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41.
42.
PURPOSE OF THE STUDY: Impaction in pertrochanteric fracture sites is a well known phenomenon; the screw-plate system is designed to stabilise the fracture. Although easier to use, the risk with the nail-plate system is postoperative penetration of the nail into the joint. The present study was conducted to determine the exact conditions of the impaction, and to identify possible ways to improve the nail-plate system. MATERIAL-METHOD: The study included 129 cases of pertrochanteric fracture, excluding sub-trochanteric fractures. All fractures were fixed with a 130 degrees angulated nail-plate. In all cases, consolidation was uneventful after 8 to a 12 weeks. The anatomical type of fracture, i.e. stable or unstable, was determined according to the size of the intermediary fragment, including the trochanter minor. The displacement was measured as the difference between the length of the nail and the length of the femoral head and neck measured along the axis of the femoral neck. The parameters examined were: fracture stability degree, bony mineralisation (Singh Index), nail length, femoral neck, length nail position in the femoral head, and above all, fracture reduction. All these parameters were computerised and compared using Stat View statistics software. RESULTS: Impaction was observed in 43 per cent of cases. Among these, 25 per cent were rated as slight (1 to 5 mm), 18 per cent as moderate (over 5 mm) and 9 per cent as marked (10 to 25 mm). Impaction was associated with demineralisation of the bone tissue (p = 0.001). The anatomical classification of the fracture was not a determining factor (p = 0.19), as marked displacements were also recorded in stable fractures. A posterior and inferior position of the intramedullary nail in the femoral head is one of displacement determining factors (p = 0.004, two-sided 1 test). Valgus over-correction is the most important factor, especially when it is associated with bony demineralisation (p = 0.02) and an inadequately centred intramedullary pin (p = 0.02). Shorter the femoral neck, and shorter the nail, greater was the frequency of nail articular penetration. DISCUSSION: The risk of articular penetration therefore reaches 15 per cent in petrochanteric fractures repaired with a nail plate, set at an angle of 130 degrees. A short neck, a cervicodiaphyseal angle superior to 140 degrees, and demineralisation are the three determining parameters. Stable or unstable fracture has in fact little effect on displacement incidence, and therefore does not, on its own, warrant the use of a prosthesis in comminuted fractures. The authors compared their results to literature on progressive sliding system: the incidence of complications associated with this type of fracture treatment is identical, but the determining parameters are different. CONCLUSION: The study shows that the nail-plate is efficient and provides simple and solid fracture fixation. However, this osteosynthesis material needs to be modified in order to improve its fixation in the femoral head.  相似文献   
43.
We describe a patient with aspergillosis of the maxillary antrum, and systemic affectation (anemia, anorexia, fever). Through a Caldwell-Luck approach, the maxillary antrum was opened and an irregular mass removed, postoperatively the patient has done well, disappearing in two months the ORL and systemic symptoms.  相似文献   
44.
Reactivity to Alcohol and Neutral Cues was compared in male, inpatient problem drinkers (N = 30). Subjects reported an overall desire not to drink alcohol which decreased in the presence of the Alcohol Cue. There were no cue-specific changes in heart rate, blood pressure and arousal level and a non-significant trend for increased stress in the Alcohol Cue condition. Subgroups of subjects reporting positive and negative desire for alcohol were identified. Subjects who reported negative desire for alcohol in the Alcohol Cue condition also reported greater self-efficacy to resist drinking in the future. These findings have implications for understanding the nature of self-reported desire for alcohol and its potential role in the treatment of alcohol dependence.  相似文献   
45.
From May 1985 to May 1989, 175 patients with previously untreated aggressive non-Hodgkin's lymphoma were randomized to receive CHOP or ProMACE-CytaBOM. Eligibility criteria included follicular large-cell diffuse small cleaved-cell, diffuse mixed, diffuse large-cell and immunoblastic lymphoma with an Ann Arbor stage II, III or IV. One hundred and forty-eight patients were evaluable. There were no significant differences between the 2 treatments in response rate (83.5% [57.5% CR] for CHOP vs. 88% [62% CR] for ProMACE-CytaBOM), time to treatment failure (29% vs. 31% at 5 yr), or overall survival (42% in both groups at 5 yr). Furthermore, there were no significant differences between the 2 regimens when response rates and outcome were analyzed for different prognostic subgroups. Toxicity was not significantly different between the 2 regimens, although only 1 patient died as result of treatment-related toxicity in the CHOP arm compared to 6 patient in the ProMACE-CytaBOM group (p = 0.126). In conclusion, in this study ProMACE-CytaBOM has not proved to be superior to CHOP in aggressive lymphomas. This trial gives support to the notion that CHOP still is the standard chemotherapy for aggressive lymphomas, and that new treatment approaches for these lymphomas should be compared to CHOP.  相似文献   
46.
OBJECTIVE: The clinical course of transitional cell carcinoma of the bladder can be difficult to predict due to its potential to invade the muscle layer and/or develop to a high grade lesion. Bladder carcinoma can arise from genetic changes that may activate the oncogenes (-c-erbB2, c-erbB1, c-myc, ras, etc.) and/or inactivate the suppressor genes (p53, Rb). The aim of the present study is to continue a study protocol on the molecular biology of bladder tumors. METHODS/RESULTS: From January, 1993 to January, 1995, 85 patients were studied. These patients were divided into two groups: the first group comprised 14 controls of urothelial tissue and the second comprised 65 cases of transitional cell carcinoma of the bladder. p53 expression was determined by an immunohistochemical method (NCL-p53-DO7 monoclonal antibody). Quantification of the p8 oncoprotein in cytosol and EGFR (epidermal growth factor receptor) in membrane was performed by ELISA (Oncogene Science) and RIA (Vienna Lab), respectively. A statistically significant relationship between the expression of p53 and EGFR with tumor stage and grade was found. Quantification of p185 and EGFR showed higher values in the tumor tissue than in the control samples, but a worse survival could not be determined. CONCLUSIONS: The present study shows that p53 expression can be considered to be a prognostic factor. It provides useful information on the aggressive behaviour of the tumor and has a direct relation with the survival rates.  相似文献   
47.
Twenty-five years of natural coordinates   总被引:3,自引:0,他引:3  
In the early eighties, the author and co-workers created and further developed the natural coordinates to describe the motion of 2-D and 3-D multibody systems. Natural coordinates do not need angles or angular parameters to define orientation, leading to constant inertia matrices and to the simplest form of the constraint equations. Natural coordinates are composed by the Cartesian coordinates of some points and the Cartesian components of some unit vectors distributed on the different bodies of the system. The points and vectors can be located in the joints, being shared by contiguous bodies, decreasing or even eliminating the need to set joint constraints and reducing the total number of variables. However, other authors prefer not to share variables in order to get even simpler equations and to keep a bigger decoupling of equations, which is preferable in some cases. In this paper the history of natural coordinates is reviewed, as well as the main contributions coming from other research groups. In the second part of the paper some application areas in which natural coordinates can be particularly advantageous are examined. Commemorative Contribution.  相似文献   
48.
In 1997 and 1999, inspection works were carried out in the 384 cable stays of the six central piers of General Rafael Urdaneta Bridge, located in Maracaibo, Venezuela. Inspection indicated the presence of water and significant settlings in the sockets of the cables and corrosion along each cable and socket. The tension of the cables was also measured, and differences of up to 30% in the tension of the cables of some of the 24 groups corresponding to the six central piers (four groups of 16 for each pier) were found. The results suggested the need to retension the cables. This paper shows the outcome of the inspection and indicates the procedure and results of the process of retension, finished in July 2000.  相似文献   
49.
The alpha2A- and alpha2C-adrenoceptor subtypes were evaluated in postmortem brains from suicides with depression (n = 22), suicides with other diagnoses (n = 12), and controls (n = 26). Membrane assays with the antagonist [3H]RX821002 (2-[3H]methoxyidazoxan) suggested the presence of alpha2A-adrenoceptors in the frontal cortex and both alpha2C-adrenoceptors and alpha2A-adrenoceptors in the caudate. The proportions in caudate were similar in controls (alpha2A, 86%; alpha2C, 14%), depressed suicides (alpha2A, 91%; alpha2C, 9%), and suicides with other diagnoses (alpha2A, 88%; alpha2C, 12%). Autoradiography of [3H]RX821002 binding under alpha(2B/C)-adrenoceptor-masking conditions confirmed the similar densities of alpha2A-adrenoceptors in the cortex, hippocampus, and striatum from controls and suicides. In the frontal cortex of depressed suicides, competition of [3H]RX821002 binding by (-)-adrenaline revealed a greater proportion (61 +/- 9%) of alpha2A-adrenoceptors in the high-affinity conformation for agonists than in controls (39 +/- 5%). Simultaneous analysis with the agonists [3H]clonidine and [3H]UK14304 and the antagonist [3H]RX821002 in the same depressed suicides confirmed the enhanced alpha2A-adrenoceptor density when evaluated by agonist, but not by antagonist, radioligands. The results indicate that depression is associated with a selective increase in the high-affinity conformation of the brain alpha2A-adrenoceptors.  相似文献   
50.
A high incidence of prostate cancer was observed in some areas of Salamanca province, Spain. After excluding the most common etiological factors as the cause, it is concluded that the only possible risk factor must be due to the presence of some environmental carcinogen. In view of the etiological relationship between Cd and the pathological state, a study was carried out on the geochemistry of this element in the area. Anomalous amounts of Cd were found in stream sediments. This anomaly does not correspond to human activity, but rather to high regional amounts of cadmium in the substrate. Thus, the contents of Cd in soils developed over substrates containing naturally-occurring anomalous amounts of cadmium and the concentration in underground waters should be considered as a risk factor in this area.  相似文献   
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