RESUMO
AIMS: To evaluate the efficacy of combined care between orthopaedic surgeons and geriatricians in the management of patients with fractured necks of femur. PATIENTS AND METHODS: A prospective study of the admissions to a district general hospital with hip fractures was carried out over a 5-year period. In the years 1992-1994, medical problems in this patient group were managed by a consultation-only service. At the end of 1994, a consultant geriatrician was appointed to manage these patients jointly with the orthopaedic surgeons, and the study was then carried through until the end of 1996. Information about the patients from admission to discharge or death was gathered prospectively using a proforma for the 3 years prior to orthogeriatric care, and the 2 years after. Main outcome measures were mortality, length of stay and discharge destination. These were compared for the two periods--pre- and post-orthogeriatric care. RESULTS: No significant differences were noted in mortality, length of stay or discharge destination. CONCLUSIONS: Combined orthogeriatric care according to our model did not have an impact on our chosen outcome measures.
Assuntos
Geriatria , Fraturas do Quadril/cirurgia , Ortopedia , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada/métodos , Feminino , Fraturas do Quadril/reabilitação , Humanos , Relações Interprofissionais , Tempo de Internação , Masculino , Prognóstico , Estudos ProspectivosAssuntos
Acidentes por Quedas , Insensibilidade Congênita à Dor/diagnóstico , Tálus/patologia , Fraturas da Ulna/etiologia , Feminino , Humanos , Lactente , Masculino , Necrose , Insensibilidade Congênita à Dor/complicações , Insensibilidade Congênita à Dor/diagnóstico por imagem , Radiografia , Tálus/diagnóstico por imagemRESUMO
We report on identical traumatic injuries in a pair of monozygotic (identical) twins treated at the same unit, one year apart. Both had sustained a complete tear of the patellar tendon and were treated surgically.
Assuntos
Doenças em Gêmeos , Articulação do Joelho , Traumatismos dos Tendões , Gêmeos Monozigóticos , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Ruptura , Tendões/cirurgiaRESUMO
The activity of pentose-shunt dehydrogenases is very low in periosteal cells of normal rat metatarsals, but increases one day post-fracture and rises linearly over the next two days. By four days post-fracture, the distribution of this activity along the bone shows two centres of high activity: the first in the region of proliferation to form callus and the second at the site where new bone is first seen, one day later. The high rate of generation of NADPH would be expected to reduce glutathione; reduced glutathione has been shown to inhibit alkaline phosphatase activity in these cells.
Assuntos
Fraturas Ósseas/enzimologia , Glucosefosfato Desidrogenase/metabolismo , Periósteo/enzimologia , Fosfatase Alcalina/metabolismo , Animais , Calo Ósseo/enzimologia , Feminino , NADP/metabolismo , Periósteo/citologia , Fosfogluconato Desidrogenase/metabolismo , Ratos , CicatrizaçãoRESUMO
The quantitative changes in alkaline phosphatase activity in the periosteal cells close to the fracture in rat metatarsal bones has been measured during the first 5 days postfracture. This study has been made possible by two technological advances, firstly the development of cryostat microtomy for cutting unfixed, undemineralised bone, and secondly the use of scanning and integrating microdensitometry for quantifying the activity in each periosteal cell. The results showed a loss of alkaline phosphatase activity close to the fracture site, with activity rising to normal values 0.8-1.0 mm from the site. No alkaline phosphatase activity was found in the cells which proliferated from the periosteum. It is suggested that reduced glutathione could cause such inhibition.
