Eficacia de un programa de rehabilitación preoperatoria en prótesis total de rodilla / Effectiveness of a pre-surgery rehabilitation program in total knee arthroplasty

Introducción. Se valora la eficacia de un programa de rehabilitación de artroplastia de rodilla, que incluye educación preoperatoria y una mayor frecuencia en las sesiones de tratamiento, comparándolo con un tratamiento menos frecuente y sin educación previa. Pacientes y método. Se realizó un ensayo clínico aleatorizado doble ciego en 64 pacientes intervenidos de prótesis total de rodilla durante el período 2004-2005. Los pacientes se visitaron las 2-3 semanas previas a la intervención y se distribuyeron aleatoriamente en grupo A (tratamiento preoperatorio, n = 29), o grupo B (protocolo habitual, n = 30). El grupo A realizó educación y cinesiterapia pre y postoperatoria que se continúó en régimen ambulatorio diario durante un mes. El grupo B realizó cinesiterapia postoperatoria. Se valoraron los resultados mediante la escala de WOMAC, el test de marcha en 6 minutos, el cuestionario de salud SF-36 y el balance articular previo a la intervención, al mes y a los 6 meses postcirugía. Resultados. No se observaron diferencias significativas entre ambos grupos en el WOMAC, SF-36, marcha en 6 minutos y balance articular al mes y a los 6 meses. Los pacientes del grupo A realizaron de forma significativa más sesiones de tratamiento (3,9), aunque invirtieron menos días en completarlo (10,2), diferencia que se incrementa si se suman las tres sesiones de formación previa. Discusión. No existen diferencias entre ambos grupos salvo en el número de sesiones realizadas. Los resultados obtenidos son similares a los encontrados en la literatura. Las diferencias no justifican la aplicación de este programa de formación previa e intensivo por el mayor coste

Introduction. The effectiveness of a rehabilitation program in total knee arthroplasty that includes pre-surgery education and a greater frequency in the treatment sessions is evaluated and compared with a less frequent treatment without previous education. Patients and method. A randomized double blind clinical test in 64 patients operated on for total knee arthroplasty during 2004-2005 years was conducted. The patients were evaluated 2-3 weeks pre-surgery and distributed randomly into group A (pre-surgery treatment, n = 29), and group B (no pre-surgery treatment, n = 30). Group A underwent education and post-surgery education and physical therapy and continued in daily outpatient treatment for one month. Group B only had post-surgery therapy three days per week. The results were evaluated with the WOMAC scale, the 6-Minutes Walk test, the SF-36 health questionnaire and the joint balance test prior to surgery, at one month and at six months post-surgery. Results. No significant differences were observed in both groups in the WOMAC, SF-36, 6-Minutes Walk test and joint balance at one month and six months. Group A patients had significantly more treatment (3.9), although they spent fewer days to complete it (10.2), a difference that increases if the three sessions of previous formation are added. Discussion. The results are similar to those of other works and a program of pre-surgery education does not contribute to any benefit to the patient. The results obtained do not justify the cost differences caused by the greater number of sessions of program A, with previous training

Meropenem susceptibility breakpoint for Pseudomonas aeruginosa strains hyperproducing mexB mRNA.

Twenty-five isolates of Pseudomonas aeruginosa with different meropenem susceptibilities were subjected to quantitative RT-PCR for analysis of transcription levels of oprD, mexB and mexD, and, in selected isolates, PA3720, which is hyper-expressed in nalC efflux mutants. Regulator genes of efflux pump MexAB-OprM, mexR and PA3721 (putative) were sequenced in selected isolates. The potential for mathematical reconstruction of the ideal susceptible population using normalised resistance interpretation (NRI) was also studied. In three isolates with intermediate susceptibility to meropenem (according to Swedish breakpoints), a reduction in MIC from 4 to 2 mg/L was observed with efflux inhibitor MC-207,110. These isolates would be considered susceptible according to British Society for Antimicrobial Chemotherapy and NCCLS breakpoints. These three isolates had between 4.6- and 5.0-fold increases in mexB transcription. None of these isolates had significant nalB mutations, but an Ala145-->Val mutation was observed in PA3721 in two of the isolates. However, these isolates had moderately increased production of PA3720 only. Single-strain regression analysis did not detect any major biological differences between the different groups. Using NRI, a disk-diffusion susceptibility breakpoint of >/= 28 mm was generated. Isolates with intermediate susceptibility to meropenem, which are considered fully susceptible in many countries, displayed possible low-grade meropenem resistance mechanisms, implying that the susceptibility breakpoint should be reconsidered. The increased transcription of mexB mRNA in such isolates seems unrelated to nalB or nalC mutations.

Evaluation of various inclusion rates of organic zinc either as polysaccharide or proteinate complex on the growth performance, plasma, and excretion of nursery pigs.

Three experiments were conducted to evaluate the effects of feeding dietary concentrations of organic Zn as a Zn-polysaccharide (Quali Tech Inc., Chaska, MN) or as a Zn-proteinate (Alltech Inc., Nicholasville, KY) on growth performance, plasma concentrations, and excretion in nursery pigs compared with pigs fed 2,000 ppm inorganic Zn as ZnO. Experiments 1 and 2 were growth experiments, and Exp. 3 was a balance experiment, and they used 306, 98, and 20 crossbred pigs, respectively. Initially, pigs averaged 17 d of age and 5.2 kg BW in Exp. 1 and 2, and 31 d of age and 11.2 kg BW in Exp. 3. The basal diets for Exp. 1, 2, and 3 contained 165 ppm supplemental Zn as ZnSO4 (as-fed basis), which was supplied from the premix. In Exp. 1, the Phase 1 (d 1 to 14) basal diet was supplemented with 0, 125, 250, 375, or 500 ppm Zn as Zn-polysaccharide (as-fed basis) or 2,000 ppm Zn as ZnO (as-fed basis). All pigs were then fed the same Phase 2 (d 15 to 28) and Phase 3 (d 29 to 42) diets. In Exp. 2, both the Phase 1 and 2 basal diets were supplemented with 0, 50, 100, 200, 400, or 800 ppm Zn as Zn-proteinate (as-fed basis) or 2,000 ppm Zn as ZnO (as-fed basis). For the 28-d Exp. 3, the Phase 2 basal diet was supplemented with 0, 200, or 400 ppm Zn as Zn-proteinate, or 2,000 ppm Zn as ZnO (as-fed basis). All diets were fed in meal form. In Exp. 1, 2, and 3, pigs were bled on d 14, 28, or 27, respectively, to determine plasma Zn and Cu concentrations. For all three experiments, there were no overall treatment differences in ADG, ADFI, or G:F (P = 0.15, 0.22, and 0.45, respectively). However, during wk 1 of Exp. 1, pigs fed 2,000 ppm Zn as ZnO had greater (P < or = 0.05) ADG and G:F than pigs fed the basal diet. In all experiments, pigs fed a diet containing 2,000 ppm Zn as ZnO had higher plasma Zn concentrations (P < 0.10) than pigs fed the basal diet. In Exp. 1 and 3, pigs fed 2,000 ppm Zn as ZnO had higher fecal Zn concentrations (P < 0.01) than pigs fed the other dietary Zn treatments. In conclusion, organic Zn either as a polysaccharide or a proteinate had no effect on growth performance at lower inclusion rates; however, feeding lower concentrations of organic Zn greatly decreased the amount of Zn excreted.

Profundapopliteal collateral index. A guide to successful profundaplasty.

The response to profundaplasty was evaluated in 232 limbs (163 patients) and correlated with segmental pressures and operative flow measurements. Of 150 limbs operated on for rest pain or ischemic necrosis, an inflow procedure (aortofemoral, femorofemoral, etc) combined with profundaplasty was successful in achieving limb salvage in 80 of 96 limbs (83%), but after profundaplasty alone only 26 of 54 limbs (48%) were salvaged. Using segmental pressure measurements, an index of the resistance of the profundapopliteal collateral system (PPCI) was calculated from the segmental pressure decrease across the knee, and demonstrated an inverse correlation with circulatory improvement. When profundaplasty was performed alone, successful limb salvage was associated with a mean PPCI of .18, compared with .46 in the group with unsatisfactory results. The PPCI is an accurate predictor of the hemodynamic potential of the geniculate collaterals and is useful in the selection of patients for profunda repair.

Alkaline reflux gastritis: a reevaluation.

The results of Roux-Y reconstruction in 46 patients diagnosed as having alkaline reflux gastritis were analyzed to determine which factors in the preoperative evaluation were associated with a good clinical result after surgery. The operation was considered successful in 30 (65 percent) of the 46 patients. Success was not related to the details of the patient's symptoms, the visible appearance of the gastric mucosa at endoscopy or the extent of histologic abnormalities in a preoperative biopsy or resected specimen of gastric mucosa. Therefore, the outcome of surgery could not be predicted from preoperative findings, and gastritis, even though it is often present, is not likely to be responsible for the symptoms in this syndrome. Nevertheless, the results of surgery for postgastrectomy bile vomiting and abdominal pain are good enough that when other conditions have been ruled out, Roux-Y reconstruction can be recommended for patients with severe complaints.

Pneumatic tourniquet as a substitute for vascular clamps in distal bypass surgery.

The pneumatic tourniquet is an effective substitute for vascular clamps in tibial and popliteal artery surgery. Intimal trauma due to clamping is avoided. Because circumferential dissection of the vessel is not necessary, the vasa vasorum are preserved minimizing ischemic injury to the vessel wall. The technique has been employed in 40 distal popliteal and tibial reconsteal and tibial reconstructions during the past year with only one complication that may possibly be related to its use. Early patency was 92% at the patient's time of discharge from the hospital. In all four patients requiring below-knee amputation, primary wound healing and successful prosthetic rehabilitation were achieved. This technique appears to be safe and simplifies distal reconstructions for lower extremity ischemia.

Asymptomatic carotid stenosis. Immediate and long-term results after prophylactic endarterectomy.

1. A review of the immediate and long-term results of prophylactic carotid endarterectomy for asymptomatic lesions of 78 carotid arteries in 72 patients between 1961 and 1976 is presented. 2. The inhospital operative mortality was zero. Two patients experienced postoperative transient neurologic deficit with complete recovery (2.6 per cent). There were no postoperative strokes. 3. Late follow-up data demonstrated that in only one patient did a stroke subsequently develop appropriate to the operative side, and it occurred 4 years after operation. Life table analysis for neurologic events carried out for up to 15 years indicated a 96 per cent stroke-free status of the surviving patients. 4. A 42 month survival rate of 83 per cent in patients treated by prophylactic carotid endarterectomy represented a statistically significant improvement over the 67 per cent survival of a comparable group of patients reported on in the literature. 5. Prophylactic carotid endarterectomy in the experience of vascular surgeons who can offer a low operative morbidity and mortality appears to be reasonable therapy in preventing stroke and prolonging survival until a randomized controlled study comparing surgery with the natural history of untreated patients shows evidence to the contrary.

Natural history of nonstenotic, asymptomatic ulcerative lesions of the carotid artery.

To define the natural history of the asymptomatic, nonstenotic, ulcerative lesion involving the carotid artery bifurcation, the arteriograms and clinical course of 67 patients with 72 asymptomatic ulcerative lesions of the carotid artery were reviewed. The angiographic appearance of ulceration was classified into three groups: minimal (group A), large (group B), and compound (group C). Using life-table methods, the clinical course of these patients was compared between groups and was also compared to a nonrandomized surgically treated group of patients with nonstenotic ulcerative lesions in whom operation was performed for hemispheric or monocular symptoms. There were no significant (P greater than .1) differences in mortality, but the differences in stroke incidence was highly significant (P less than .001). The annual stroke rate, averaged over seven years, was 0.4% per year for group A, 1.47% per year for the surgically treated group, and 12.5% per year for groups B and C. The data indicate that group A ulcers have a benign prognosis, in noticeable contrast to group B and C ulcers which incur a high risk for subsequent stroke.

Maintenance of viable arterial allografts by cryopreservation.

An experimental study, designed to investigate the feasibility of maintaining fresh, viable arterial allografts by cryopreservation, is presented. Cryopreserved femoral arterial allografts were shown to be equal in patency rate when compared with fresh controls. The cryopreserved allografts were shown to be superior to fresh allografts in the parameters of intimal integrity, absence of host rejection, and reduced surface thrombogenicity. This experimental study supports the thesis that cryopreservation in liquid nitrogen, utilizing 15% dimethyl sulfoxide (DMSO) and methylprednisolone as a cryoprotectant solution, is an excellent method of preserving and storing fresh allograft arteries for use as a small vessel replacement.