ABSTRACT
INTRODUCTION: Knee osteoarthritis and low back pain (LBP) are two conditions with relatively high prevalence in patients over 65 years. The objective was to determine the effect of symptomatic LBP on the patient-reported outcome after primary TKA. MATERIAL AND METHOD: A cohort of 48 patients with concomitant LBP was prospectively matched 1:2 with patients without LBP for gender, age, body mass index and preoperative knee function. LBP severity was measured with the Oswestry Disability Index (ODI). Patient-reported outcomes were assessed with reduced Short-Form (SF12), Western Ontario and McMaster Universities score (WOMAC), and visual analogue scale (VAS) for satisfaction. Functional outcome was assessed with the Knee Society Scores (KSS). RESULTS: The mean postoperative follow-up was 3.2 years. At last follow-up, LBP cohort had significantly worse SF12, WOMAC, KSS and VAS scores than those patients without LBP. Preoperative ODI score was significantly correlated with outcomes. CONCLUSION: Worse functional and patient-reported outcomes were obtained in patients over 65 years with concomitant LBP, and this was related to the intensity of preoperative LBP. Despite successful outcome in the knee, the LBP usually remains after TKA and this may impair satisfaction and patient-reported outcomes. These patients should be properly informed about their potential outcomes.
Subject(s)
Arthroplasty, Replacement, Knee/adverse effects , Knee Joint/surgery , Low Back Pain/epidemiology , Osteoarthritis, Knee/surgery , Pain, Postoperative/epidemiology , Aged , Female , Follow-Up Studies , Humans , Knee Joint/diagnostic imaging , Low Back Pain/diagnosis , Male , Pain Measurement , Pain, Postoperative/diagnosis , Prospective Studies , Spain/epidemiology , Time FactorsABSTRACT
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Subject(s)
Humans , Diagnosis, Dual (Psychiatry)/statistics & numerical data , Substance-Related Disorders/epidemiology , Mental Disorders/epidemiology , Community Networks/organization & administration , Evaluation of Results of Therapeutic Interventions , Patient Care Team/organization & administrationABSTRACT
PURPOSE: To study surgical treatment results of third cranial nerve palsy. METHOD: We have retrospectively studied 11 patients with a third cranial nerve palsy (10 unilateral and 1 bilateral) who were subjected to surgery. The etiology was traumatic in 4 cases, congenital in 2, vascular in 4, and tumoral in 1. Torticollis was present in 7 patients and 5 had diplopia. A good aesthetic result was defined by a final deviation of less than 10 prismatic diopters, a medium result by a deviation between 10-20 diopters and a bad result if the deviation was > or = 20 diopters. A good functional result was considered if there was no diplopia when the eyes were in their primary position. RESULTS: In all instances large recessions and/or resections of horizontal recti muscles were performed. Vertical deviation was treated in 4 cases. Multiple surgery was needed in 3 cases, 2 patients being operated on twice and 1 case was operated on four times. Botulinum toxin was used in 4 cases, before or after surgery. The aesthetic result was good in 7 cases, medium in 2, and bad in the other 2. Postoperative diplopia was present in 4 cases. Mean postoperative follow-up was 27.9 months. CONCLUSIONS: Large recti muscle recessions and resections are our first surgical technique to treat problems of third cranial nerve palsy. Sometimes several surgeries are required to treat vertical deviation and previous hypocorrection. Botulinum toxin is a complementary treatment. Functional results are worse than aesthetic ones.
Subject(s)
Oculomotor Muscles/surgery , Oculomotor Nerve Diseases/surgery , Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Oculomotor Nerve Diseases/diagnosis , Ophthalmologic Surgical Procedures , Postoperative Complications , Retrospective Studies , Treatment OutcomeABSTRACT
Objetivo: Estudiar los resultados obtenidos con la cirugía de la parálisis del III par craneal.Material y método: Se ha realizado un estudio retrospectivo de 11 casos con parálisis del III par (10 unilaterales y 1 bilateral) que fueron operados. La etiología fue traumática en 4 casos, congénita en 2, vascular en 4 y tumoral en 1. Del total de la muestra, 7 pacientes tenían tortícolis y 5 diplopía. Se consideró buen resultado estético si la desviación final era - de 20. Se consideró buen resultado funcional si no había diplopía en posición primaria de la mirada (PPM).Resultados: Todos los casos fueron operados con retroinserciones y/o resecciones amplias de rectos horizontales. En 4 casos se operó la desviación vertical. 2 casos necesitaron 2 cirugías y 1 requirió un total de 4 intervenciones. En 4 enfermos se inyectó toxina botulínica previa o posterior a la cirugía. El resultado estético ha sido bueno en 7 casos, regular en 2 y malo en 2. Un total de 4 enfermos quedó con diplopía postoperatoria . El tiempo de seguimiento medio fue de 27,9 meses.Conclusiones: Las retroinserciones y resecciones amplias de músculos rectos son nuestra técnica de elección para el tratamiento quirúrgico de las parálisis del III par. A veces son necesarias varias cirugías para corregir el componente vertical y las hipocorrecciones. La toxina botulínica es un tratamiento complementario. Los resultados funcionales son peores que los estéticos
Purpose: To study surgical treatment results of third cranial nerve palsy.Method: We have retrospectively studied 11 patients with a third cranial nerve palsy (10 unilateral and 1 bilateral) who were subjected to surgery. The etiology was traumatic in 4 cases, congenital in 2, vascular in 4, and tumoral in 1. Torticollis was present in 7 patients and 5 had diplopia. A good aesthetic result was defined by a final deviation of less than 10 prismatic diopters, a medium result by a deviation between 10-20 diopters and a bad result if the deviation was >- 20 diopters. A good functional result was considered if there was no diplopia when the eyes were in their primary position.Results: In all instances large recessions and/or resections of horizontal recti muscles were performed. Vertical deviation was treated in 4 cases. Multiple surgery was needed in 3 cases, 2 patients being operated on twice and 1 case was operated on four times. Botulinum toxin was used in 4 cases, before or after surgery. The aesthetic result was good in 7 cases, medium in 2, and bad in the other 2. Postoperative diplopia was present in 4 cases. Mean postoperative follow-up was 27.9 months.Conclusions: Large recti muscle recessions and resections are our first surgical technique to treat problems of third cranial nerve palsy. Sometimes several surgeries are required to treat vertical deviation and previous hypocorrection. Botulinum toxin is a complementary treatment. Functional results are worse than aesthetic ones
Subject(s)
Humans , Oculomotor Muscles/surgery , Oculomotor Nerve Diseases/surgery , Oculomotor Nerve Diseases/diagnosis , Ophthalmologic Surgical Procedures , Postoperative Complications , Retrospective Studies , Treatment OutcomeABSTRACT
According to the Edmonton protocol, human islet transplantation can result in insulin independency for periods longer than 3 years. However, this therapy for type 1 diabetes is limited by the scarcity of cadaveric donors. Owing to the ability of embryonic stem cells to expand in vitro and differentiate into a variety of cell types, research has focused on ways to manipulate these cells to overcome this problem. It has been demonstrated that mouse embryonic stem cells can differentiate into insulin-containing cells, restoring normoglycaemia in diabetic mice. To this end, mouse embryonic stem cells were transfected with a DNA construct that provides resistance to neomycin under the control of the regulatory regions of the human insulin gene. However, this protocol has a very low efficiency, needing improvements for this technology to be transferred to human stem cells. Optimum protocols will be instrumental in the production of an unlimited source of cells that synthesise, store and release insulin in a physiological manner. The review focuses on the alternative source of tissue offered by embryonic stem cells for regenerative medicine in diabetes and some key points that should be considered in order for a definitive protocol for in vitro differentiation to be established.
Subject(s)
Insulin/metabolism , Islets of Langerhans/metabolism , Stem Cells , Tissue Engineering/methods , Cell Culture Techniques , Cell Differentiation , Humans , Insulin Secretion , Islets of Langerhans Transplantation , Transplantation, HeterologousABSTRACT
Nutrients, such as glucose and fatty acids, have a dual effect on pancreatic beta-cell function. Acute administration of high glucose concentrations to pancreatic beta-cells stimulates insulin secretion. In addition, short term exposure of this cell type to dietary fatty acids potentiates glucose-induced insulin release. On the other hand, long-term exposure to these nutrients causes impaired insulin secretion, characterized by elevated exocytosis at low concentrations of glucose and no response when glucose increases in the extracellular medium. In addition, other phenotypic changes are observed in these conditions. One major step in linking these phenotypic changes to the diabetic pathology has been the recognition of both glucose and fatty acids as key modulators of beta-cell gene expression. This could explain the adaptative response of the cell to sustained nutrient concentration. Once this phase is exhausted, the beta-cell becomes progressively unresponsive to glucose and this alteration is accompanied by the irreversible induction of apoptotic programs. The aim of this review is to present actual data concerning the development of the toxicity to the main nutrients glucose and fatty acids in the pancreatic beta-cell and to find a possible link to the development of type 2 diabetes.
