ABSTRACT
BACKGROUND: In the pathophysiology of open-angle glaucoma altered perfusion of the optic nerve head is of importance. Up to now these disturbances were presumed to be the chief cause of glaucomatous damage in patients with normal tension glaucoma showing other vascular disturbances like migraine or tinnitus. PATIENTS AND METHODS: Peak systolic velocity (PSV) and end-diastolic velocity (EDV) were measured and the resistive index (RI) was calculated by colour Doppler imaging (CDI) in the ophthalmic artery (OA), central retinal artery (CRA) and in the short and long posterior ciliary arteries (SPCA, LPCA) in 18 patients with normal tension glaucoma (NTG), in 18 patients with high tension glaucoma (HTG) and in 18 normal control subjects. RESULTS: In an upright sitting position both glaucoma groups showed statistically significant decreases in PSV and EDV in CRA and SPCA compared to the control subjects. HTG when compared to NTG and normal subjects showed statistically significant decreases of EDV and statistically significant increases of RI in LPCA. In addition, compared to normal subjects, HTG patients showed statistically significant increases of RI in both OA and SPCA. DISCUSSION: Both glaucoma groups showed decreased blood flow velocities in the small retrobulbar vessels in an upright sitting position. Normal tension glaucoma patients with symptoms of vasospasms compared to patients with high tension glaucoma showed only small differences in ocular haemodynamics.
Subject(s)
Blood Flow Velocity , Glaucoma/diagnosis , Glaucoma/physiopathology , Migraine Disorders/physiopathology , Optic Disk/physiopathology , Raynaud Disease/physiopathology , Tinnitus/physiopathology , Female , Glaucoma/complications , Humans , Intraocular Pressure , Male , Middle Aged , Migraine Disorders/complications , Migraine Disorders/diagnosis , Optic Disk/blood supply , Raynaud Disease/complications , Raynaud Disease/diagnosis , Reference Values , Tinnitus/complications , Tinnitus/diagnosisABSTRACT
Extraction of an internal fixation device during the conversion of a failed intertrochanteric osteotomy to a total hip arthroplasty (THR) may lead to excessive trauma of the femoral shaft. In an attempt to bypass this risk, we performed THR leaving the old osteosynthetic material (straight plates and screws) in 10 of 48 patients operated on during the last 20 years. In another 8 patients, most of the osteosynthetic material was removed, but screw fragments were left in the canal. Insertion of the cement and the stem was unexpectedly easy in all 18 cases. After a mean follow-up of 10 (5-20) years there were no clinical problems. Radiographically, there were no signs of loosening, with only an occasional slight osteoporosis of the greater trochanter. Although theoretically the coexistence of different metals in the shaft should be avoided, in practice it does not appear to create a problem for patients. This may be attributed to insulation of the dissimilar materials by the cement. In conclusion, in cases where removal of the osteosynthetic device is expected to lead to severe trauma of the femur, our findings indicate that it is no disadvantage to perform the THR leaving the internal fixation material in place.
Subject(s)
Arthroplasty, Replacement, Hip , Bone Plates , Bone Screws , Osteotomy , Adult , Aged , Aged, 80 and over , Follow-Up Studies , Humans , Middle Aged , Treatment FailureABSTRACT
Thirty revision total hip arthroplasties were performed using the Wagner long uncemented femoral stem. Pre-operative indication included severe proximal femoral bone loss (and in no case was the proximal femur able to support a standard-length uncemented stem). For 15 (50%) patients the procedure was a first revision whereas the other 15 (50%) patients had already undergone one or more previous revisions. The average follow-up was 36.5 months. In all cases regeneration of the proximal femoral bone stock occurred without bone graft. Subsidence of the stem was noted in 6 (20%) patients, but was asymptomatic and did not require re-operation.
