = 0.001). The use of reamed femoral nails gives significant advantages over unreamed femoral nails.