Postoperative analgesic effect, of preoperatively administered dexamethasone, after operative fixation of fractured neck of femur: randomised, double blinded controlled study.

Background: Fractured neck of femur is a common cause of hospital admission in the elderly and usually requires operative fixation. In a variety of clinical settings, preoperative glucocorticoid administration has improved analgesia and decreased opioid consumption. Our objective was to define the postoperative analgesic efficacy of single dose of dexamethasone administered preoperatively in patients undergoing operative fixation of fractured neck of femur. Methods: Institutional ethical approval was granted and written informed consent was obtained from each patient. Patients awaiting for surgery at Cork University Hospital were recruited between July 2009 and August 2012. Participating patients, scheduled for surgery were randomly allocated to one of two groups (Dexamethasone or Placebo). Patients in the dexamethasone group received a single dose of intravenous dexamethasone 0.1 mg kg -1 immediately preoperatively. Patients in the placebo group received the same volume of normal saline. Patients underwent operative fixation of fractured neck of femur using standardised spinal anaesthesia and surgical techniques. The primary outcome was pain scores at rest 6 h after the surgery. Results: Thirty seven patients were recruited and data from thirty patients were analysed. The groups were similar in terms of patient characteristics. Pain scores at rest 6 h after the surgery (the principal outcome) were lesser in the dexamethasone group compared with the placebo group [0.8(1.3) vs. 3.9(2.9), mean(SD) p = 0.0004]. Cumulative morphine consumption 24 h after the surgery was also lesser in the dexamethasone group [7.7(8.3) vs. 15.1(9.4), mean(SD) mg, p = 0.04]. Conclusions: A single dose of intravenous dexamethasone 0.1 mg kg -1 administered before operative fixation of fractured neck of femur improve significantly the early postoperative analgesia. Trial registration: ClinicalTrials.gov identifier: NCT01550146, date of registration: 07/03/2012

Numerical investigations on the strain-adaptive bone remodelling in the periprosthetic femur: Influence of the boundary conditions

Background: There are several numerical investigations on bone remodelling after total hip arthroplasty (THA) on the basis of the finite element analysis (FEA). For such computations certain boundary conditions have to be defined. The authors chose a maximum of three static load situations, usually taken from the gait cycle because this is the most frequent dynamic activity of a patient after THA. Materials and methods: The numerical study presented here investigates whether it is useful to consider only one static load situation of the gait cycle in the FE calculation of the bone remodelling. For this purpose, 5 different loading cases were examined in order to determine their influence on the change in the physiological load distribution within the femur and on the resulting strain-adaptive bone remodelling. First, four different static loading cases at 25%, 45%, 65% and 85% of the gait cycle, respectively, and then the whole gait cycle in a loading regime were examined in order to regard all the different loadings of the cycle in the simulation. Results: The computed evolution of the apparent bone density (ABD) and the calculated mass losses in the periprosthetic femur show that the simulation results are highly dependent on the chosen boundary conditions. Conclusion: These numerical investigations prove that a static load situation is insufficient for representing the whole gait cycle. This causes severe deviations in the FE calculation of the bone remodelling. However, accompanying clinical examinations are necessary to calibrate the bone adaptation law and thus to validate the FE calculations.

The use of expandable megaprostheses for reconstruction of the distal femur in pediatric patients after bone tumor resection

Expandable prostheses are becoming increasingly popular in the reconstruction of children with bone sarcomas of the lower limb. Since the introduction of effective chemotherapy in the treatment of these pathologies, in the 70s, there has been need for new limb salvage techniques. In children, limb salvage of the lower limbs is particularly challenging, not in the last place, because of the loss of growth potential. Therefore, expandable prostheses have been developed. However, the first experiences with these implants were not very successful. High complication rates and unpredictable outcomes raised major concerns on this innovative type of reconstruction. The rarity of the indication is one of the main reasons why there has been a relatively slow learning curve and implant development regarding this type of prosthesis. This PhD thesis, gives an overview of the introduction, the development, the current standards, and the future perspectives of expandable prostheses for the reconstruction of the distal femur in children.

Low Bone Mass In Human Immunodeficiency Virus-infected Climacteric Women Receiving Antiretroviral Therapy: Prevalence And Associated Factors.

Low bone mineral density (BMD) has been found in human immunodeficiency virus (HIV)-infected patients; however, data on associated factors remain unclear, specifically in middle-aged women. This study aims to evaluate factors associated with low BMD in HIV-positive women. In this cross-sectional study, a questionnaire was administered to 206 HIV-positive women aged 40 to 60 years who were receiving outpatient care. Clinical features, laboratory test results, and BMD were assessed. Yates and Pearson χ(2) tests and Poisson multiple regression analysis were performed. The median age of women was 47.7 years; 75% had nadir CD4 T-cell counts higher than 200, and 77.8% had viral loads below the detection limit. There was no association between low BMD at the proximal femur and lumbar spine (L1-L4) and risk factors associated with HIV infection and highly active antiretroviral therapy. Poisson multiple regression analysis showed that the only factor associated with low BMD at the proximal femur and lumbar spine was postmenopause status. Low BMD is present in more than one third of this population sample, in which most women are using highly active antiretroviral therapy and have a well-controlled disease. The main associated factor is related to estrogen deprivation. The present data support periodic BMD assessments in HIV-infected patients and highlight the need to implement comprehensive menopausal care for these women to prevent bone loss.

Avaliação da qualidade de vida em pacientes idosos um ano após o tratamento cirúrgico de fraturas transtrocanterianas do fêmur

OBJECTIVE: Evaluate the impact that trochanteric hip fractures produce on life quality of elderly patients, treated surgically, during one year of monitoring. METHODS: Were selected 73 elderly with transtrochanteric femur fracture, aged equal or over than 65 years and of both sexes. All participants underwent a standardized questionnaire which obtained information on lifestyle habits, functionality, physical activity, ambulation and cognitive state. Were excluded patients who died, not walking, with neurological diseases and pathological fractures. RESULTS: The average age was 80.17 ± 7.2 years and 75% was female. When comparing the summation of activities of daily living (p = 0.04) and instrumental daily living (p = 0.004) obtained before and after fracture, the patients become more dependent after fracture. Activities of daily living that worsened after fracture were bathing (p = 0.04), toileting (p = 0.02) and dressing (p = 0.04). All instrumental activities of daily living showed a significant difference, with functional dependence after fracture, increased need for walking aid (p = 0.00002), aged (p = 0.01) and not doing housework (p = 0.01). The low score on the test Minimental was associated with a greater dependence to perform activities of daily living before (p = 0.00002) and after (p = 0.01) fracture. CONCLUSION: After a year, activities of daily living that depended on the lower limbs worsened significantly, all instrumental activities of daily living were significantly worse in more than 50% of patients and more than half of patients who walked without support lost this ability.

Sistema MINUS® - técnica minimamente invasiva para o tratamento das fraturas transtrocanterianas do fêmur

The MINUS system was developed as a minimally invasive procedure that uses a diaphyseal cephalic extramedullary implant for the treatment of transtrochanteral fractures of the femur in elderly patients. The implant consists of a sliding screw coupled to a plate adapted to the minimally invasive technique. The surgical access is approximately three centimeters in length located on the lateral surface of the hip, below the projection of the small trochanter. A perfectly adapted instrument was used for the procedure, which also requires the use of an image intensifier, reducing surgery time and rate of bleeding. The objective of this study is to present a new instrument and implant, developed specifically for treatment with the minimally invasive technique, reducing the length of the conventional surgical access from 10 to three centimetres. This new implant was given the commercial name of MINUS System.

Efeitos do treinamento com pesos sobre a densidade mineral ossea, força muscular e variaveis funcionais na menopausa

Universidade Estadual de Campinas . Faculdade de Educação Física

Composição corporal e somatotipo em pessoas com síndrome de Down

Universidade Estadual de Campinas . Faculdade de Educação Física

Successful transplant of mesenchymal stem cells in induced osteonecrosis of the ovine femoral head: preliminary results

PURPOSE: Evaluate the bone tissue recovery following transplantation of ovine mesenchymal stem cells (MSC) from bone marrow and human immature dental-pulp stem cells (hIDPSC) in ovine model of induced osteonecrosis of femoral head (ONFH). METHODS: Eight sheep were divided in three experimental groups. First group was composed by four animals with ONFH induced by ethanol through central decompression (CD), for control group without any treatment. The second and third group were compose by two animals, six weeks after ONFH induction received transplantation of heterologous ovine MSC (CD + oMSC), and hIDPSC (CD + hIDPSC), respectively. In both experiments the cells were transplanted without application of any type of immunosupression protocol. RESULTS: Our data indicate that both cell types used in experiments were able to proliferate within injured site providing bone tissue recovery. The histological results obtained from CD+hIDPSC suggested that the bone regeneration in such animals was better than that observed in CD animals. CONCLUSION: Mesenchymal stem cell transplant in induced ovine osteonecrosis of femoral head by central decompression technique is safe, and apparently favors bone regeneration of damaged tissues.

A new species of Sickesia (Laniatores: Stygnidae: Opiliones) and new records for the State of Piauí, Brazil

Sickesia tremembe sp. nov. is described from Piauí, Northeast Brazil (type-locality: Sete Cidades National Park, Brasileira and Piracuruca municipalities). It differs from S. usta and S. helmuti by the clavate male femur IV and chelicerae segment I with a pair of large tubercles on retrolateral surface. The Stygnidae Stygnus polyacanthus (Mello-Leitão, 1923); the Cosmetidae, Gryne pluriarcuata Mello-Leitão, 1936 and undetermined species of Paecilaema and Gryne and also representatives of Escadabiidae and Sclerosomatidae (Gagrellinae) are recorded from this state, for the first time.

Avaliação radiográfica da cobertura acetabular à cabeça femoral, após osteotomia tripla e aplicação de cunha sacroilíaca, em pelve de cadáveres de cães

Na tentativa de evitar algumas das dificuldades associadas à osteotomia pélvica tripla (OPT), foi desenvolvido experimentalmente o método de aplicação de cunha na junção sacroilíaca para aumentar a ventroversão acetabular. O objetivo deste estudo foi aplicar as técnicas de cunha sacroilíaca e OPT em cadáveres e avaliar radiograficamente a eficácia da ventroversão acetabular. Para tal, foram utilizados 10 cadáveres de cães, adultos, com 15-25 kg. Em cada hemipelve direita foi realizada OPT com placas de 20° e 40°. Na hemipelve esquerda foram aplicadas cunhas nas articulações sacroilíacas de 20° e 40°. Avaliações radiográficas em projeções ventrodorsais foram realizadas para mensuração da cobertura acetabular à cabeça femoral nas duas técnicas. De acordo com os dados obtidos pode-se observar que não houve diferença entre a técnica de OPT e o uso de cunha sacroilíaca utilizando implantes de 20° e 40°, mas ocorreu diferença significativa (p<0,05) entre os cães antes e após a aplicação dos implantes de 20° e 40°, e também entre os que receberam implantes de 20° e os de 40°. A aplicação de cunha sacroilíaca produziu resultados semelhantes à OPT, e também se mostrou como de mais fácil aplicação.

A new species of Baurusuchus (Crocodyliformes, Mesoeucrocodylia) from the Upper Cretaceous of Brazil, with the first complete postcranial skeleton described for the family Baurusuchidae

The present work describes a new species of Baurusuchidae from Upper Cretaceous sediments of the Bauru Basin, and provides the first complete postcranial description for the family. Many postcranial features observed in the new species are also present in other notosuchian taxa, and are thus considered plesiomorphic for the genus. These are: long cervical neural spines; robust deltopectoral crest of the humerus; large proximal portion in the radiale that contacts the ulna; ulnare anterior distal projection; supra-acetabular crest well developed laterally; post-acetabular process posterodorsally deflected; presence of an anteromedial crest in the femur; fourth trocanter of femur posteriorly positioned; tibia with a laterally curved shaft; calcaneum tuber posteroventrally oriented; osteoderms ornamented with grooves and imbricated in the tail. On the other hand, we found the following sacral and carpal features to be unique among all mesoeucrocodylians analyzed: transverse processes of sacral vertebrae dorsolaterally deflected; presence of a longitudinal crest in the lateral surface of sacral vertebrae; pisiform carpal with a condyle-like surface. The majority of these cited features corroborates a cursorial locomotion for the new species described in the present study, suggesting that members of the family Baurusuchidae were also cursorial species.

A importância das quedas no mesmo nível entre idosos no estado de são paulo

OBJETIVO: Analisar as características das quedas no grupo etário com 60 anos ou mais, com ênfase nas quedas no mesmo nível, residentes no Estado de São Paulo, a partir da análise das diferentes fontes de informação oficiais. MÉTODOS: Foram analisadas as 1.328 mortes registradas no SIM em 2007, 20.726 internações no SIH/SUS em 2008 e os 359 atendimentos realizados em 24 UEs do Estado de São Paulo em 2007. Um teste de regressão logística foi utilizado para testar associações entre variáveis nos atendimentos em emergências. RESULTADOS: O sexo masculino preponderou nas mortes (51,2 %) enquanto o sexo feminino preponderou nas internações (61,1%) e atendimentos em emergências (60,4%). O coeficiente de mortalidade foi 31/100.000 habitantes, aumentando com a idade e atingindo o valor de 110,7/100.000 habitantes na faixa de 80 anos e mais. As quedas no mesmo nível foram responsáveis pela maior proporção de mortes definidas (35%), nas internações (47,5%) e também nas emergências (66%), crescendo de importância com o aumento das faixas etárias. A residência foi o local de ocorrência em 65,8% dos casos atendidos nas emergências. Os traumatismos de cabeça assumem importância nas mortes; as fraturas de fêmur foram as lesões mais frequentes nas internações e emergências. Nas emergências, as mulheres foram 1,55 vezes significativamente mais prováveis de serem atendidas por uma queda do que pelas outras causas externas que os homens. Comparativamente à faixa de 60 a 69 anos, os indivíduos na faixa de 70 a 79 anos foram 2,10 vezes e os indivíduos de 80 anos e mais foram 2,26 vezes significativamente mais prováveis de serem atendidos por uma queda do que pelas outras causas externas. Não houve diferença estatisticamente significante quanto ao sexo ou faixa etária quando se comparou os indivíduos que sofreram quedas no mesmo nível e outros tipos de queda. CONCLUSÃO: Recomenda-se que a prevenção das quedas entre idosos entre na pauta de discussão das políticas públicas sem mais demora.

Association between osteoporosis and rheumatoid arthritis in women: a cross-sectional study

CONTEXT AND OBJECTIVES: Osteoporosis has frequently been observed in patients with rheumatoid arthritis. The present study was undertaken in order to evaluate factors associated with osteoporosis among women with rheumatoid arthritis. DESIGN AND SETTING: Cross-sectional study, carried out in a public hospital in São Paulo. METHODS: The participants were 83 women with rheumatoid arthritis (53.7 ± 10.0 years old). Bone mineral density (BMD) and body composition were measured by dual energy X-ray absorptiometry. The patients were divided into three groups according to BMD: group 1, normal BMD (n = 24); group 2, osteopenia (n = 38); and group 3, osteoporosis (n = 21). Tests were performed to compare differences in means and correlations, with adjustments for age, duration of disease and cumulative corticosteroid. The relationships between clinical factors, physical activity score, dietary intake, body composition and biochemical parameters were analyzed using linear regression models. RESULTS: Mean calcium, vitamin D and omega-6 intakes were lower than the recommendations. Associations were found between BMD and age, disease duration, parathyroid hormone concentration and fat intake. The linear regression model showed that being older, with more years of disease and lower weight were negatively correlated with BMD [Total femur = 0.552 + 0.06 (weight) + 0.019 (total physical activity) - 0.05 (age) - 0.003 (disease duration); R² = 48.1; P < 0.001]. CONCLUSION: The present study indicates that nutritional factors and body composition are associated with bone mass in women with rheumatoid arthritis.