ABSTRACT
PURPOSE: To assess the lower-limb alignment and posterior tibial slope in Pakistanis. METHODS: 40 male and 19 female healthy Pakistanis aged 20 to 45 years were recruited. A full weight-bearing anteroposterior radiograph of the entire lower limb of each subject was obtained. The axial alignment was measured based on the centres of the femoral head, knee, and ankle. The tibiofemoral (TF) angle, knee joint line obliquity angle (angle J), and posterior tibial slope were determined. RESULTS: The mean TF angle was more varus in men than women (178.4 degrees vs. 180.0 degrees, p<0.001). The mean angle J was more medially inclined in men than women (93.4 degrees vs. 91.4 degrees, p=0.007). The mean medial tibial slope was greater in women than men (16.0 degrees vs. 12.5 degrees, p<0.001). The posterior tibial slope was greater in women than men (14.1 degrees vs. 12.5 degrees, p=0.02), and was greater than the 5 degrees to 10 degrees commonly reported. CONCLUSIONS: Knee alignment and geometry vary in different population subsets. With regard to total knee arthroplasty, the more medially inclined angle J in Pakistani men suggests that an anteroposterior cut of the distal femur should be in increased external rotation, compared with Pakistani women. Whereas the greater posterior tibial slope in Pakistanis suggests that a proximal tibial cut with a greater posterior tibial slope may reduce the chance of tibial loosening and increase postoperative knee range of motion, especially when using posterior cruciate ligament-retaining designs.
Subject(s)
Femur/anatomy & histology , Knee Joint/anatomy & histology , Knee Joint/diagnostic imaging , Tibia/anatomy & histology , Adult , Body Weights and Measures , Female , Femur/diagnostic imaging , Humans , Knee Joint/physiology , Knee Prosthesis , Male , Pakistan , Posture , Prosthesis Fitting , Radiography , Range of Motion, Articular , Reference Values , Sex Factors , Tibia/diagnostic imaging , Weight-Bearing , Young AdultABSTRACT
BACKGROUND: Pulmonary hypertension carries significant maternal and fetal risk during pregnancy and the postpartum period. As maternal mortality is high, specific targeted therapy for pulmonary hypertension may be required during pregnancy. CASES: We describe 2 pregnant patients who presented with severe secondary pulmonary arterial hypertension during their last trimester. They were electively treated in the late antepartum and early postpartum periods with sildenafil and intravenous epoprostenol and successfully delivered healthy infants via cesarean section without postpartum complications. CONCLUSION: Although pulmonary hypertension is associated with a risk of maternal mortality and most women are advised against pregnancy, new therapies may improve the outcome of pregnancy in patients with pulmonary hypertension.
Subject(s)
Epoprostenol/therapeutic use , Hypertension, Pulmonary/drug therapy , Piperazines/therapeutic use , Pregnancy Complications, Cardiovascular/drug therapy , Pregnancy Outcome , Sulfones/therapeutic use , Vasodilator Agents/therapeutic use , Adult , Cesarean Section , Drug Therapy, Combination , Epoprostenol/adverse effects , Female , Humans , Infant, Newborn , Piperazines/adverse effects , Pregnancy , Pregnancy Trimester, Third , Pulmonary Wedge Pressure/drug effects , Purines/adverse effects , Purines/therapeutic use , Sildenafil Citrate , Sterilization, Tubal , Sulfones/adverse effects , Vascular Resistance/drug effects , Vasodilator Agents/adverse effects , Young AdultABSTRACT
Recent guidelines by the Heart Failure Society of America have recommended consideration for use of nitroprusside, nitroglycerin, or nesiritide in addition to diuretics to achieve hemodynamic and symptomatic improvement. This article reviews the results of previous studies evaluating the pharmacologic and clinical effects and safety profiles of these drugs in patients with heart failure.
