1
|
Tsiantouli E, Biver E, Chevalley T, Petrovic R, Hannouche D, Ferrari S. Prevalence of Low Serum Alkaline Phosphatase and Hypophosphatasia in Adult Patients with Atypical Femur Fractures. Calcif Tissue Int 2022; 110:703-711. [PMID: 35229197 PMCID: PMC9108106 DOI: 10.1007/s00223-022-00949-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/17/2022] [Indexed: 12/13/2022]
Abstract
Hypophosphatasia (HPP) is a rare genetic disorder characterized by low serum alkaline phosphatase (ALP), its manifestations may include atypical femoral fractures (AFF). However, the prevalence of low serum ALP and HPP in patients with AFF remains unknown. We retrospectively analyzed ALP levels and clinical manifestations compatible with HPP in 72 adult patients with confirmed AFF by chart review. ALP values were compared with those of a control group of patients with prior proximal femoral fracture during antiresorptive treatment (n = 20). Among the AFF patients, 18 (25%) had at least one serum ALP value ≤ 40 IU/L, although in all but one case, at least one ALP value > 40 IU/L was also detected at another time point. Most low ALP values were associated with antiresorptive treatment (P = 0.049) and lowest levels of ALP did not differ between the AFF and the control groups (P = 0.129). However, low ALP values among AFF patients were associated with a higher rate of bilateral AFF (50% vs 22%, P = 0.025), metatarsal fracture (33% vs 7%, P = 0.006), and with trends for more frequent use of glucocorticoid (22% vs 8%, P = 0.089) and proton pump inhibitor (61% vs 44%, P = 0.220). In one AFF patient with low ALP and clinical suspicion of HPP, a rare pathogenic heterozygous variant of the ALPL gene was identified. In conclusion, low ALP values are common among subjects with AFF and mainly related to concomitant antiresorptive medication. Hence, low serum ALP has low specificity for HPP among AFF patients.
Collapse
Affiliation(s)
- Eleni Tsiantouli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Emmanuel Biver
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Thierry Chevalley
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Robert Petrovic
- Institute of Medical Biology, Genetics and Clinical Genetics, University Hospital Bratislava, Bratislava, Slovakia
| | - Didier Hannouche
- Division of Orthopedic Surgery, Department of Surgery, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Serge Ferrari
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
- Service and Laboratory of Bone Diseases, Department of Medicine, Geneva University Hospitals (HUG), 64 avenue de la Roseraie, 1205, Geneva, Switzerland.
| |
Collapse
|
2
|
Tjeenk Willink R, Devos B, Vundelinckx B, De Schepper J, Vanderstappen J, De Mulder K. Vitamin D, calcium and albumin bloodserum levels in Belgian orthopedic patients - is systematic screening justified? Acta Orthop Belg 2020; 86:185-192. [PMID: 33418605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In the setting of fracture care, orthopedic surgeons are primarily focused on treating the fracture itself, but more and more attention is being paid to prevention of such fractures and identifying risk factors associated with worse postoperative prognoses. In our study we collected postoperative vitamin D, calcium and albumin bloodserum levels from 163 patients who were admitted with a femur fracture and from 233 patients who were admitted for an elective hip arthroplasty during the period of 365 days. Results : 84.21% of the fracture population had a vitamin D deficiency (< 20 ng/mL) as well as 77.30% of the elective hip arthroplasty population. There were no significant seasonal differences in the fracture population. 80.27% of the fracture population had an albumin deficiency (< 29 g/L) compared to 38.75% of the reference population. There were no significant statistical differences in vitamin D and albumin bloodserum levels between the under 75 years old age group and the over 75 years old age group. We can make the tentative assumption that systematic screening for all hip fracture patients and all elective hip arthroplasty patients admitted to our orthopedic ward - independent of their age, season or pathology - is justified and we advise other hospitals to implement this as well.
Collapse
|
3
|
Bravo D, Josephson AM, Bradaschia-Correa V, Wong MZ, Yim NL, Neibart SS, Lee SN, Huo J, Coughlin T, Mizrahi MM, Leucht P. Temporary inhibition of the plasminogen activator inhibits periosteal chondrogenesis and promotes periosteal osteogenesis during appendicular bone fracture healing. Bone 2018; 112:97-106. [PMID: 29680264 PMCID: PMC5970081 DOI: 10.1016/j.bone.2018.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 02/11/2018] [Accepted: 04/17/2018] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Aminocaproic acid is approved as an anti-fibrinolytic for use in joint replacement and spinal fusion surgeries to limit perioperative blood loss. Previous animal studies have demonstrated a pro-osteogenic effect of aminocaproic acid in spine fusion models. Here, we tested if aminocaproic acid enhances appendicular bone healing and we sought to uncover the effect of aminocaproic acid on osteoprogenitor cells (OPCs) during bone regeneration. METHODS We employed a well-established murine femur fracture model in adult C57BL/6J mice after receiving two peri-operative injections of aminocaproic acid. Routine histological assays, biomechanical testing and micro-CT analyses were utilized to assess callus volume, and strength, progenitor cell proliferation, differentiation, and remodeling in vivo. Two disparate ectopic transplantation models were used to study the effect of the growth factor milieu within the early fracture hematoma on osteoprogenitor cell fate decisions. RESULTS Aminocaproic acid treated femur fractures healed with a significantly smaller cartilaginous callus, and this effect was also observed in the ectopic transplantation assays. We hypothesized that aminocaproic acid treatment resulted in a stabilization of the early fracture hematoma, leading to a change in the growth factor milieu created by the early hematoma. Gene and protein expression analysis confirmed that aminocaproic acid treatment resulted in an increase in Wnt and BMP signaling and a decrease in TGF-β-signaling, resulting in a shift from chondrogenic to osteogenic differentiation in this model of endochondral bone formation. CONCLUSION These experiments demonstrate for the first time that inhibition of the plasminogen activator during fracture healing using aminocaproic acid leads to a change in cell fate decision of periosteal osteoprogenitor cells, with a predominance of osteogenic differentiation, resulting in a larger and stronger bony callus. These findings may offer a promising new use of aminocaproic acid, which is already FDA-approved and offers a very safe risk profile.
Collapse
Affiliation(s)
- D Bravo
- Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY, United States; Department of Cell Biology, New York University School of Medicine, New York, NY, United States
| | - A M Josephson
- Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY, United States; Department of Cell Biology, New York University School of Medicine, New York, NY, United States
| | - V Bradaschia-Correa
- Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY, United States; Department of Cell Biology, New York University School of Medicine, New York, NY, United States
| | - M Z Wong
- Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY, United States; Department of Cell Biology, New York University School of Medicine, New York, NY, United States
| | - N L Yim
- Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY, United States; Department of Cell Biology, New York University School of Medicine, New York, NY, United States
| | - S S Neibart
- Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY, United States; Department of Cell Biology, New York University School of Medicine, New York, NY, United States
| | - S N Lee
- Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY, United States; Department of Cell Biology, New York University School of Medicine, New York, NY, United States
| | - J Huo
- Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY, United States; Department of Cell Biology, New York University School of Medicine, New York, NY, United States
| | - T Coughlin
- Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY, United States; Department of Cell Biology, New York University School of Medicine, New York, NY, United States
| | - M M Mizrahi
- Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY, United States; Department of Cell Biology, New York University School of Medicine, New York, NY, United States
| | - P Leucht
- Department of Orthopaedic Surgery, New York University School of Medicine, New York, NY, United States; Department of Cell Biology, New York University School of Medicine, New York, NY, United States.
| |
Collapse
|
4
|
Clendenen N, Nunns GR, Moore EE, Reisz JA, Gonzalez E, Peltz E, Silliman CC, Fragoso M, Nemkov T, Wither MJ, Hansen K, Banerjee A, Moore HB, D’Alessandro A. Hemorrhagic shock and tissue injury drive distinct plasma metabolome derangements in swine. J Trauma Acute Care Surg 2017; 83:635-642. [PMID: 28463938 PMCID: PMC5608631 DOI: 10.1097/ta.0000000000001504] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Tissue injury and hemorrhagic shock induce significant systemic metabolic reprogramming in animal models and critically injured patients. Recent expansions of the classic concepts of metabolomic aberrations in tissue injury and hemorrhage opened the way for novel resuscitative interventions based on the observed abnormal metabolic demands. We hypothesize that metabolic demands and resulting metabolic signatures in pig plasma will vary in response to isolated or combined tissue injury and hemorrhagic shock. METHODS A total of 20 pigs underwent either isolated tissue injury, hemorrhagic shock, or combined tissue injury and hemorrhagic shock referenced to a sham protocol (n = 5/group). Plasma samples were analyzed by UHPLC-MS. RESULTS Hemorrhagic shock promoted a hypermetabolic state. Tissue injury alone dampened metabolic responses in comparison to sham and hemorrhagic shock, and attenuated the hypermetabolic state triggered by shock with respect to energy metabolism (glycolysis, glutaminolysis, and Krebs cycle). Tissue injury and hemorrhagic shock had a more pronounced effect on nitrogen metabolism (arginine, polyamines, and purine metabolism) than hemorrhagic shock alone. CONCLUSION Isolated or combined tissue injury and hemorrhagic shock result in distinct plasma metabolic signatures. These findings indicate that optimized resuscitative interventions in critically ill patients are possible based on identifying the severity of tissue injury and hemorrhage.
Collapse
Affiliation(s)
- Nathan Clendenen
- Department of Anesthesiology, University of Colorado Denver, Aurora, CO, USA
| | - Geoffrey R Nunns
- Department of Surgery - University of Colorado Denver, Aurora, CO, USA
| | | | - Julie A Reisz
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver, Aurora, CO, USA
| | - Eduardo Gonzalez
- Department of Surgery - University of Colorado Denver, Aurora, CO, USA
| | - Erik Peltz
- Department of Surgery - University of Colorado Denver, Aurora, CO, USA
| | - Christopher C Silliman
- Department of Surgery - University of Colorado Denver, Aurora, CO, USA
- Bonfils Blood Center, Denver, CO, USA
- Department of Pediatrics, University of Colorado Denver, Aurora, CO, USA
| | - Miguel Fragoso
- Department of Surgery - University of Colorado Denver, Aurora, CO, USA
| | - Travis Nemkov
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver, Aurora, CO, USA
| | - Matthew J Wither
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver, Aurora, CO, USA
| | | | - Anirban Banerjee
- Department of Surgery - University of Colorado Denver, Aurora, CO, USA
| | - Hunter B Moore
- Department of Surgery - University of Colorado Denver, Aurora, CO, USA
| | - Angelo D’Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver, Aurora, CO, USA
| |
Collapse
|
5
|
Iizuka Y, Iizuka H, Kaneko T, Mieda T, Takechi R, Suzuki H, Sorimachi Y, Suto T, Tachibana M, Yoneyama T, Omodaka T, Hashimoto S, Hamano N, Sakane H, Shimoyama D, Kohama I, Ohshima A, Nozaki T, Kamiyama M, Moteki T, Ohshima A, Takamine S, Honda A, Ueno A, Tajika T, Okamura K, Warita T, Yonemoto Y, Shitara H, Ohsawa T, Takagishi K. Bone turnover markers and the factors associated with atypical femur fractures among Japanese patients. Injury 2016; 47:2484-2489. [PMID: 27670281 DOI: 10.1016/j.injury.2016.09.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 09/19/2016] [Accepted: 09/20/2016] [Indexed: 02/02/2023]
Abstract
Many previous reports have indicated that atypical femur fractures (AFFs) are associated with the administration of bisphosphonates (BPs). A number of risk factors and hypotheses regarding the pathogenesis of AFFs have been reported to date. The purpose of the present study was to identify the factors associated with AFFs in Japanese individuals and to elucidate the association between bone metabolism and AFFs by evaluating bone turnover markers (BTMs). We prospectively reviewed all patients with femur fractures and identified the patients with AFFs and typical femur fractures (TFFs). We collected the demographic and clinical data that were relevant to the present study, namely age, gender, affected side, affected site, concomitant medical history, and comorbid conditions, and measured the levels of BTMs within 24h after trauma. Welch's test and Fisher's exact probability test were used for the statistical analyses. A total of 338 patients, including 10 patients with AFFs and 328 patients with TFFs, were analyzed under the inclusion criteria. The use of BPs (p<0.001) and collagen disease and chronic granulomatous disease (CD/CGD) (p=0.025) were more frequently observed in patients with AFFs than in patients with TFFs, while the levels of BTMs, including N-terminal propeptides of type 1 procollagen (P1NP), isoform 5b of tartrate-resistant acid phosphatase (TRACP-5b) and undercarboxylated osteocalcin (ucOC) were significantly lower in patients with AFFs than in patients with TFFs. Furthermore, the level of TRACP-5b was found to be significantly lower in patients with atypical subtrochanteric fractures than in atypical diaphyseal fractures (p=0.025). Moreover, the levels of P1NP (p=0.016) and TRACP-5b (p=0.015) were found to be significantly lower in patients with AFFs than in patients with TFFs in a subgroup analysis of BPs users. The use of BPs was considered to be a factor associated with AFFs. Our comparison of the BTMs in patients with AFFs and TFFs indicated that the severe suppression of bone turnover was associated with the pathogenesis of AFFs. The extent of the influence of suppressed turnover on the pathogenesis of AFFs may differ depending on the fracture site.
Collapse
Affiliation(s)
- Yoichi Iizuka
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan.
| | - Haku Iizuka
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan
| | - Tetsuya Kaneko
- Department of Orthopaedic Surgery, Inoue Hospital, 55, Torimachi, Takasaki, Gunma 370-0053, Japan
| | - Tokue Mieda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan
| | - Rumi Takechi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan; Department of Orthopaedic Surgery, Gunma Cardiovascular Center, 3-12, Ko, Kameizumimachi, Maebashi, Gunma 371-0004, Japan
| | - Hideki Suzuki
- Department of Orthopaedic Surgery, Gunma Cardiovascular Center, 3-12, Ko, Kameizumimachi, Maebashi, Gunma 371-0004, Japan
| | - Yasunori Sorimachi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan; Department of Orthopaedic Surgery, Maebashi Red Cross Hospital, 3-21-36 Asahimacho, Maebashi, Gunma 371-0014, Japan
| | - Takahito Suto
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan; Department of Orthopedic Surgery, Isesaki Municipal Hospital, 12-1, Tsunatorihonmachi, Isesaki, Gunma 372-0817, Japan
| | - Masahiro Tachibana
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan; Department of Orthopedic Surgery, Isesaki Municipal Hospital, 12-1, Tsunatorihonmachi, Isesaki, Gunma 372-0817, Japan
| | - Tomotaka Yoneyama
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan; Department of Orthopaedic Surgery, Takasaki General Medical Center, 36, Takamatsucho, Takasaki, Gunma 370-0829, Japan
| | - Takuya Omodaka
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan; Department of Orthopaedic Surgery, Fujioka General Hospital, 942-1, Fujioka, Fujioka, Gunma 375-8503, Japan
| | - Shogo Hashimoto
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan; Department of Orthopaedic Surgery, Gunma Chuo Hospital, 1-7-13, Kouncho, Maebashi, Gunma 371-0025, Japan
| | - Noritaka Hamano
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan; Department of Orthopaedic Surgery, Gunmaken Saiseikai Maebashi Hospital, 564-1, Kamishindenmachi, Maebashi, Gunma 371-0821, Japan
| | - Hideo Sakane
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan; Department of Orthopaedic Surgery, Tone Central Hospital, 1855-1, Higashiharashinmachi, Numata, Gunma 378-0053, Japan
| | - Daisuke Shimoyama
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan; Department of Orthopaedic Surgery, Takasaki General Medical Center, 36, Takamatsucho, Takasaki, Gunma 370-0829, Japan
| | - Isaku Kohama
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan; Department of Orthopaedic Surgery, Maebashi Red Cross Hospital, 3-21-36 Asahimacho, Maebashi, Gunma 371-0014, Japan
| | - Atsufumi Ohshima
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan; Department of Orthopaedic Surgery, Gunma Chuo Hospital, 1-7-13, Kouncho, Maebashi, Gunma 371-0025, Japan
| | - Tatsuya Nozaki
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan; Department of Orthopaedic Surgery, Gunmaken Saiseikai Maebashi Hospital, 564-1, Kamishindenmachi, Maebashi, Gunma 371-0821, Japan
| | - Masataka Kamiyama
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan; Department of Orthopaedic Surgery, 6-3, Kiryu Kosei General Hospital, Orihimecho, Kiryu, Gunma 376-0024, Japan
| | - Tomohiko Moteki
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan; Department of Orthopedic Surgery, Isesaki Municipal Hospital, 12-1, Tsunatorihonmachi, Isesaki, Gunma 372-0817, Japan
| | - Asuka Ohshima
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan; Department of Orthopaedic Surgery, Fujioka General Hospital, 942-1, Fujioka, Fujioka, Gunma 375-8503, Japan
| | - Shuhei Takamine
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan; Department of Orthopaedic Surgery, Saint Pierre Hospital, 786-7, Kamisanomachi, Takasaki, Gunma 370-0857, Japan
| | - Akira Honda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan; Department of Orthopaedic Surgery, Public Tomioka General Hospital, 2073-1, Tomioka, Tomioka, Gunma 370-2393, Japan
| | - Akira Ueno
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan; Department of Orthopaedic Surgery, Zenshukai Hospital, 1381, Ninomiyamachi, Maebashi, Gunma 379-2117, Japan
| | - Tsuyoshi Tajika
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan
| | - Koichi Okamura
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan
| | - Toshiro Warita
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan
| | - Yukio Yonemoto
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan
| | - Hitoshi Shitara
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan
| | - Takashi Ohsawa
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan
| | - Kenji Takagishi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showamachi, Maebashi, Gunma 371-8511, Japan
| |
Collapse
|
6
|
Liu C, Guan Z, Xu Q, Zhao L, Song Y, Wang H. Relation of thromboelastography parameters to conventional coagulation tests used to evaluate the hypercoagulable state of aged fracture patients. Medicine (Baltimore) 2016; 95:e3934. [PMID: 27311005 PMCID: PMC4998491 DOI: 10.1097/md.0000000000003934] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Fractures are common among aged people, and rapid assessment of the coagulation status is important. The thromboelastography (TEG) test can give a series of coagulation parameters and has been widely used in clinics. In this research, we looked at fracture patients over 60 and compared their TEG results with those of healthy controls. Since there is a paucity of studies comparing TEG assessments with conventional coagulation tests, we aim to clarify the relationship between TEG values and the values given by conventional coagulation tests.Forty fracture patients (27 femur and 13 humerus) over 60 years old were included in the study. The change in their coagulation status was evaluated by TEG before surgery within 4 hours after the fracture. Changes in TEG parameters were analyzed compared with controls. Conventional coagulation test results for the patients, including activated partial thromboplastin time (APTT), international normalized ratio (INR), fibrinogen, and platelets, were also acquired, and correlation analysis was done with TEG parameters, measuring similar aspects of the coagulation cascade. In addition, the sensitivity and specificity of TEG parameters for detecting raised fibrinogen levels were also analyzed.The K (time to 20 mm clot amplitude) and R (reaction time) values of aged fracture patients were lower than controls. The values for angle, maximal amplitude (MA), and coagulation index (CI) were raised compared with controls, indicating a hypercoagulable state. Correlation analysis showed that there were significant positive correlations between fibrinogen and MA/angle, between platelets and MA, and between APTT and R as well. There was significant negative correlation between fibrinogen and K. In addition, K values have better sensitivity and specificity for detecting elevated fibrinogen concentration than angle and MA values.Aged fracture patients tend to be in a hypercoagulable state, and this could be effectively reflected by a TEG test. There were correlations between TEG parameters and corresponding conventional tests. K values can better predict elevated fibrinogen levels in aged fracture patients.
Collapse
|
7
|
Amouzougan A, Deygat A, Trombert B, Constant E, Denarié D, Marotte H, Thomas T. Spectacular improvement in vitamin D status in elderly osteoporotic women: 8-year analysis of an osteoporotic population treated in a dedicated fracture liaison service. Osteoporos Int 2015; 26:2869-75. [PMID: 26104797 DOI: 10.1007/s00198-015-3206-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 06/10/2015] [Indexed: 01/22/2023]
Abstract
UNLABELLED In a population of postmenopausal women with a fragility fracture, we found a drastic reduction in the proportion of women with severe (<25 nmol/L) and moderate (25 to 75 nmol/L) hypovitaminosis D, especially from 2009 onwards. These results show that supplementation has been very widely integrated into current practice. INTRODUCTION Vitamin D (25(OH)D) is essential for bone health. In institutionalised osteoporotic women, it reduces the risk of fragility fractures. Numerous articles suggesting the possibility of extraosseous effects have generated a growing number of publications and recommendations on more widespread administration, to limit the risks of moderate or severe hypovitaminosis D. We assessed the impact on clinical practice of these recommendations concerning 25(OH)D supplementation in elderly at-risk populations. METHODS A total of 1486 postmenopausal osteoporotic women were seen in the context of a fracture liaison service (i.e. a rheumatology consultation following a peripheral fragility fracture), between May 2005 and December 2012. Of these, 1107 had a 25(OH)D assay (femur, n = 520; humerus, n = 207; wrist, n = 380). RESULTS The average age of the total population was 76.7 ± 9.9 years, while for women with an available 25(OH)D assay, the average age was 75.1 ± 11.8 years. The average 25(OH)D (nmol/L) level was similar for the three fracture sites: femur, 30 ± 36.2; humerus, 27.5 ± 24; and wrist, 31 ± 26. A drastic reduction in the proportion of women with severe (<25 nmol/L) and moderate (25 to 75 nmol/L) hypovitaminosis D was observed, especially from 2009 onwards, with a mean prevalence of 69 and 30 % respectively before that year and 35 and 52 % thereafter. Conversely, the proportion of women with 25(OH)D at the threshold value of 75 nmol/L increased from 1.2 to 24 %. Overall, mean serum 25(OH)D levels were significantly higher when comparing the two periods 2005-2008 and 2009-1012 (17.6 ± 14.6 and 48.4 ± 39.2 nmol/L, respectively; p < 0.0001). CONCLUSION These results show that supplementation has been very widely integrated into current practice. We can expect it to yield beneficial effects in osseous and extraosseous terms in osteoporotic women, particularly the very elderly.
Collapse
Affiliation(s)
- A Amouzougan
- INSERM U1059, Lab Biologie Intégrée du Tissu Osseux, Université de Lyon, Lyon, France
- Rheumatology Department, University Hospital of Saint-Etienne, 42023, Saint-Etienne, France
| | - A Deygat
- INSERM U1059, Lab Biologie Intégrée du Tissu Osseux, Université de Lyon, Lyon, France
- Rheumatology Department, University Hospital of Saint-Etienne, 42023, Saint-Etienne, France
| | - B Trombert
- SSPIM, University Hospital of Saint-Etienne, Saint-Etienne, France
- EA SNA-EPIS, PRES Lyon, Saint-Etienne, France
| | - E Constant
- INSERM U1059, Lab Biologie Intégrée du Tissu Osseux, Université de Lyon, Lyon, France
- Rheumatology Department, University Hospital of Saint-Etienne, 42023, Saint-Etienne, France
| | - D Denarié
- INSERM U1059, Lab Biologie Intégrée du Tissu Osseux, Université de Lyon, Lyon, France
- Rheumatology Department, University Hospital of Saint-Etienne, 42023, Saint-Etienne, France
| | - H Marotte
- INSERM U1059, Lab Biologie Intégrée du Tissu Osseux, Université de Lyon, Lyon, France
- Rheumatology Department, University Hospital of Saint-Etienne, 42023, Saint-Etienne, France
| | - T Thomas
- INSERM U1059, Lab Biologie Intégrée du Tissu Osseux, Université de Lyon, Lyon, France.
- Rheumatology Department, University Hospital of Saint-Etienne, 42023, Saint-Etienne, France.
| |
Collapse
|
8
|
Xie B, Tian J, Yang C, Zhou DP, Xiang LB. [Case-control study on the efficacy of preoperative recombinant human erythropoietin administration for reducing transfusion requirements in elderly patients undergoing elective surgery for femoral intertrochanteric fractures]. Zhongguo Gu Shang 2015; 28:633-637. [PMID: 26399106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To evaluate preoperative application of recombinant human erythropoietin (rHuEPO) in reducing transfusion requirements in elderly patients undergoing elective surgery for femoral intertrochanteric fractures. METHODS From January 2011 to December 2013,442 cases of elderly patients with femoral intertrochanteric fracture were retrospectively reviewed. According to inclusion and exclusion criteria, 119 cases were eventually included and divided into the treatment group and the control group. There were 12 males and 40 females, with a mean age (71.4 ± 12.8) years old, and the patients received preoperative administration of rHuEPO 10,000 U qod combined with iron dextran 200 mg (3 times each day). While 16 males and 51 females in control group, with a mean age (70.9 ± 16.2) years old, and the patients only received preoperative administration of iron dextran 200 mg (3 times each day). All the patients received closed reduction and PFNA-II or Internal fixation surgeries. The perioperative blood transfusion rate, average amount of blood transfusion, postoperative complications, the length of hospital stay and mortality within 30 days were compared between the two groups. RESULTS There were no statistical differences between two groups in the baseline indexes (P > 0.05). Overall,71 of 119 patients (59.7%) received at least one unit allogeneic blood transfusion (ABT). However,there were significant differences in perioperative ABT rates (48.1% vs 68.7%, χ2 = 4.77, P < 0.05) and the average amount of blood transfusion between treatment group and control group, which were (1.8 ± 0.4) U/pte vs (3.6 ± 1.1) U/pte (t = 2.244, P < 0.05). Postoperative hemoglobin (Hb) on postoperative days 7 and 30 was higher in treatment group than that in control group. In addition, in treatment group, Hb levels were higher on postoperative day 30 than those on admission, which were (128.2 ± 20.6) g/L vs (118.2 ± 18.9) g/L (t = 2.133, P < 0.05). There were no statistical differences in postoperative complications, the length of hospital stay and mortality within 30 days. CONCLUSION For elderly patients with femoral intertrochanteric fractures undergoing elective surgery, preoperative application of rHuEPO can significantly reduce perioperative transfusion requirements, and is likely to reduce ABT-related infection, but its long-term safety remains to be evaluated.
Collapse
|
9
|
Keskin D, Kiziltunc A. Reduction of Total Antioxidant Capacity after Femoral Fracture. Acta Chir Orthop Traumatol Cech 2015; 82:293-295. [PMID: 26516734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE OF THE STUDY The aim of this study was to determine the changes in total antioxidant capacity (TAC) during the fracture healing process. MATERIAL AND METHODS Twenty patients with isolated closed femoral fracture, between the ages 18 and 60 years, were included in the study. The control group was formed with healthy volunteers. Venous blood was drawn from the healthy volunteers once, and from the patients five times during 14 days after fracture. TAC was measured in the sera of these samples. RESULTS In the patient group, the serum TAC was the highest in the first 6 hours, whereas there was a decreasing trend on the 3rd, 7th and 14th days, and an increasing trend on the 5th day. The mean serum TAC in all measurements of the patient group were lower than those in the control group. CONCLUSION The present study suggests that TAC may be decreased in considerable amounts during the first 2 weeks of fracture healing.
Collapse
Affiliation(s)
- D Keskin
- Department of Orthopaedics and Traumatology, Ondokuz Mayis University, Faculty of Medicine, Samsun, Turkey
| | | |
Collapse
|
10
|
Listernick R. A 16-year-old boy with abnormal blood count after a femur fracture. Pediatr Ann 2014; 43:91-4. [PMID: 24605854 DOI: 10.3928/00904481-20140221-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
11
|
Kulianda OO. [Dynamics of the cytokines profile in pentoxiphylline application under conditions of polytrauma]. Klin Khir 2013:73-75. [PMID: 24502018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The impact of pentoxiphylline on the cytokines profile while the polytrauma simulation in rats was studied in experiment. There was established, that application of pentoxiphylline in polytrauma prophylaxes the significant rising of proinflammatory cytokines and lowering of the anti-inflammatory cytokines level.
Collapse
|
12
|
Pidruchna SR. [Impact of xenoimplants on metabolic changes in the liver of rats in combined trauma]. Klin Khir 2013:59-62. [PMID: 23718038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In recent years there are intensively studied the role of hepatocytic affection in the complications progress in trauma of various genesis, including the multiple and combined. Positive correcting impact of lyophilized xenoimplants on the hepatic markers activity was demonstrated in the animal blood plasm while severe and combined trauma. Activity of alkaline phosphatase and gammaglutamyltranspeptidase in laboratory animals in polytrauma have had reduced essentially after correction performance during 1 week, and while combined trauma--on the 3rd day.
Collapse
|
13
|
Abstract
INTRODUCTION In polytrauma patients with an injury severity score (ISS)>16, early long bone and pelvic fracture fixation within 24h after injury has been shown to be beneficial. In contrast, surgery in the presence of subclinical hypoperfusion (SCH), defined as normal vital signs with a serum lactate≥2.5mmol/L may be detrimental. This study aimed to investigate the effect of fracture fixation in polytrauma patients with SCH. METHODS We undertook a database review extracting 88 polytrauma patients with a new injury severity score (NISS)>16 with significant long bone or pelvic fractures (extremity NISS≥9) who underwent surgical fracture stabilisation within 48h of injury. In the group of patients with normal vital signs (mean arterial pressure≥60mmHg and heart rate≤110 beats/min) we compared outcomes between those with a normal preoperative lactate (<2.5mmol/L) and those with a raised lactate (≥2.5mmol/L). RESULTS Of the 36 patients with normal preoperative vital signs, 17 had normal lactates (control group) and 19 abnormal lactates (SCH group). There were no significant differences in the method of fixation or theatre time between the groups. The SCH group required more inotropic support in the first 24h post surgery (p=0.02) and had higher sequential organ failure assessment (SOFA) scores on day 3 (p=0.003). Although not reaching mathematical significance those with SCH required on average 10 days longer on mechanical ventilation. CONCLUSION Early fracture fixation in patients with SCH as defined by normal vital signs and a lactate≥2.5mmol/L is associated with significant postoperative morbidity. Consideration should be given to delaying surgery in this cohort.
Collapse
Affiliation(s)
- Ben Grey
- Edendale Hospital, Pietermaritzburg, South Africa.
| | | | | |
Collapse
|
14
|
Takaoka S, Yamaguchi T, Tanaka KI, Morita M, Yamamoto M, Yamauchi M, Yano S, Sugimoto T. Fracture risk is increased by the complication of hypertension and treatment with calcium channel blockers in postmenopausal women with type 2 diabetes. J Bone Miner Metab 2013; 31:102-7. [PMID: 23073638 DOI: 10.1007/s00774-012-0389-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 09/09/2012] [Indexed: 01/22/2023]
Abstract
Patients with type 2 diabetes mellitus (T2DM) frequently have other common diseases such as hypertension (HT), dyslipidemia (DL), and cardiovascular disease (CVD). However, it is unknown whether or not the complication of these diseases would affect fracture risk in T2DM patients. We evaluated prevalent morphometric vertebral fractures (VFs) and prior non-VFs in 155 and 195 Japanese T2DM postmenopausal women, respectively, and examined their association with HT, DL, or CVD. VF, non-VF, HT, DL, and CVD were found in 53 (34 %), 30 (15 %), 136 (70 %), 124 (64 %), and 45 (23 %) women, respectively. Multivariate logistic regression analyses adjusted for age, body mass index (BMI), and serum creatinine showed that the presence of HT significantly increased VF risk [odds ratio (OR) 4.05, P = 0.0047], but not non-VF risk. This result was still significant after an additional adjustment for each of blood pressure levels, treatments with anti-hypertensive medications, and a history of falls. In contrast, calcium channel blocker (CCB) treatment significantly increased VF and non-VF risks after adjustments for age, BMI, serum creatinine, and blood pressure levels (OR 2.33, P = 0.0320 and OR 2.95, P = 0.0150, respectively), while these significances disappeared after an additional adjustment for a history of falls. These findings suggest that the presence of HT increases VF risk independent of blood pressure levels, anti-hypertensive medications, or falls, and that CCB treatment increases both VF and non-VF risks possibly via falls in T2DM postmenopausal women.
Collapse
Affiliation(s)
- Shin Takaoka
- Internal Medicine 1, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Giganti MG, Liuni F, Celi M, Gasbarra E, Zenobi R, Tresoldi I, Modesti A, Bei R, Tarantino U. Changes in serum levels of TNF-alpha, IL-6, OPG, RANKL and their correlation with radiographic and clinical assessment in fragility fractures and high energy fractures. J BIOL REG HOMEOS AG 2012; 26:671-680. [PMID: 23241117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Stages of bone turnover during fracture repair can be assessed employing serum markers of osteoblastic and osteoclastic activity, inflammatory cytokines, clinical evaluation and imaging instruments. Our study compare the fracture healing process in fragility fractures and high energy fractures by evaluating serum changes of interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-alpha), osteoprotegerin (OPG) and receptor activator of the nuclear factor-kB ligand (RANKL) in combination with radiographic (Radiographic Union Scale for Tibial fractures, RUST) and clinical (Lower extremity measure, LEM) assessments. We enrolled 56 patients divided into four corresponding groups: group A with high energy trauma fracture (tibial/femoral shaft); group B with low energy trauma fracture (femoral fractures); healthy (control A) and osteoporotic subjects (control B). Blood samples were collected before surgery (T0) and after 10 weeks (T10). Serum concentrations of IL-6, TNF-alpha, RANKL and OPG were quantified using commercial enzyme-linked immunosorbent assay (ELISA) kits. Our results show that RANKL values are significantly higher at T10 than at T0 in low energy trauma fractures (group B). OPG is significantly lower in each control group than that of the respective fractured group and its concentration at T0 and at T10 is significantly lower in high than in low energy fractures. RANKL/OPG ratio is significantly higher in both controls than in fractured groups, and significantly increases after 10 weeks. IL-6 and TNF-alpha concentrations significantly decrease during fracture healing and are higher in high (group A) than in low energy fractures (group B). Significant differences were also found in both RUST score and LEM between groups A and B. Changes in TNF-alpha and IL-6 levels correlate with RUST and LEM in fragility and high energy fractures, while RANKL/OPG ratio is associated with these clinical parameters only in fragility fractures. These findings suggest that serum levels of IL-6, TNF-alpha, RANKL and OPG might be used to monitor the stages of fracture repair. Further studies will be needed to confirm the role of these cytokines in fracture repair.
Collapse
Affiliation(s)
- M G Giganti
- Dept. of Clinical Sciences and Translational Medicine, University of Rome, Rome, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Elikov AV, Karavaev SA, Tsapok PI. [The characteristics of metabolism in patients with fractures of shin and thigh bones depending on immobilization period]. Klin Lab Diagn 2012:6-8. [PMID: 22545465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The comprehensive biochemical examination of 20 patients with fractures of shin and thigh bones aged from 18 to 50 years was organized. The treatment consisted of skeletal traction meaning a lingering limitation of locomotive activity The blood sampled at 7th, 14th, 21th, 28th and 35th days after trauma. The blood plasma was analyzed to establish the indicators of protein and purine metabolism, lipoperoxidation processes and antiradical activity. The study established the catabolic direction of metabolism and the intensification of lipoperoxidation processes of the background of decreasing of antiradical activity. The research data can be recommended to apply in controlling the impact of forced limitation of locomotive activity on the course of post-trauma process.
Collapse
|
17
|
Estai MA, Suhaimi F, Das S, Shuid AN, Mohamed Z, Soelaiman IN. Expression of TGF-β1 in the blood during fracture repair in an estrogen-deficient rat model. Clinics (Sao Paulo) 2011; 66:2113-9. [PMID: 22189738 PMCID: PMC3226608 DOI: 10.1590/s1807-59322011001200018] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2011] [Accepted: 08/08/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Previous studies have reported that osteoporosis due to estrogen deficiency influences fracture healing. Transforming growth factor (TGF-b) has been found to be involved in fracture healing via the regulation of the differentiation and activation of osteoblasts and osteoclasts. The current study aimed to determine the effects of estrogen on the expression of TGF-β1 during fracture healing in ovariectomized rats. METHODS Thirty female Sprague-Dawley rats weighing 200-250 g were assigned to: (i) a sham-operated group that was given a normal saline; (ii) an ovariectomized control group that was given a normal saline; or (iii) an ovariectomized + estrogen (100 mg/kg/day) group that was treated with conjugated equine estrogen. The right femur of all rats was fractured, and a Kirschner wire was inserted six weeks post-ovariectomy. Treatment with estrogen was given for another six weeks post-fracture. At the end of the study, blood samples were taken, and the right femur was harvested and subjected to biomechanical strength testing. RESULTS The percentage change in the plasma TGF-β1 level before treatment was significantly lower in the ovariectomized control and estrogen groups when compared with the sham group (p<0.001). After six weeks of treatment, the percentage change in the plasma TGF-β1 level in the estrogen group was significantly higher compared with the level in the ovariectomized control group (p = 0.001). The mean ultimate force was significantly increased in the ovariectomized rats treated with estrogen when compared with the ovariectomized control group (p = 0.02). CONCLUSION These data suggest that treatment with conjugated equine estrogen enhanced the strength of the healed bone in estrogen-deficient rats by most likely inducing the expression of TGF-β1.
Collapse
Affiliation(s)
- Mohamed Abdalla Estai
- Department of Anatomy, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia.
| | | | | | | | | | | |
Collapse
|
18
|
Yang KH, Park SY, Park SW, Lee SH, Han SB, Jung WK, Kim SJ. Insufficient bilateral femoral subtrochanteric fractures in a patient receiving imatinib mesylate. J Bone Miner Metab 2010; 28:713-8. [PMID: 20607326 DOI: 10.1007/s00774-010-0203-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 06/01/2010] [Indexed: 01/05/2023]
Abstract
We present a case of insufficient bilateral femoral subtrochanteric fractures in a patient who was treated with imatinib mesylate, an anticancer drug, for 1 year after a diagnosis of chronic myelogenous leukemia (CML). A 60-year-old woman presented with bilateral thigh pain for 6 months. A plain radiograph revealed bilateral progressive insufficient fractures on the subtrochanteric areas of the femurs. MRI of the femurs revealed incomplete stress fractures and no evidence of bone metastasis on either femur. Bone densitometry showed normal T-scores around the hip joint and spine. The patient had normal serum levels of calcium, vitamin D derivatives, and thyroid hormones. Serum phosphate levels were decreased, and parathyroid hormone levels were increased. Serum osteocalcin and urinary N-telopeptide of collagen cross-links (NTx) were both decreased. A bone biopsy demonstrated normocellular marrow without leukemic cells. A histomorphometric evaluation of her bones revealed reduced bone turnover despite secondary hyperparathyroidism. The serum markers for bone metabolism and histomorphometric evaluations in this patient suggest that the drug may have an effect on bone metabolism. These effects could be seen for both bone formation and resorption: this could result in impaired bone mineralization, a severely suppressed bone turnover rate, insufficient fractures, and bone necrosis, which are sometimes seen with long-term use of bisphosphonates. To our knowledge, this is the first case of an insufficient bilateral femoral shaft fracture that is potentially related to the use of imatinib mesylate in a patient with CML. Careful examination of bone metabolism should be performed in patients with CML because imatinib mesylate treatment is a lifelong process.
Collapse
Affiliation(s)
- Kyu-Hyun Yang
- Department of Orthopaedic Surgery, Yonsei Univerisity, College of Medicine, Seoul, Korea
| | | | | | | | | | | | | |
Collapse
|
19
|
Koutsostathis S, Tsaganos T, Giamarellos-Bourboulis EJ, Kotsaki A, Papalois A, Efstathopoulos N. Eicosapentanoic acid prolongs survival and attenuates inflammatory response in an experimental model of lethal trauma. Prostaglandins Leukot Essent Fatty Acids 2010; 83:69-74. [PMID: 20538444 DOI: 10.1016/j.plefa.2010.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Revised: 05/13/2010] [Accepted: 05/15/2010] [Indexed: 01/16/2023]
Abstract
In an attempt to define the efficacy of intravenously administered n-3 polyunsaturated fatty acids (PUFAs) in an animal model of lethal trauma following femur fracture, an intravenous solution of eicosapentanoic acid (EPA) - one n-3 PUFA - was administered in 25 rabbits; 13 were controls and 12 were treated with EPA 30 min after fracture. Vital signs were recorded and serum concentrations of tumor necrosis factor-alpha (TNFalpha) and respiratory burst of neutrophils were assessed. Survival of controls was 7.7% and of animals treated with EPA 50% (log-rank: 5.162; p: 0.023). Vital signs of both groups did not differ. Oxidative burst of neutrophils was greater among EPA-treated animals compared with controls at 48 h (p: 0.010). Serum levels of TNFalpha of the former group were decreased compared with the latter at 48 h (p: 0.019). Bacterial growth of enterobacteriaceae from liver and spleen after death or euthanasia was lower among EPA-treated rabbits than controls. These results suggest that EPA possesses considerable immunomodulatory activities improving survival in a model of lethal trauma. Restoration of oxidative burst conferring efficient phagocytosis of evading bacteria seems the most probable mechanism of action.
Collapse
|
20
|
Wu ZJ, Zhao WL, Zeng YH, Zhu YZ, Ou JY. [Effects of Tongmai decoction on the perioperative changes of plasma TNF-alpha and IL-6 in patients with femoral fractures]. Zhongguo Gu Shang 2010; 23:500-503. [PMID: 20701121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To explore the effects of Tongmai decoction on the perioperative changes of serum concentrations of tumor necrosis factor alpha (TNF-alpha) and interleukin (IL)-6 in patients with femoral fractures, and conform the effectiveness of Tongmai decoction on inflammatory factors in patients with femoral fractures, providing the theoretical evidence for the clinical use of Tongmai decoction. METHODS From October 2007 to May 2009, 60 patients with closed traumatic femoral fractures were selected according to the inclusion criterias and exclusion criterias. All the patients were randomly divided into three groups (group A, group B and group C). Twenty patients in group A (Tpanax Notoginseng pill group), 13 patients were male and 7 patients were female; ranging in age from 20 to 45 years, averaged 32.0 years; the disease course ranged from 2.0 to 26.0 h, with an average of 9.5 h. Twenty patients in group B (Tpanax Notoginseng pills and Lornoxicam injection group),12 patients were male and 8 patients were female; ranging in age from 23 to 42 years, averaged 31.0 years; the disease course ranged from 3.5 to 25.0 h, with an average of 13.6 h. Twenty patients in group C (Tpanax Notoginseng pill, Lornoxicam injection and Tongmai decoction group), 14 patients were male and 6 patients were female; ranging in age from 21 to 44 years, averaged 31.5 years; the disease course ranged from 4.6 to 29.0 h, with an average of 13.3 h. Among all the patients, 42 patients with fractures were fixed with femoral intramedullary nailing, and other 18 patients with femoral locking plate fixation. The patients in group A took Tpanax Notoginseng pills orally, 4 g each time and twice daily; the patients in group B took Tpanax Notoginseng pills orally as group A, and at the same time received intramuscular injection of Lornoxicam, 8 mg each time and once daily; the patients in group C took Tpanax Notoginseng pills orally and received intramuscular injection of Lornoxicam as group B, and at the same time took Tongmai decoction (R ) orally, 200 ml each time and twice daily. The above medications were administered to the three groups on the second day after admission to hospital. Peripheral blood samples were taken for determination of pro-inflammatory cytokines of TNF-alpha and IL-6 in blood serum on the 2nd and 6th days before operation and on the 8th and 13th days after operation. And all the patients were evaluated liver and kidney function at the 2nd and 7th days after admission. Analysis of variance and least significant difference-test were done with the help of SPSS 17.0 statistic software. RESULTS The differences among three groups of TNF-alpha and IL-6 in blood serum at the 2nd day after admission and 2 days after operation had no statistical significance (P > 0.05). The TNF-alpha and IL-6 levels among 3 groups had statistical differences at the 7th day after admission and at the 7th day after operation (P < 0.05, P < 0.01). There were significant differences of TNF-alpha and IL-6 levels between the 7th day after admission and the 2nd day after admission, the 7th day after operation and the 2nd day after admission (P < 0.01). There were also significant differences of TNF-alpha and IL-6 levels between group C compared with group A and B at the 7th day after admission and the 7th day after operation(P < 0.05, P < 0.01). CONCLUSION The serum concentrations of TNF-alpha and IL-6 level significantly increased in perioperative period. The results indicate that the Tongmai decoction may play an important role in inhibiting the release of TNF-alpha and IL-6 into the blood stream and decreasing the incunabula complication at early traumatic stage.
Collapse
Affiliation(s)
- Zheng-Jie Wu
- Department of Orthopaedics and Traumatology, Foshan Hospital of Traditional Chinese Medicine, Foshan 528000, Guangdong, China.
| | | | | | | | | |
Collapse
|
21
|
Holstein JH, Herrmann M, Schmalenbach J, Obeid R, Olkü I, Klein M, Garcia P, Histing T, Pohlemann T, Menger MD, Herrmann W, Claes L. Deficiencies of folate and vitamin B12 do not affect fracture healing in mice. Bone 2010; 47:151-5. [PMID: 20399291 DOI: 10.1016/j.bone.2010.04.592] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Revised: 04/08/2010] [Accepted: 04/08/2010] [Indexed: 11/20/2022]
Abstract
PURPOSE Recently, hyperhomocysteinemia has been shown to be associated with impaired fracture healing in mice. The main causes for hyperhomocysteinemia are deficiencies of folate and vitamin B12. However, there is no information on whether deficiencies of these B vitamins are affecting bone repair, too. METHODS We used two groups of mice to investigate the impact of folate and vitamin B12 deficiency on fracture healing: mice of the first group were fed a folate- and vitamin B12-deficient diet (n=14), while mice of the second group received an equicaloric control diet (n=13). Four weeks after stabilizing a closed femur fracture, bone repair was analyzed by histomorphometry and biomechanical testing. In addition, serum concentrations of homocysteine, folate, vitamin B12, the bone formation marker osteocalcin (OC), and the bone resorption marker collagen I C-terminal crosslaps (CTX) were measured. RESULTS Serum analyses revealed significantly decreased concentrations of folate and vitamin B12 in animals fed the folate- and vitamin B12-deficient diet when compared to controls. This was associated with a moderate hyperhomocysteinemia in folate- and vitamin B12-deficient mice, while no hyperhomocysteinemia was found in controls. Three-point bending tests showed no significant differences in callus stiffness between bones of folate- and vitamin B12-deficient animals and those of control animals. In accordance, the histomorphometric analysis demonstrated a comparable size and tissue composition of the callus, and also serum markers of bone turnover did not differ significantly between the two groups. CONCLUSIONS We conclude that folate and vitamin B12 deficiency does not affect bone repair in mice.
Collapse
Affiliation(s)
- J H Holstein
- Department of Trauma, Hand and Reconstructive Surgery, University of Saarland, Homburg/Saar, Germany.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Wu ZJ, Zhang CL, Zeng YH, Zhu YZ, Li Y. [Analysis of the effects of different medicines on hypercoagulability state variations of femoral shaft fracture and after its operation]. Zhong Yao Cai 2010; 33:1019-1023. [PMID: 21049628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To explore the role of Tong Mai Tang & Lornoxicam on the serum concentrations of tumor necrosis factor alpha (TNF-alpha), interleukin (IL-6) , D-dipolymer( D-Di), Platelet count (PLC) in treatment of femoral shaft fracture among period surgery time. METHODS We selected 120 cases of traumatic femoral shaft fracture patients according to the inclusion criteria and exclusion criteria, which were randomized dividend into four groups (I, II, III, IV respectively) of the same size based on the random number table method of 30 patients each. Therapeutic methods of four groups following as: Group I, Tpanax Notoginseng Pills PO; Group II, Tpanax Notoginseng Pills PO, Lornoxicam For Injection, 8 mg IM; Group III, Tpanax Notoginseng Pills PO, Tong Mai Decoctions 200 mL PO; Group IV, Tpanax Notoginseng Pills PO, Lornoxicam For Injection 8 mg IM, Tong Mai Decoctions 200 mL PO. The above medications were administered to the four groups after admission to hospital the next day. Peripheral blood samples were taken for immune determination of pro-inflammatory cytokines of TNF-alpha, IL-6, D-Di, PLC in blood serum on the 2nd and 6th day before operation and on the 8th and 13th day after operation in the morning. And all patients received liver and kidney function examination 2nd and 13th day after admission. Analysis of variance and least significant difference-test were done with the help of SPSS 17.0 statistic software. RESULTS The difference among four groups in TNF-alpha and IL-6 were significant (P < 0.05). And there were also significant statistic difference between group II/III/IV and group I group (P < 0.05). But the difference between group II and group III was insignificant (P > 0.05). However, the group contrast result between group IV and group II/III had statistics difference (P < 0.05). The difference in D-Di PLC at 6th day and 8th day were significant (P < 0.05). The group comparisons in group I/II/IV were also significant. There were non-statistics significance in group II compared 6th day/8th day with 2nd day (P > 0.05). The comparison between the 13th day with the first three time sections had statistics significance. And there were statistics significance at the 13th day between group IV and group II (P < 0.05). CONCLUSION The serum concentrations of TNF-alpha, IL-6, D-Di and PLC level were significantly increased in peroperative period, These results seem to indicate that the Tong Mai Decoctions & Lornoxicam may play an important role in inhibiting the release of TNF-alpha, IL-6, D-Di and PLC into the blood stream and decreasing the incunabula complication at early traumatic stage. The Tong Mai Decoctions & Lornoxicam was the worth promoting screened China and the West union medication combination.
Collapse
Affiliation(s)
- Zheng-Jie Wu
- Department of Orthopedics and Trauma, Foshan Hospital of Traditional Chinese Medicine, Foshan 528000, China
| | | | | | | | | |
Collapse
|
23
|
Sun TS, Chen XB, Liu Z, Ma ZY, Zhang JZ. [Relationship between the operation time of multiple fractures with system inflammation changes and clinical outcomes]. Zhonghua Wai Ke Za Zhi 2008; 46:961-965. [PMID: 19035192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To investigate the relationship between the operation time of femur shaft fracture with post-operation system inflammation changes and clinical outcomes for those multiple fractures. METHODS This investigation was designed as a prospective, nonrandomized cohort study. From April 2005 to August 2007, all 78 hospitalized patients were divided into 3 groups by an inclusion criteria: multiple fractures with opened fracture of femur shaft (group A, n = 26), multiple fractures with closed fracture of femur shaft (group B, n = 23), single closed fracture of femur shaft (group C, n = 29). In the group A, damage control orthopaedics (DCO) procedure were performed. In the group B and C, all the femur shaft fractures were performed intramedullary nail fixation early (< 24 h). From serially sampled venous blood, inflammatory reaction index were estimated by measured the concentration of IL-6, TNF-alpha surround the operation, and the conditions of multiple organs were estimated by assayed PaO2/FiO2, total bilirubin (TBIL), creatinine (Cr) levels, the postoperation complication rates were analyzed among each groups. The extent of inflammation changes, multiple organs damage conditions and postoperation complication rates were compared and analyzed among the 3 groups. RESULTS In the group A, the median increase values of IL-6,TNF-alpha after the secondary surgery were 59 ng/L and 85 ng/L, whereas they were 154 ng/L and 250 ng/L respectively in the group B, there was a significant difference between the 2 groups (P < 0.01). In addition, the median increase values of IL-6, TNF-alpha after the first surgery in group A and in group C were both significantly less than group B (P < 0.01). Correspondingly, the abnormal rates of PaO2/ FiO2, TBIL, Cr levels occurred in the group B were all greater than group A after the 2 surgery procedures (P < 0.05), and in the aspects of average ventilation days, ICU staying days, duration of positive fluid balance (input/output > 500 ml/24 h), the group B were all greater than group A after the second surgery ( P < 0.01). Compared with group A after the first surgery, group B showed a longer average ventilation days, but it had no significant difference in average ICU stay days and duration of positive fluid balance. In addition, for group C, all the aspects above were less than group B (P < 0.01). Concerned with the complications after surgery in each groups, fat embolism and MODS rate between group A and B had no significant difference (11.5% vs 13.0% ,P > 0.05), but higher than which of group C (P < 0.01). CONCLUSIONS The early intramedullary nail fixation of femur shaft fracture in multiple fractures may lead to a significant system inflammation changes, and may develop the subclinical changes of multiple organs. However, these changes are less in those surgery procedures later performed, namely intramedullary nail fixation of femur shaft fracture in multiple fractures as a primary definitive treatment has a potential risk, and should be carefully evaluated.
Collapse
Affiliation(s)
- Tian-Sheng Sun
- Institute of Orthopaedics, Beijing Army General Hospital of Chinese People's Liberation Army, Beijing 100700, China. suntiansheng-@163.com
| | | | | | | | | |
Collapse
|
24
|
Abstract
OBJECTIVES This project was developed to identify ways to support hospital-based improvements for the identification and management of osteoporosis following treatment of a fragility fracture. DESIGN This is a retrospective review of medical records of sets of consecutive patients who were admitted for surgical treatment of fragility fracture following introduction of several versions of admission and discharge care pathways. Effectiveness of the admission pathway was defined as % subjects with measurement of serum 25- hydroxyvitamin D (25(OH)D) during hospitalization; effectiveness of the discharge pathway was defined as % subjects with documentation of instructions for calcium and/or vitamin D supplementation. SETTING This study reviewed medical records of patients admitted to hospital for surgical treatment of a fragility fracture. PARTICIPANTS Medical records were evaluated for 98 patients older than 50-years who were admitted with a fragility fracture of the hip or femur. MEASUREMENTS Medical records were reviewed for the % subjects with documentation of an in-hospital order for serum 25(OH)D and with documentation of instructions to patients upon discharge concerning calcium and vitamin D intake. Median value of serum 25(OH)D was calculated. RESULTS In accordance with the admission pathway, serum 25(OH)D was measured in 37% (36/98). The median 25(OH)D level was 19.5 ng/mL; 78% were vitamin D insufficient [serum 25(OH)D < or = 32 ng/mL] and 58% were vitamin D deficient [serum 25(OH)D < or = 20 ng/mL]. In accordance with the discharge pathway, 74% (71/96) were discharged on calcium and/or vitamin D. CONCLUSION The high prevalence of vitamin D insufficiency (78%) observed in this study affirms the importance of incorporating vitamin D supplementation in hospital-based fracture care pathways. The discharge pathway was more effective than the newer admission pathway, a finding attributable to effects of familiarity, retraining, and introduction of computer-prompts. These evolving pathways represent a much-needed paradigm shift in the care of fragility fracture patients.
Collapse
Affiliation(s)
- J Glowacki
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA.
| | | | | | | | | |
Collapse
|
25
|
Abstract
FES (fat embolism syndrome) is a clinical problem, and, although ARDS (acute respiratory distress syndrome) has been considered as a serious complication of FES, the pathogenesis of ARDS associated with FES remains unclear. In the present study, we investigated the clinical manifestations, and biochemical and pathophysiological changes, in subjects associated with FES and ARDS, to elucidate the possible mechanisms involved in this disorder. A total of eight patients with FES were studied, and arterial blood pH, PaO(2) (arterial partial pressure of O(2)), PaCO(2) (arterial partial pressure of CO(2)), biochemical and pathophysiological data were obtained. These subjects suffered from crash injuries and developed FES associated with ARDS, and each died within 2 h after admission. In the subjects, chest radiography revealed that the lungs were clear on admission, and pulmonary infiltration was observed within 2 h of admission. Arterial blood pH and PaO(2) declined, whereas PaCO(2) increased. Plasma PLA(2) (phospholipase A(2)), nitrate/nitrite, methylguanidine, TNF-alpha (tumour necrosis factor-alpha), IL-1beta (interleukin-1beta) and IL-10 (interleukin-10) were significantly elevated. Pathological examinations revealed alveolar oedema and haemorrhage with multiple fat droplet depositions and fibrin thrombi. Fat droplets were also found in the arterioles and/or capillaries in the lung, kidney and brain. Immunohistochemical staining identified iNOS (inducible nitric oxide synthase) in alveolar macrophages. In conclusion, our clinical analysis suggests that PLA(2), NO, free radicals and pro-inflammatory cytokines are involved in the pathogenesis of ARDS associated with FES. The major source of NO is the alveolar macrophages.
Collapse
Affiliation(s)
- Shang Jyh Kao
- Division of Chest Medicine, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | | | | |
Collapse
|
26
|
[Hemodynamic steal syndrome in the distal limb segments in patients treated by Ilizarov method]. Vestn Ross Akad Med Nauk 2007;:37-41. [PMID: 17605182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Complex physiological examination of 149 patients with lower limb bone defects was performed using Doppler ultrasonography, rheovasography, percutaneous measurement of oxygen and carbon dioxide during treatment with Ilizarov apparatus. Within the process of treatment with Ilizarov apparatus, with marked collateral circulation, steal syndrome is noted in the distal parts of limb due to the effect of "functional shunting" in the zone of distraction regenerate bone. Steal syndrome during treatment by Ilizarov technique is registered, according to rheovasography and Doppler data, in 57% of patients with a defect in the femoral bone, in 24% of patients with post-traumatic defects in shin bones, and in 85% of patients with congenital defects in shin bones. In the compensated form of steal syndrome in the distal segment, according to polarography data, normoxia combined with hypocapnia is registered; oxygen requirements at rest are met by its more complete utilization, and activation of anaerobic processes.
Collapse
|
27
|
Pallister I, Bhatia R, Katpalli G, Allison D, Parker C, Topley N. Alteration of Polymorphonuclear Neutrophil Surface Receptor Expression and Migratory Activity After Isolation: Comparison of Whole Blood and Isolated PMN Preparations from Normal and Postfracture Trauma Patients. ACTA ACUST UNITED AC 2006; 60:844-50. [PMID: 16612307 DOI: 10.1097/01.ta.0000215583.08765.ce] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Post-traumatic MOF results from local tissue injury because of migration and activation of dysfunctional polymorphonuclear leukocytes (PMN). Although fracture surgery exacerbates the postinjury inflammatory response, it is usually beneficial. This study compared changes in PMN receptor expression and migratory activity, in whole blood and following PMN isolation. METHODS IL-8 mediated PMN migration and expression of CXCR-1, CD11b, and CD18 was studied in isolated and whole blood PMN in normal controls. Migration was studied at admission and day 5 after surgery in trauma patients undergoing fracture surgery. RESULTS PMN isolation results in increased expression of surface receptors and enhanced migration in normal controls. In trauma patient samples, isolated PMN migration is enhanced after injury, but suppressed when migration from whole blood is studied, both after injury and fracture surgery. CONCLUSION PMN isolation results in priming for migration, which has a relatively greater impact upon PMN in trauma patients. The observation that PMN activity may decline but priming potential remains enhanced is novel. Further refinements of whole blood and isolated PMN techniques are clearly warranted. This may help to resolve the mismatch in clinical and scientific experience in those patients with major fractures requiring surgical stabilization.
Collapse
Affiliation(s)
- Ian Pallister
- Department of Trauma & Orthopaedics, Morriston Hospital, Swansea NHS Trust, UK
| | | | | | | | | | | |
Collapse
|
28
|
Unal VS, Gulcek M, Unveren Z, Karakuyu A, Ucaner A. Blood Loss Evaluation in Children Under the Age of 11 with Femoral Shaft Fractures Patients with Isolated Versus Multiple Injuries. ACTA ACUST UNITED AC 2006; 60:224-6; discussion 226. [PMID: 16456460 DOI: 10.1097/01.ta.0000196374.40891.63] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Blood loss from non-cavitary hemorrhages is a significant source of hypovolemic shock in trauma patients. It has been reported that pediatric femoral fractures do not cause excess blood loss if there is no additional injury or trauma. The purpose of this study was to define the magnitude of blood loss resulting from pediatric femoral fractures and the factors influencing the loss. METHODS Twenty children under the age of 11 with femoral shaft fractures were included in this study. The patients' data were collected prospectively for 2 years. Hemoglobin concentrations, hematocrit levels, emergency room records, and clinical findings were evaluated and additional injuries were considered. RESULTS AND CONCLUSION The patients with additional trauma showed significant decreases in both hemoglobin concentrations and hematocrit levels, comparison with the patients who had only isolated femoral fractures. If there is an obvious decrease in hematocrit and/or hemoglobin concentration in a child with a femoral fracture, the possibility of additional injuries should be investigated.
Collapse
Affiliation(s)
- Vuslat Sema Unal
- Ankara Numune Education and Research Hospital, Ankara Opera 06100, Turkey.
| | | | | | | | | |
Collapse
|
29
|
Adah F, Benghuzzi H, Tucci M, Russell G, England B. Effects of sustained release of statin by means of tricalcium phosphate lysine delivery system in defect and segmental femoral injuries on certain biochemical markers in vivo. Biomed Sci Instrum 2006; 42:126-35. [PMID: 16817597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Statins, which are 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors are widely used for the treatment of hyperlipidemia, and recent studies and animal data suggest that statins promote osteogenesis and increase bone strength. However, little is known about the effects of statins delivered by sustained delivery system to a target site of a defect and segmental bone fractures on certain biochemical markers including reproductive hormones. The purpose of this study was to develop a targeted statin delivery system using Tricalcium Phosphate Lysine (TCPL) for defect and segmental femoral injuries and evaluate the effects on alkaline phosphatase, total protein, malinodialdehyde, glutathione, total cholesterol, testosterone, luteinizing hormone, statins, and follicle-stimulating hormone. Because of the influence oral intake of statins might have on certain body organs, we also examine the histomorphology of the vital and reproductive organs of the animals receiving statins for a period of 30 days and 12 weeks post surgery. Simvastatin used in this study significantly increased fracture healing and without significant influence on the body weights and the weights and morphology of the vital and reproductive organs. There was a significant reduction in the cholesterol levels on the 3rd week in both phases of the study and at the conclusion of the study the difference in the cholesterol levels was no more significant in both phases. Other biochemical markers including plasma LH, FSH and testosterone levels were not affected by active treatment with simvastatin. In conclusion, short and long-term simvastatin treatment delivered at a fracture target site did not influence vital and reproductive organs, the systemic levels of the biochemical markers studied, but was able to effectively stimulate bone formation in simple and complicated segmental fractures.
Collapse
Affiliation(s)
- Felix Adah
- University of Mississippi Medical Center, Jackson, MS, USA
| | | | | | | | | |
Collapse
|
30
|
Rodionova LV, Dmitrieva LA, Belokhvostikova TS, Taranenko EN. [Relationship between immunity and mineral metabolism in patients with long bone injuries complicated and uncomplicated by posttraumatic osteomyelitis]. Klin Lab Diagn 2005:37-40. [PMID: 16078531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
|
31
|
Pelinka LE, Jafarmadar M, Redl H, Bahrami S. NEURON-SPECIFIC-ENOLASE IS INCREASED IN PLASMA AFTER HEMORRHAGIC SHOCK AND AFTER BILATERAL FEMUR FRACTURE WITHOUT TRAUMATIC BRAIN INJURY IN THE RAT. Shock 2004; 22:88-91. [PMID: 15201708 DOI: 10.1097/01.shk.0000130157.34382.3f] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Neuron-specific enolase (NSE) is an acknowledged marker of traumatic brain injury. Several markers originally considered reliable in the setting of traumatic brain injury have been challenged after having been studied more extensively. The aim of our experimental study was to determine whether NSE is a reliable marker of traumatic brain injury early after trauma. Hemorrhagic shock was achieved by bleeding anesthetized rats to a mean arterial pressure (MAP) of 30-35 mmHg through a femoral catheter until incipient decompensation. MAP was maintained at 30-35 mmHg until 40% of shed blood had been administered as Ringer's solution and was then increased and maintained at 40-45 mmHg for 40 min by further administration of Ringer's solution, mimicking the phase of inadequate preclinical resuscitation. Blood samples were drawn at the end of the 40-min period of inadequate resuscitation. Femur fracture was achieved in anesthetized rats by bilateral application of forceps. Blood samples were drawn 30 and 60 min after fracture. Hemorrhagic shock caused NSE increase versus laboratory controls at the end of inadequate resuscitation (P < 0.01). Bilateral femur fracture caused NSE increase versus laboratory controls 30 min after fracture, which was significant 60 min after fracture (P < 0.01). During femur fracture, MAP remained at a level that is not associated with shock in rats. Our findings show for the first time that NSE increases after hemorrhagic shock as well as after femur fracture without hemorrhagic shock in rats. From a clinical point of view, these findings indicate that NSE cannot be considered a reliable marker of traumatic brain injury early after trauma in cases associated with hemorrhagic shock and/or femur fracture.
Collapse
Affiliation(s)
- Linda E Pelinka
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology and Research Center of the Worker's Compensation Board (AUVA), Vienna, Austria.
| | | | | | | |
Collapse
|
32
|
Kirui PK, Cameron J, Benghuzzi HA, Tucci M, Patel R, Adah F, Russell G. Effects of sustained delivery of thymoqiunone on bone healing of male rats. Biomed Sci Instrum 2004; 40:111-6. [PMID: 15133944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
The use of natural products as an alternative to conventional treatment in healing and treatment of various diseases has been on the rise in the last few decades. Nigella sativa, a natural herb has long been used as a natural medicine for treatment of many acute, as well as, chronic conditions. These include diabetes, hypertension and dermatological conditions. The specific objectives of this study were: (1) to successfully deliver the active component of black seed called Thymoqiunone (TMQ) at sustained level using TCPL drug delivery system; (2) to evaluate the physiological responses associated with sustained delivery of TMQ in femoral defect animal model (bone healing). A total of 15 adult male rats were randomly divided into three equal groups. Animals in group I served as controls, animals in group II served as sham while animals in group III served as experimental group (femur defect model). Group III animals were surgically implanted with TCPL capsule loaded with 0.02 grams of TMQ and 200 mg vancomycin. Blood samples, x-rays and body weights were collected and recorded weekly. At the end of 30 days post treatment, all animals were sacrificed and vital as well as reproductive organs were collected and analyzed histopathologically. Metabolic biochemical markers were also evaluated. The results of this study revealed the following: (i) gross anatomical observation indicated difference in healing pattern of animals in group III compared to those in group II (sham); (ii) no significant differences in all levels of cholesterol, proteins, malondialdehyde and alkaline phosphatase in all groups; (iii) no significant differences in the wet weights of vital as well as reproductive organs in all the groups. In conclusion, it appears that sustained levels of TMQ can enhance bone healing with little or no side effects on major vital and reproductive organs.
Collapse
|
33
|
Benghuzzi H, Tucci M, Tsao A, Russell G, England B, Ragab A. Stimulation of osteogenesis by means of sustained delivery of various natural androgenic hormones. Biomed Sci Instrum 2004; 40:99-104. [PMID: 15133942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Sex steroids play an essential role in the maintenance of bone health throughout life, and the mechanisms by which these effects are mediated in a subject of much controversy. Osteoblast cells appear to be stimulated by androgens in vitro, however their use in vivo is limited due to the virilizing side effects as well as alterations in the lipoprotein profiles. The use of targeted sustained release of anabolic steroids may stimulate fracture healing without untoward side effects. The specific aims were: (1) to compare fracture healing in a rat femoral defect model using tricalcium phosphate lysine (TCPL) drug delivery systems to deliver T, DHT and AED for long duration; (2) to quantify the level of steroid delivered from the system; and (3) to use bone histomorphometric techniques to analyze new bone formation at the defect site. A total of 125 adult male Sprague Dawley were obtained and acclimatized for two weeks in the animal care prior surgical procedures. All animals were kept on a 12-hour day/night cycle and were fed Purina rodent chow and water ad libitum. The animals were randomly divided into five equal groups (n = 25 per group). Group 1 animals were used as the intact control. Group 2-5 animals were placed under anesthesia and a standard approach was used to create a 6-mm defect using a dental burr in the midshaft of the femur. Group 2 animals were implanted with a sham TCPL delivery system adjacent to the defect. Animals in groups 3, 4, and 5 received a TCPL delivery system loaded with T, DHT, and AED, respectively. Animals were weighed, x-rayed, and blood samples were drawn on a weekly basis. The rats were sacrificed after 3, 6, 9 12 and 15 weeks and reproductive, vital organs, and fracture calluses were collected and analyzed. Morphometric analysis of the femurs revealed that the use of sustained delivery of DHT induced remarkable bone ingrowth compared to the sham and other experimental groups. All treated femurs appeared healthy and normal bone architecture was observed by the end of the 6 week phase. Measurements of the inner perimeter of the bone on the endosteal side showed significant reduction in the androgens treated animals. The quantitative findings confirms our preliminary studies and endorsing the previous data that the sustained delivery of T or its metabolite (DHT) can stimulate the osteoblastic activities in which eventually causes an increase in the cortical bone density.
Collapse
Affiliation(s)
- Hamed Benghuzzi
- University of Mississippi Medical Center, Jackson, MS 39216, USA
| | | | | | | | | | | |
Collapse
|
34
|
Pelinka LE, Szalay L, Jafarmadar M, Schmidhammer R, Redl H, Bahrami S. Circulating S100B is increased after bilateral femur fracture without brain injury in the rat. Br J Anaesth 2003; 91:595-7. [PMID: 14504167 DOI: 10.1093/bja/aeg225] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND S100B is an acknowledged marker of brain damage. However, trauma without brain damage also causes an increase in S100B. S100B concentrations are highest in multiple trauma patients with long bone fractures. Clinically, extensive long bone fractures are associated with haemorrhagic shock and haemorrhagic shock per se is associated with increased S100B. The aim of our experimental study was to verify the S100B increase in long bone fracture without haemorrhagic shock. METHODS and results. Bilateral femur fracture was carried out in 10 anaesthetized rats. Blood samples were drawn for immuno-luminometrical S100B measurement 5, 15, 30, 120, and 240 min after fracture. Mean arterial pressure (MAP), heart rate, and body temperature were monitored continuously. S100B increased after bilateral femur fracture and reached a peak 30-120 min after fracture (P<0.001). MAP remained at a level which is not associated with shock in rats. Heart rate and body temperature remained unchanged. Autopsy verified open bilateral femur fracture surrounded only by small zones of clotted blood. CONCLUSIONS S100B is increased in bilateral femur fracture without haemorrhagic shock in rats. This finding suggests that bone marrow is a potential extracerebral source of S100B.
Collapse
Affiliation(s)
- L E Pelinka
- Ludwig Boltzmann Institute of Experimental and Clinical Traumatology and Research Unit of the Workers' Compensation Board (AUVA), Donaueschingenstrasse 13, A-1200 Vienna, Austria.
| | | | | | | | | | | |
Collapse
|
35
|
Abstract
UNLABELLED The influence of mechanical tissue strain caused by flexible fracture fixation on the systemic occurrence of systemic mitogens during callus healing was investigated. For this purpose the mitogenic capacity and growth factor concentration of sera from patients undergoing fracture treatment were determined. Sera from 9 patients whose fractures had been stabilized by external fixation were collected before and during fracture treatment. The sera were added to cell culture media of the osteoblastic cell line SaOS-2. After 5-6 days cell proliferation was measured. Transforming growth factor-beta1 (TGF-beta1) and insulin-like growth factor-I (IGF-I) concentrations were analyzed in serum samples from different healing stages. STATISTICS paired Wilcoxon-test. Sera from fracture patients decreased SaOS-2 proliferation in the first week after surgery (p<0.05) compared to sera obtained prior to surgery. In the fourth or fifth week proliferation increased significantly (p<0.03). The increased proliferation of the SaOS-2 cells was associated with elevated levels of TGF-beta and IGF-I (p<0.05). The higher mitogenic activity of sera suggests an increased level of circulating mitogens. In a previous study this increase had also been observed in patients during distraction osteogenesis treatment but not in patients with primary bone healing by a stable fixated plate. It is therefore assumed that their release from the fracture site is a consequence of mechanical stimulation by interfragmentary movement of fracture ends.
Collapse
Affiliation(s)
- Daniela Kaspar
- Institut für Unfallchirurgische Forschung und Biomechanik, Universität Ulm, Helmholtzstr. 14, 89081 Ulm, Germany.
| | | | | | | | | |
Collapse
|
36
|
Abstract
Hypercalcemia and osteolytic bone lesion are important complications in the prognosis of patients with adult T cell leukemia/lymphoma (ATL). We report a 61-year-old Japanese woman who died of ATL and had multiple osteolytic lesions and pathological fractures of her extremities. Highly increased serum levels of Interleukin-6 (IL-6) and a parathyroid hormone-related protein (PTHrP) together with a high level of serum calcium observed at the time of fractures suggested their contribution to the formation of the bone lesions.
Collapse
Affiliation(s)
- Saburo Anzai
- Department of Dermatology, Oita Medical University, Hasama-machi, Japan
| | | | | | | | | | | |
Collapse
|
37
|
Li Z, Yang X, Lu L, Yu Y, Yao Y. Gut barrier function damage following multiple firearm injuries in a porcine model. Chin Med Sci J 2001; 16:209-13. [PMID: 12903757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
OBJECTIVE To study the characteristics and pathogenesis of gut barrier damage following multiple firearm injuries in a porcine model. METHODS Twenty-four small pigs were divided into 4 groups: control group (n = 6, group C), group H (n = 6, gunshot-induced tangential fracture of parietal bone), group L (n = 6, gunshot-induced comminuted fracture of bilateral femora) and group M (n = 6, combined group H + L). Gastric intramucosal pH (pHi), plasma endotoxin levels in portal vein, and plasma D-lactate levels were measured and blood samples were cultured at different intervals after trauma. The animals were sacrificed at 72 h following trauma and intestinal tissues were harvested for pathological examination and diamine oxidase (DAO) activity measurement. RESULTS In group M at 72 h, pHi was significantly lower than that of group H and L ( P < 0.01), and plasma endotoxin level was significantly higher than that of group H (P < 0.01) and group L (P < 0.05). Simultaneously, in group M, D-lactate level was markedly higher than that of group H ( P < 0.01), and incidence of positive blood culture was much higher than that of group H and L ( P < 0.05). Necrosis and exfoliation were revealed at ileum villus top in all trauma groups, especially in group M, in which ileum DAO activity declined most significantly as well. CONCLUSION Multiple trauma is prone to cause gastrointestinal ischemia even without hemorrhagic shock. The damage of gut barrier in multiple trauma appears to be more severe than that in one-site trauma, thereby promoting gut-derived endotoxemia and bacterial translocation and contributing to the development of endogenous infection.
Collapse
Affiliation(s)
- Z Li
- Department of Surgery, 304th Hospital of PLA, Beijing 100037
| | | | | | | | | |
Collapse
|
38
|
Crowl AC, Young JS, Kahler DM, Claridge JA, Chrzanowski DS, Pomphrey M. Occult hypoperfusion is associated with increased morbidity in patients undergoing early femur fracture fixation. J Trauma 2000; 48:260-7. [PMID: 10697084 DOI: 10.1097/00005373-200002000-00011] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The presence of persistent occult hypoperfusion (OH) is associated with higher morbidity and mortality rates after trauma. Early femur fracture fixation in trauma patients with multiple injuries is associated with decreased morbidity and mortality. Association of OH and incidence of postoperative complications after intramedullary (IM) fixation in patients with femur fractures was investigated. METHODS A retrospective study design was used. All patients with femur fractures admitted to the trauma service of a Level I trauma center between January 1, 1995, and August 1, 1998, who were older than 18 years of age and who had IM fracture fixation within 24 hours of admission and serum lactate determinations on admission and at proscribed intervals, were included in the study. Patients with lactic acid levels > or = 2.5 mmol/L were determined to have OH. No patients had clinical signs of shock (hypotension, tachycardia, decreased urine output) on transfer to the operating room. Complete resuscitation was defined as a lactic acid level < 2.5 mmol/L. Patients were divided into two groups based on presence/absence of OH determined from the lactic acid level immediately before surgery. The incidence of all postoperative organ complications was recorded, and complication rates were compared between groups. Total hospital costs were also compared. RESULTS One hundred seventy-seven patients with femur fractures were admitted to the trauma service during this period. Seventy-nine patients met initial criteria for inclusion in the study. Further review excluded 32 patients. Occult hypoperfusion was present in 20 patients before early IM fixation (group 2). Twenty-seven patients were completely resuscitated before early IM fixation (group 1). Injury Severity Scores were similar in both groups. Group 2 had 35 complications in 20 patients, and group 1 had 11 complications in 27 patients. A significant difference was found in incidence of postoperative complications in group 1 (20%) versus group 2 (50%). Group 2 also had a significantly higher proportion of postoperative infections than group 1 (72% vs. 28%, respectively) and higher total hospital costs ($46,469 vs. $23,139). CONCLUSION The presence of OH in trauma patients undergoing early IM fixation of a femur fracture is associated with a twofold higher incidence of postoperative complications. Clinical judgment, not surgical dogma, should guide the timing of IM fixation in these patients. Identifying and correcting OH through relatively simple resuscitative measures may be advantageous in reducing morbidity in the patient with multiple injuries.
Collapse
Affiliation(s)
- A C Crowl
- Department of Surgery, University of Virginia Health System, Charlottesville 22906-0005, USA
| | | | | | | | | | | |
Collapse
|
39
|
O'Connell IP, Barton RN, Horan MA, Maycock PF. Disrupted cortisol-ACTH relationships in elderly women given corticotrophin-releasing hormone two weeks after proximal femur fracture. Clin Endocrinol (Oxf) 2000; 52:51-9. [PMID: 10651753 DOI: 10.1046/j.1365-2265.2000.00894.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE In elderly women with hip fractures plasma cortisol is persistently higher than in healthy elderly women, possibly causing undesirable catabolic effects. A lack of corresponding changes in plasma ACTH or in the cortisol response to exogenous ACTH has prompted us to study cortisol-ACTH relationships after giving corticotrophin-releasing hormone (CRH) to such subjects. SUBJECTS Seventeen women aged 70-90 years who had sustained a hip fracture about two weeks previously were compared with 19 healthy women aged 68-85 years. MEASUREMENTS 100 microg CRH was injected into each subject and ACTH and cortisol concentrations were measured at intervals for 90 minutes beforehand and 180 minutes afterwards. The concentrations of vasopressin and various cytokines and related peptides were also measured during the baseline period. RESULTS Under baseline conditions plasma cortisol was higher and plasma ACTH lower in the injured patients than in the healthy subjects. The patients showed smaller incremental ACTH and cortisol responses to CRF but because of the higher baseline value the peak cortisol concentration was enhanced. A strong correlation between the cortisol and ACTH responses in the healthy subjects was completely lost in the patients and the slope of the ACTH-cortisol dose-response relationship varied greatly between individuals, with no overall increase. The concentrations of vasopressin, interleukin-1 receptor antagonist and soluble tumour necrosis factor receptors were higher in the patients but did not correlate with the responses to CRH. CONCLUSIONS The results are not consistent with increased sensitivity to ACTH and suggest an independent stimulus to the adrenals of hip-fracture patients. Its identity is unknown as the non-ACTH stimuli proposed hitherto are reported to enhance sensitivity to ACTH.
Collapse
Affiliation(s)
- I P O'Connell
- North-western Injury Research Centre, University of Manchester, UK
| | | | | | | |
Collapse
|
40
|
Olson JD. Addressing clinical etiologies of a prolonged aPTT. CAP Today 1999; 13:28, 30, 32 passim. [PMID: 10623389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- J D Olson
- Department of Pathology, University of Texas Health Science Center, San Antonio, USA
| |
Collapse
|
41
|
Giannoudis PV, Smith RM, Bellamy MC, Morrison JF, Dickson RA, Guillou PJ. Stimulation of the inflammatory system by reamed and unreamed nailing of femoral fractures. An analysis of the second hit. J Bone Joint Surg Br 1999; 81:356-61. [PMID: 10204951 DOI: 10.1302/0301-620x.81b2.8988] [Citation(s) in RCA: 146] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
It has been suggested that reamed intramedullary nailing of the femur should be avoided in some patients with multiple injuries. We have studied prospectively the effect of femoral reaming on the inflammatory process as implicated in the pathogenesis of acute respiratory distress syndrome (ARDS) and multiple-organ failure (MOF). We studied changes in the levels of serum interleukin-6 (IL-6) (proinflammatory cytokine), neutrophil CD11b (C3) receptor expression (activated neutrophil adhesion molecule), serum soluble intracellular adhesion molecule (s-ICAM-1), serum soluble E-selectin (the soluble products of endothelial adhesion molecules) and plasma elastase (neutrophil protease) in a series of patients with femoral fractures treated by nailing. We have also compared reamed nailing with unreamed nailing. We found that the levels of serum IL-6 and elastase rose significantly during the nailing procedure indicating a measurable 'second hit'. There was no clear response in leukocyte activation and no difference in the release of endothelial adhesion molecule markers. There was no significant difference between groups treated by reamed and unreamed nailing. Although clinically unremarkable, the one patient who died from ARDS was shown to be hyperstimulated after injury and again after nailing, suggesting the importance of an excessive inflammatory reaction in the pathogenesis of these serious problems. Our findings have shown that there is a second hit associated with femoral nailing and suggest that the degree of the inflammatory reaction may be important in the pathogenesis of ARDS and MOF.
Collapse
Affiliation(s)
- P V Giannoudis
- St James's University Hospital, and University of Leeds, England, UK
| | | | | | | | | | | |
Collapse
|
42
|
Babst R, Bongiorno L, Marini M, Roda LG, Spagnoli G, Urbani A. Trauma decreases leucine enkephalin hydrolysis in human plasma. J Pharmacol Exp Ther 1999; 288:766-73. [PMID: 9918587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Abstract
Plasma hydrolysis of leucine enkephalin was evaluated, together with several cellular immune parameters, in a homogeneous group of human subjects who had undergone severe trauma (proximal femur fracture); data obtained were compared with those obtained in an age-matched control group. In the experimental group, immediately after hospitalization, substrate hydrolysis was reduced with respect both to the control subjects and the same patients 4 weeks after the trauma. Chromatographic separation of the enzymes active on leu-enkephalin showed that the reduction of substrate hydrolysis is mainly attributable to the decrease in the activity of enkephalin-degrading enzymes, principally of aminopeptidases, per se, whereas the role of the low-molecular-weight plasma inhibitors is only minor. In the same subjects, several of the immunological parameters measured underwent modifications that may be considered stress related. However, the absence of a quantitative relationship between reduction in hydrolysis and modifications of immune parameters does not support the hypothesis of a direct relationship between these two sets of data.
Collapse
Affiliation(s)
- R Babst
- Research Division, Department of Surgery, University of Basel, Basel, Switzerland
| | | | | | | | | | | |
Collapse
|
43
|
Aguilar MM, Battistella FD, Owings JT, Olson SA, MacColl K. Posttraumatic lymphocyte response: a comparison between peripheral blood T cells and tissue T cells. J Trauma 1998; 45:14-8. [PMID: 9680005 DOI: 10.1097/00005373-199807000-00003] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND T-cell response to trauma has been assessed primarily by sampling peripheral blood lymphocytes. We hypothesized that lymphocytes residing in tissue and traveling through lymph vessels are more likely to be activated by tissue injury and hemorrhage-induced hypoperfusion. We compared peripheral blood T-cell response with tissue or lymph T-cell response in an ovine model of multiple injury. METHODS Anesthetized adult sheep instrumented with a chronic prefemoral lymph fistula were subjected to lower-extremity fractures, fixed-volume hemorrhage, resuscitation, and fracture stabilization. Peripheral blood and tissue T-cell receptor expression was determined at baseline and after injury. RESULTS At baseline, we found significant differences in the expression of CD4, CD8, and L selectin between peripheral blood T cells and tissue T cells. After trauma, the percentage of tissue T cells expressing CD8 decreased from 19 +/- 9 to 14 +/- 5 (p < 0.05) and the percentage expressing gammadelta-TcR receptors decreased from 12 +/- 4 to 7 +/- 2 (p < 0.05). T-cell phenotype composition in peripheral blood was not affected by trauma. CONCLUSION Peripheral blood T-cell composition differs from tissue T-cell composition before and after trauma. Trauma produced changes in tissue T-cell phenotypes but not in peripheral blood T-cell phenotypes.
Collapse
Affiliation(s)
- M M Aguilar
- Department of Surgery, University of California, Davis, Health System, Sacramento, USA
| | | | | | | | | |
Collapse
|
44
|
Sterk J, Willy C, Gerngross H. [Femur osteosynthesis in the polytrauma patient--considerations for reasonable surgery time frame from the viewpoint of military service medical treatment]. Langenbecks Arch Chir Suppl Kongressbd 1998; 114:1005-10. [PMID: 9574317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECT What are the concepts of secondary osteosynthesis in polytrauma patients? What are indicators underlying these concepts? Are there consequences for Military Medicine? RESULTS Conservative stabilization techniques are unsuitable. The intramedullary nail is considered to be large-scaled and technically demanding. It leads to additional stress for the patient (second hit). The following parameters are not suitable: General status, soft-tissue condition, lung fluid, thrombocytes, PNM elastase, cathepsine, lactate, CRP, neopterin, AT III, t-PA-inhibitor, PFI-index, bilirubin. CONCLUSIONS An objective parameter for the choice of the proper timing of definitive fracture treatment does not exist. In the literature, only few parameters are enumerated. Inconsistent recommendations are hardly discussed. Therefore, from the viewpoint of Military Medicine, we recommend external fixation for primary stabilization. Finally, the systemic inflammatory response has eased off after 5-7 days. Then the definitive operative procedure--intramedullary nailing--should be planned.
Collapse
Affiliation(s)
- J Sterk
- Abteilung Chirurgie, Bundeswehrkrankenhaus Ulm
| | | | | |
Collapse
|
45
|
Kotel'nikov GP, Kondurtsev VA, Chesnokova IG. [Traumatic disease: clinico-pathogenetic, diagnostic and prognostic significance of hemostatic changes]. Klin Med (Mosk) 1998; 76:31-4. [PMID: 9532912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
46
|
Giannoudis PV, Smith MR, Evans RT, Bellamy MC, Guillou PJ. Serum CRP and IL-6 levels after trauma. Not predictive of septic complications in 31 patients. Acta Orthop Scand 1998; 69:184-8. [PMID: 9602781 DOI: 10.3109/17453679809117625] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We studied 31 blunt trauma victims, Injury Severity Score (ISS) mean 14 (9-57), for the pattern of release of C-reactive protein (CRP) and cytokine interleukin-6 (IL-6). Blood samples were taken on admission (within 6 hours of injury), as well as at 24 hours, and 3, 5 and 7 days. Serum CRP and IL-6 were measured by ELISA. Subsequent surgical events and sepsis were noted. Serum IL-6 levels on admission were considerably higher (median 135 pg mL-1) than our laboratory reference range (< 5 pg mL-1), slowly returning towards reference values during the study. Serum CRP levels were similar to laboratory normal values on admission (median 8.5 mg L-1 vs 7.5 mg L-1), reaching peak values (median 110 mg L-1) after 3 days. There was a correlation between IL-6 release and ISS but not between CRP and ISS. Patients undergoing surgery showed further increases in IL-6 and CRP levels postoperatively. Of 24 surgical patients, 9 developed postoperative sepsis. In blunt trauma patients, early assessment of the markers CRP or IL-6 were not useful for the diagnosis of sepsis. Levels of CRP following accidental or surgical trauma should be assessed with caution.
Collapse
Affiliation(s)
- P V Giannoudis
- Department of Trauma, St. James's University Hospital, Leeds, U.K
| | | | | | | | | |
Collapse
|
47
|
Niedźwiedzki T, Dabrowski Z, Brudnicki J, Januszewski M. [Relationship between osteocalcin serum level and radiologic changes in long bone fracture healing--preliminary conclusions]. Chir Narzadow Ruchu Ortop Pol 1997; 62:149-54. [PMID: 9273254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The osteocalcin serum level was monitored in 6 patients with long bone fracture. Immunohistochemical method was used at the day of fracture and also 7, 10, 14, 21, and 28 days after. In 3 cases an autogenic bone marrow grafting was done and osteocalcin level was monitored. The progressive increase was observed in the 4th week after fracture.
Collapse
|
48
|
Ciarallo L, Fleisher G. Femoral fractures: are children at risk for significant blood loss? Pediatr Emerg Care 1996; 12:343-6. [PMID: 8897541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To quantify the frequency of blood loss necessitating transfusion and identify the clinical factors predictive of severe hemorrhage in children with femoral fractures. DESIGN Retrospective review of computerized discharge diagnoses and medical records between January 1, 1987, and July 31, 1992. SETTING Tertiary care children's hospital. PATIENTS Children younger than 18 years of age, discharged between January 1, 1987, and July 31, 1992, with a final diagnosis of femur fracture. RESULTS The 257 patients ranged in age from birth to 18 years with a mean of 6.5 years; 183 (71%) were male. Fractures were closed in 250 (98%) and represented isolated injuries in 225 (87%) patients. The mean systolic blood pressure (SBP) was 119 mmHg, the mean heart rate (HR) was 114 beats/min, and the mean hematocrit (Hct) was 35.2% on arrival. Eight (2.9%) patients had a SBP less than 90 mmHg, all of which were normal values for age. There were 19 patients with a HR > 150, all were < 4 years old with a mean SBP of 110 mmHg and a mean Hct of 35.6%; none required transfusion. There were 18 patients with a Hct < 30%, 4/18 or 22% required transfusion. Seven of the 257 patients (2.7%) received blood transfusions. All were male, with closed fractures, who were older (11.7 +/- 4.9 vs 6.3 +/- 4.7 years) than the 250 nontransfused patients (P = 0.004). There were no significant differences in presenting vital signs, Hct, type of fracture, or time required to get to the emergency department. Five of the seven transfused patients presented with a Hct < 30% as compared to 13 of the 250 nontransfused patients (P < 0.00002). Two of the transfused patients had isolated femoral fractures; one with hemophilia and the other with a prior femoral fracture. The remaining five patients were multiple trauma victims, with significant injuries in addition to femoral fractures. CONCLUSIONS Otherwise healthy pediatric patients with isolated femoral fractures rarely lose sufficient amounts of blood to necessitate blood transfusion. The majority may be managed by observation alone. Multiple trauma (multiple fractures, pelvic disruptions, retroperitoneal injuries) and underlying disorders are indications for careful monitoring, Hct determination, and cross match for blood. Patients who are older, present with a Hct < 30%, or who have multiple traumatic injuries have a relatively greater risk of needing a transfusion.
Collapse
Affiliation(s)
- L Ciarallo
- Department of Pediatrics, Harvard Medical School, Boston, USA
| | | |
Collapse
|
49
|
Abstract
In this study, the effect of free oxygen radicals on lipid peroxidation and the antioxidant role of alpha-tocopherol (vitamin E) in these reactions were investigated in haematoma fluid and venous blood samples in rabbits with femoral fracture. There were 21 male rabbits, divided into 3 groups. Conjugated dienes values (as optical density) were compared in venous blood of the rabbits in Group I taken preanaesthesia and after the onset of anaesthesia and the difference between these values proved to be insignificant (P > 0.05). A control group (Group 2) was given saline before fracture occurrence and the other group (Group 3) was injected with alpha-tocopherol 20 mg/kg intramuscularly. Venous blood samples and fracture haematoma fluids in both Group 2 and Group 3 were assayed biochemically. It was established that conjugated dienes values in fracture haematoma fluid in rabbits in the control group were higher than the values in the venous blood of the rabbits in the same group (P < 0.05). However, conjugated dienes values in the alpha-tocopherol injected group both in the haematoma fluid and in venous blood were reduced compared with those in the control group (P < 0.5). In view of the fact that ischaemia and reperfusion develop in fractured regions and that general body ischaemia develops following serious fractures of the extremities, we consider that prophylactic administration of antioxidants such as alpha-tocopherol may be beneficial in suppressing the destructive effects of free oxygen radicals in cells.
Collapse
Affiliation(s)
- K Durak
- Uludağ University Department of Orthopaedics and Traumatology, Görükle, Bursa, Turkey
| | | | | | | | | | | |
Collapse
|
50
|
Abstract
Cortisol production rate and urinary free cortisol excretion have been measured in healthy elderly women and elderly women about two weeks after upper femur fracture. Plasma cortisol was determined mid-morning, at the start of urine collection. All three variables were higher in the injured patients than in the control subjects. Urinary free cortisol excretion showed the greatest rise and was correlated with cortisol production rate in the patients. In the control subjects there was no correlation and nearly all the points fell below the regression line for the injured patients, indicating that urinary free cortisol excretion rose in relation to cortisol production rate after injury. Measurement of creatinine clearance showed that this was not due to an increased glomerular filtration rate, and a possible explanation is decreased metabolic clearance of cortisol. Plasma cortisol was not significantly correlated with either cortisol production rate or urinary free cortisol excretion.
Collapse
Affiliation(s)
- R N Barton
- North Western Injury Research Centre, Manchester, UK
| | | | | |
Collapse
|