Proinsulin and age in general population.

OBJECTIVE: The objective of this study was to assess the relationship between fasting proinsulin (PI) and age in general population and to determine whether there are differences regarding this association in obese and non-obese persons. METHODS: A random population-based sample (n=656) of Romanians (26-80 years) living in Bucharest, Romania was studied; 432 persons had diabetes and they were not analyzed in this paper. Circulating levels of fasting plasma glucose (FPG), fasting plasma insulin (FPI), fasting plasma proinsulin (FPP), fasting plasma C-peptide, HbA1c, lipid profile, creatinine, urea were measured. The homeostasis model assessment of insulin resistance (HOMA-IR), HOMA-B, and Quicki index were also calculated. RESULTS: For all participants proinsulin was the highest in the third quartile of the age group (59-67 years), with a median proinsulin of 5.8 pmol/L. Subsequently, proinsulin increased with age, from 2.6 pmol/L for participants aged 20-51 years, to 4.7 pmol/L for participants aged 51-59 years; proinsulin levels decreased in the upper quartile 4.8 pmol/L for those aged over 67 years. In sex-specific analyses, proinsulin increased with age for both men and women, except for those in the upper quartile. The prevalence of the obesity was 30.4% (n=68); obesity prevalence did not increase with age (p=0.26). Fasting proinsulin levels significantly increased with body mass index (BMI) category from lean (n=67, 2.9 pmol/L) to overweight (n=89, 4.5 pmol/L) and obese (n=69, 6.63 pmol/L) (p<0.0001). CONCLUSIONS: Our study has demonstrated a close association between age and elevated proinsulin and proinsulin/insulin ratio in general population.

The extended use of modular knee endoprostheses.

Modular knee prostheses have been used since the 1980's. Their goal was to offer an alternative to reconstructing large bony defects without using bone grafting. Initially, they were used for reconstruction after resection of tumours about the knee. Their success encouraged their use in the treatment of some failed total knee arthroplasties, with large bony defects and severe ligamentous instability. We have implanted 7 modular knee prostheses between July 2006 and January 2009. There were 4 tumoral cases, 1 case of desarthrodhesis after a Campanacci procedure and two cases of failed total knee arthroplasties. We have achieved encouraging results using these implants with all but one patient surviving at two years after surgery. All the implants were considered to function normally regarding range-of motion, muscle strength and gait. The surgical and medical management of patients with bone sarcomas has advanced greatly during the last 20 years, improving their overall survival. Thus, the surgeons are provided with increased abilities to perform limb-sparing or joint-mobility sparing surgery.

[Resection--reconstruction in malignant tumors of the locomotory apparatus]. / Rezectia--reconstructie în tumorile maligne ale aparatului locomotor.

The malignant bone and soft tissue tumors, represents, like any other type of cancer, a continuous challenge for surgeon, who is constrained to search and find new techniques, to improve not only the life expectancy, but the quality of the life too. This aim determined orthopedic surgeons to perform new operations, with a complex technique, like resection - reconstruction of the limb. In orthopedic clinic of Elias Hospital, we had 35 patients with malignant tumors of the limbs; we performed 14 resection--reconstructions, with or without preserving the joint mobility. In 3 cases, we used for reconstruction, modular endoprosthesis and we were able to preserve limb integrity and, also, the joint normal function. The good results we achieved until now represents a motivation for us to continue the battle against this terrible affection.