Background The anterior midline skin incision in a TKA provides excellent surgical exposure. However, it usually requires sectioning the infrapatellar branch of the saphenous nerve which may be associated with lateral cutaneous hypesthesia and neuroma formation.Questions/purposes We asked whether an anterolateral skin incision to the knee would decrease the area of skin hypesthesia and associated postoperative discomfort. Patients and Methods We randomized 69 knees to receive a TKA through either a midline or an anterolateral skin incision. We assessed skin sensitivity by application of the Semmes-Weinstein monofilament at 13 reference points at 6 weeks and 6 and 12 months postoperatively.
Visceral glomerular epithelial cells (GEC) are crucial for glomerular permselectivity and structural integrity in the kidney. The current study addressed the role of cyclooxygenase (COX)-2 and its product prostaglandin (PG) E2 in GEC survival. We generated a subclone of cultured rat GEC, which overexpress COX-2 in an inducible manner. When COX-2 was induced, GEC survived better in serum-deprived conditions. Induction of COX-2 was correlated with increased PGE2 generation, increased activation of extracellular signal-regulated kinase, decreased apoptosis, and increased cell proliferation. Rat GEC abundantly expressed the EP4 isoform of PGE2 receptor. Induction of COX-2 and addition of exogenous PGE2 both lead to decreased serum deprivation-induced apoptosis, which was accompanied by activation of the survival kinase Akt. Anti-apoptotic effect of COX-2 induction was reversed by the specific inhibitor of the EP4 receptor, L-161982. PGE2 also inhibited puromycin aminonucleoside-induced GEC apoptosis in vitro. Acute puromycin aminonucleoside nephrosis (PAN) is a rat model of GEC injury and proteinuria. In rats with PAN, glomerular apoptosis, quantified as caspase-3 activity, as well as urinary protein excretion were significantly increased, compared with control rats. Administration of L-161982 in rats with PAN further exacerbated caspase-3 activation and proteinuria. Thus COX-2 and its product PGE2 may have anti-apoptotic/protective effect on GEC via the EP4 receptor of PGE2.
Based on a multi-year experience of the Burdenko neurosurgical institute and Moscow region forensic medical examination Bureau for the first time there has been developed the conception of head injury sequelae. Definitions of “head injury sequelae” and “head injury complications” are given. Clinical and morphological classification has been developed with special emphasis being placed on tissue changes, CSF dynamics and vascular sequelae of head injury. A detailed clinical, CT and MRI analysis of each of the outlined forms of head injury alongside with the conceptual approaches of their treatment is presented. Criteria of adequate forensic medical examination of this frequent posttraumatic pathology are given by the authors.
The aim of the investigation – to study changes in hepatic tissue resulting from the influence of low temperatures (– 195,8 °C) in experiments and clinic. Hepatic tissue investigations in experiment have been carried out using electron and light microscopy. During the surgery instruments of original design have been used – cryoscalpels and cryodestructors. Experiments have been carried out on 45 sexually mature dogs of both sexes. Animals have been separated into 3 groups. On the first group (consisting of 12 animals), in the acute experiment, there have been studied features of cryoscalpel design characteristics. In the second series of experiment (on 22 dogs) there have been made a comparative study of hepatic resection using cryoultrasonic scalpel and simple surgical scalpel by means of the study of hemorrhage quantity. In 11 cases there have been studied hepatic morphological changes affected by cryoeffect. By the effect of low temperature ice crystals are appeared in hepatic tissue intracellularly and outside the cell, they cause mechanical injury and rupture of hepatic tissue. In 45 days connective tissue elements are formed at the place of cryodestruction. The use of cryoultrasonic scalpel in hepatic resection in the experiment decreases the hemorrhage quantity by 1,26 times as compared to the traditional methods. Positive experimental investigations allowed to use the low temperature with success in clinical practice at 253 patients with different localized hepatic diseases with 13 lethal outcomes (5,1%). Thus, the used cryosurgical technique during surgical operations allows to decrease significantly the hemorrhage, to eliminate parenchymatous bleeding and to prevent relapses of disease both at growths and at parasitic hepatic affection.
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