[Evaluation of tourniquet effects on coagulation during knee arthroscopy]

Tissue trauma, pain and surgical stress can increase coagulability in perioperative period. Tourniquet application can increase DVT by blood stasis and releasing tromboxane, but some studies concluded that tourniquet will increase fibrinolysis. In this study, the changes in coagulability and fibrinolysis due to tourniquet application were evaluated by thrombelastograph during knee arthroscopy. In this clinical trial, 30 patients without known risk factors of coagulopathies were studied. Blood sampling were done immediately before tourniquet inflation [TI] as well as 2 and 30 minutes after tourniquet deflation [TD]. Thrombelasthographic parameters including R-time, K-time, alpha angle, MA, LY30 and LY60 were measured and analyzed by t-paired test and ANOVA in SPSS software. The mean of R-time at 2 and 30 minutes after TD decreased and the mean of alpha increased in comparison with before TI [p<0.0001]. The mean of MA at 2 and 30 minutes after TD increased first and then decreased and LY30 decreased first and then increased in comparison to before TI [p, 0.001]. Tourniquet application initially can increase coagulability and the probability of thrombus formation after TD, but after a short time, compensatory clot lysis occurs by increasing fibrinolytic activities

[Resulted outcome of proximal and distal realignment in patients with patellar subluxation and dislocation]

Anterior knee pain is a common complaint in orthopedic patients, and patellar malalignment is a fragment cause of this alignment. Severe malalignment would result insubluxation and dislocation of patella: the result of surgical treatment with proximal and distal realignment [P/DR] for such pathology, performed in Sadoghee and Al-Zahra hospital [in Isfahan] from 1994 to 1999 is reported in this article. A retrospective study of 26 cases, 4 male and 22 female patients, with average age of 28 years. which had patellar instability and had undergone P/D-R during a five year period [1944-1999] in two of the hospital in Isfahan, was performed. These cases had all failed the initial conservative treatment. The cases were follow-up for a period of 3.5 years. Results of surgery were canalized in term of subjective relief of symptoms, and objective evaluation of quadriceps power, knee motion, as well as radiographic signs of knee degeneration, patellar subluxation, patella alta or patella infra. 30 knees had received the index operation - 16 [53%] right and 14 [47%] left side. The result of surgery was good in 28 [94%] and poor in 2 knees. 20 patients [71%] had normal radiographs, 5 cases [18%] had evidence of mild and 2 cases severe degeneration. Patellar intra was also observed in one knee. proximal and distal realignment surgery for cases that suffer from patellar instability and are non-responsive to conservative treatment is associated with high rate of success without serious complication