Acta orthopaedica Scandinavica
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Between April 1990 and December 1994, we treated 24 patients with telangiectatic osteosarcoma (TO) of the extremities with neoadjuvant chemotherapy using 2 protocols. Surgery consisted of limb salvage in 21 patients and amputation or rotation plasty in 3. The histologic response to chemotherapy was good (90% or more tumor necrosis) in 23 patients, of whom 12 had total necrosis. ⋯ There were no local recurrences. Comparing these results to the ones achieved in 269 contemporary patients with conventional osteosarcoma of the extremities using the same protocols for chemotherapy, we found a significantly better histologic response to chemotherapy (96% vs 68% of good histologic response; p = 0.004) and disease-free survival (83% vs 55%; p = 0.01) in the TO group. We conclude that TO, once considered a lethal tumor, seems to be even more sensitive to chemotherapy than conventional osteosarcoma, and that most of these patients may be cured without amputation.
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We determined the current trends in the number and incidence of osteoporotic fractures of the proximal humerus in Finland by collecting from the National Hospital Discharge Register all patients 60 years of age or more who were admitted to Finnish hospitals in 1970-1998 for primary treatment of such fractures. The fracture was defined osteoporotic if it was caused by a low-energy trauma only, i.e., a fall from standing height or less. ⋯ Even after the age-adjustment, the incidence of fractures showed a clear increase: in women from 50 in 1970 to 133 in 1998, and in men from 14 in 1970 to 49 in 1998. If this trend continues, there will be three times more osteoporotic fractures of the proximal humerus in Finland in the year 2030 than there were in 1998.
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Randomized Controlled Trial Comparative Study Clinical Trial
Intraarticular morphine after arthroscopic ACL reconstruction: a double-blind placebo-controlled study of 40 patients.
We compared analgesic effects and pharmacokinetics of intraarticular versus intravenous administration of morphine after arthroscopic anterior cruciate ligament surgery. In a double-blind placebo-controlled study, 40 patients were randomly allocated to one of four treatment groups. ⋯ After intraarticular injection of 1 mg and 5 mg morphine, respectively, low concentrations of morphine-6-glucuronide (M6G) were found in the circulation, while morphine-3-glucuronide (M3G) appeared late after the injection in concentrations that considerably exceeded those of morphine in groups I and II. The analgesic effect of intraarticular morphine together with the low levels of morphine and morphine-6-glucuronide in plasma further strengthens the view that opioids have a peripheral mechanism of action.
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Randomized Controlled Trial Clinical Trial
Tranexamic acid, given at the end of the operation, does not reduce postoperative blood loss in hip arthroplasty.
We performed a randomized double-blind study on the effect of tranexamic acid on postoperative blood loss and blood transfusions in 39 primary THR operations. Tranexamic acid was given at the end of the operation and 3 hours later. Ultrasound examination 1 week later was performed to measure the occurrence of deep hematomas. ⋯ This lack of effect was possibly related to the fact that the drug was administered too late. In 11 of the 20 patients receiving tranexamic acid, blood transfusion was not necessary, this being the case in 4/19 in the placebo group (p = 0.05). The occurrence of postoperative deep venous thromboses was similar in the tranexamic acid and placebo groups.