Clinical outcome of radiosynoviorthesis: a meta-analysis including 2190 treated joints.

A variety of indications for radiosynoviorthesis have been reported in literature, but the clinical outcome differs and depends on the primary disease and the pre-existing degenerative changes. This metaanalysis was carried out to establish groups for radiosynoviorthesis based on clinical outcome with respect to primary disease, clinical stage and the pre-existing degenerative changes. The literature search was carried out using the MEDLINE search term 'radionuclide synovectomy'. Based on reports in the literature we determined groups for radiosynoviorthesis for clinical use. Our literature list comprised 2190 joints that were treated with radiosynoviorthesis. The overall response rate for all treated joints was 72.5+/-17%. The mean improvement rate for the treated joints in rheumatoid arthritis was 66.7+/-15.4%. For osteoarthritis the success rate was 56+/-11%, with better results in case of minimal radiological changes. Radiosynoviorthesis in patients with changes according to Steinbrocker I and II was successful in 72.8+/-12.3%, and in 64+/-17.3%, respectively. Steinbrocker III and IV had a mean success rate of 52.4+/-23.6%. In the case of haemophilia and Willebrand's disease a reduction of joint bleedings and factor usages after radiosynoviorthesis was evident in 91+/-4.3%. In patients with pigmented villonodular synovitis radiosynoviorthesis was successful in 77.3+/-25.3%. It is concluded that radiosynoviorthesis provides better results in rheumatoid arthritis than in osteoarthritis. Minimal or moderate changes according to Steinbrocker stages I and II respond better to radionuclide therapy than do stages III and IV. Deformed or unstable joints might fail treatment and therefore surgical interventions should be considered. Close cooperation with orthopaedists and rheumatologists is necessary to consider radiosynoviorthesis in each patient to ensure optimal medical care.

AP-translation in the proximal disc adjacent to lumbar spine fusion. A retrospective comparison of mono- and polysegmental fusion in 120 patients.

120 consecutive patients with painful spondylolisthesis underwent combined anterior and posterior fusion. Patients were divided retrospectively into two groups. In group I, 46 patients were treated with monosegmental fusion. In group II, 74 had polysegmental fusion. The mean follow-up time was 3 (2-7) years. Anterior posterior (AP)-translation in the first disc superior to fusion was measured according to Wiltse and Winter (1983). In group I, 3 and in group II, 10 patients developed an AP-translation of more then 3 mm in the disc adjacent to the fusion. AP-translation correlated with the number of fused segments and the follow-up time.

Effects of cisatracurium on cerebral and cardiovascular hemodynamics in patients with severe brain injury.

BACKGROUND: For neuroanesthesia and neurocritical care the use of drugs that do not increase or preferentially decrease intracranial pressure (ICP) or change cerebral perfusion pressure (CPP) and cerebral blood flow (CBF) are preferred. The current study investigates the effects of a single rapid bolus dose of cisatracurium on cerebral blood flow velocity, ICP, CPP, mean arterial pressure (MAP) and heart rate (HR) in 24 mechanically ventilated patients with intracranial hypertension after severe brain trauma (Glasgow coma scale <6) under continuous sedation with sufentanil and midazolam. METHODS: Patients were randomly assigned to receive either 2xED95 (n=12) or 4xED95 (n=12) of cisatracurium as a rapid i.v. bolus injection. Before and after bolus administration mean cerebral blood flow velocity (BFV, cm/s) was measured in the middle cerebral artery using a 2-MHz transcranial Doppler sonography system, ICP (mm Hg) was measured using an extradural probe, and MAP (mm Hg) and HR (b/min) were measured during a study period of 20 min. Cerebral perfusion pressure (CPP=MAP-ICP) was also calculated. RESULTS: Our data show that a single bolus dose of up to 4xED95 cisatracurium caused no significant (P<0.05) changes in BFV, ICP, CPP, MAP and HR. Possible histamine-related events were not observed during the study. CONCLUSIONS: The results from this study suggest that cisatracurium is a safe neuromuscular blocking agent for use in adult severe brain-injured patients with increased ICP under mild hyperventilation and continuous sedation.

The possibility of creating lordosis and correcting scoliosis simultaneously after partial disc removal. Balance lines of lumbar motion segments.

STUDY DESIGN: The feasibility of correcting scoliosis and creating lordosis simultaneously in the thoracolumbar and lumbar spine by anterior instrumentation was investigated by in vitro testing. OBJECTIVES: To evaluate the vertebral zones in which a compressive load applied in a motion segment creates side bending and lordosis in intact motion segments and after partial disc removal. SUMMARY OF BACKGROUND DATA: Most investigators have observed a kyphogenic effect of anterior scoliosis instrumentation and recommended dorsal placement of screws and the use of wedge grafts, although wedge grafts were not used routinely by all surgeons. METHODS: Zones of lordosization and side bending were determined by evaluation of balance lines between extension-flexion and side bending, respectively, by axial loading on ligamentous human motion segments with intact discs and after partial disc removal. RESULTS: In lumbar motion segments with intact discs, it is possible to achieve ipsilateral side bending and lordosization by anterior instrumentation. After partial disc removal, the balance line between extension and flexion runs through the ipsilateral pedicle, and, therefore, a compressive load between the vertebral bodies always creates kyphosis. CONCLUSIONS: After partial disc removal, it is not possible to create lordosis and correction of scoliosis simultaneously by ipsilateral anterior instrumentation without the use of intervertebral wedge grafts.

Removal of femoral sherman plates--not a simple operation.

Surgical removal of a Sherman plate from the femur in an adult treated in childhood for Perthes' disease or developmental dysplasia of the hip (DDH) can be time-consuming and difficult. We analyzed the factors that govern the complexity and complications of plate removal. The notes, operative details, and radiographs of 77 operations for removal of a Sherman plate inserted at the first femoral osteotomy for DDH were assessed. The plates had been in place for 1-32 years and were either completely buried in bone or endosteal in 24%, depending on the time elapsed before removal. Approximately one in five screw heads sheared or required excision, the screw shanks subsequently had to be cored from the bone. The operation took > 90 min in more than one quarter of the patients. The procedure is far from benign. Sherman plates should be removed early when possible, and joint replacement should not be planned to coincide with plate removal. The risks of plate removal must be explained to patients.