The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Jul 2001
Randomized Controlled Trial Comparative Study Clinical TrialMechanical prophylaxis against deep-vein thrombosis after pelvic and acetabular fractures.
Deep-vein thrombosis is a common complication following pelvic and acetabular fractures. The hypothesis of this study was that pulsatile mechanical compression is superior to standard sequential mechanical compression for decreasing the prevalence of deep-vein thrombosis in patients with pelvic or acetabular fracture. ⋯ Pulsatile compression was associated with fewer deep-vein thromboses than was standard compression, with the difference representing a trend but not reaching significance with the number of patients studied.
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J Bone Joint Surg Am · Jul 2001
Comparative Study Clinical TrialOral pentoxifylline inhibits release of tumor necrosis factor-alpha from human peripheral blood monocytes : a potential treatment for aseptic loosening of total joint components.
Pentoxifylline (Trental) is a methylxanthine-derivative drug that has been used for more than twenty years in the treatment of peripheral vascular disease. Pentoxifylline is also a potent inhibitor of tumor necrosis factor-alpha (TNF-alpha) secretion, both in vitro and in vivo, and has demonstrated efficacy in the treatment of certain animal and human inflammatory diseases. Pentoxifylline has a potential therapeutic role in the treatment of aseptic loosening of total joint replacement components because it inhibits TNF-alpha secretion by particle-stimulated human peripheral blood monocytes. The purpose of our study was to determine whether the particle-stimulated secretion of TNF-alpha by peripheral blood monocytes was inhibited in volunteers who had received pentoxifylline orally. ⋯ To our knowledge, this is the first study to demonstrate the ability of an oral drug to decrease the release of TNF-alpha from human peripheral blood monocytes exposed ex vivo to particle debris. TNF-alpha is involved in the pathogenesis of osteolysis and subsequent loosening of total joint arthroplasty components. The ability to suppress the release of TNF-alpha in patients with a total joint replacement may help to control osteolysis and to reduce the development of aseptic loosening. This effect could increase implant longevity and decrease the need for revision arthroplasty.
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Patients' expectations of medical care are linked to their requests for treatment and to their assessments of outcome and satisfaction. Our goals were to measure patients" preoperative expectations of knee surgery and to develop and test patient-derived knee expectations surveys. ⋯ Patients have multiple expectations of knee surgery in the areas of symptom relief and improvement of physical and psychosocial function, and these expectations vary according to the diagnosis. We developed two valid and reliable surveys that can be used preoperatively to direct patient education and shared decision-making and to provide a framework for setting reasonable goals. Reexamining patients' responses postoperatively could provide a way to assess fulfillment of expectations, which is a crucial patient-derived measure of outcome and satisfaction.
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J Bone Joint Surg Am · Jul 2001
The Internet as a communication tool for academic orthopaedic surgery departments in the United States.
The Internet's appeal as an affordable, accessible medium for information transfer makes it a potentially useful tool for practicing physicians. In the past several years, Internet-based health-care companies have proliferated, and many medical centers have established individual web sites. The purpose of the present study was to evaluate academic orthopaedic surgery departments in the United States with respect to Internet visibility and content. ⋯ Academic orthopaedic surgery departments in the United States underutilize the Internet as a source of clinical and educational services. In addition, existing orthopaedic web sites are difficult to access with use of popular search engines. Thus, academic orthopaedic surgery departments in the United States are missing a valuable opportunity to promote awareness of their institutions and to become educational resources for the community.