ABSTRACT
BACKGROUND: Total knee arthroplasty (TKA) can result in major postoperative pain which can impact the recovery and rehabilitation of patients and for this reason the use of a pain-control infusion pumps (PCIP) enhances analgesia for TKA. PURPOSE: To investigate whether a PCIP of levobupivacaine would reduce pain in patients following TKA. METHODS: This was a prospective, randomized, controlled study conducted in 55 patients. Criteria for participation were unilateral TKA for osteoarthritis and no allergies to levobupivacaine. The primary outcomes measured were postoperative pain intensity on Visual Analogue Scale (VAS) score measured at 24 h and 48 h. Other measures included amount of narcotics, presence of adverse events, and length of hospital stay. RESULTS: PCIP-treated patients (n = 28) showed significant reductions in VAS score at any time versus control (p < 0.01). Amount of narcotics, presence of adverse events, and length of hospital stay were significantly less with the PCIP versus control (each p < 0.01). CONCLUSION: The use of a mix of levobupivacaina, ketoral-trometamina, and adrenalin provides a safe and effective means in post-operative pain relief in patients undergoing TKA. LEVEL OF EVIDENCE: Level II therapeutic study.
ABSTRACT
Some human papillomaviruses (HPVs) such as HPV type 16 (HPV16) and HPV18 are involved in cervical carcinoma, and they can immortalize and transform keratinocytes. Endothelin-1 (ET-1) is produced in keratinocytes and has been shown to act through ETA receptors as an autocrine growth factor for keratinocytes. This study examines whether HPV16 alters the ET-1-mediated autocrine loop in human keratinocytes, providing a selective growth advantage for transformed cells. ET-1 is released in similar amounts from normal and HPV-transfected keratinocytes. All HPV-transfected cell lines express high-affinity ETA receptors. A two-fold increase in ET-1 binding sites is present in HPV16-immortalized keratinocytes, and this effect seems to be linked to the overexpression of mRNA for this receptor rather than to differences in the surface/internalized ratio of the receptors. ET-1 induces significant increases in [3H]thymidine incorporation and cell proliferation. Furthermore, HPV-transfected keratinocytes can proliferate in the absence of any growth factor added to the growth medium, and the ETA receptor antagonist BQ123 prevents this proliferation. These data suggest a new mechanism in the growth control of HPV-transformed cells mediated by the upregulation of ET-1 autocrine loop.
Subject(s)
Cell Transformation, Viral , Endothelin-1/physiology , Keratinocytes/cytology , Papillomaviridae/physiology , Repressor Proteins , Cell Division , Cell Line, Transformed , Cells, Cultured , Child , Endothelin-1/biosynthesis , Humans , Keratinocytes/virology , Mitogens/metabolism , Mitogens/pharmacology , Oncogene Proteins, Viral/physiology , Papillomavirus E7 Proteins , RNA, Messenger , Receptors, Endothelin/genetics , Receptors, Endothelin/metabolismABSTRACT
An MRI tomograph was used to examine 396 patients with suspected disc pathology of the lumbosacral region. Forty two patients in whom disc herniation was diagnosed underwent surgery. MR proved to be a reliable and accurate method for the diagnosis of disc herniation, revealing its site and size as well as compression on the neural structures. The limits of MR are discussed and integrated diagnostic protocol in lumbosacral disc pathology is proposed.
