Acute compartment syndrome (ACS) of the lower leg is a time-sensitive orthopedic emergency that relies heavily on precise clinical findings. Late findings of ACS can lead to limb amputation, contractures, paralysis, multiorgan failure, and death. Hallmark symptoms of ACS include the 6 P’s: pain, poikilothermia, pallor, paresthesia, pulselessness, and paralysis. Suspicion of ACS is confirmed by measurement of intracompartmental pressure of the affected compartment. The definitive treatment of ACS is timely fasciotomy. We review the pathophysiology, common causes, diagnosis, and treatment of this potentially devastating condition.
In eight healthy men a 20-min load of 1.5 W/kg body weight on a bicycle ergometer led to a significant increase of alanine and decline of leucine. Exhausting exercise caused in the same subjects a highly significant increase of alanine and decline of isoleucine, threonine, ornithine, leucine, serine, glycine, and asparasine and glutamine. The methionine and citrulline level declines also significantly. The total amino acids practically did not change. Physical exercise led furthermore to a marked increase of serum ammonia and uric acid. Urea nitrogen changed only little and on average had rather a declining tendency. The rise of alanine suggests the existence of a glucose-alanine cycle, the drop of ornithine and citrulline is most probably associated with the inhibition of ureogenesis in the liver. The reduction of leucine and isoleucine is probably the result of the entry of these amino acids into muscle and their deamination.
Obstructive sleep apnea (OSA) is highly prevalent in patients undergoing total joint arthroplasty (TJA) and is a major risk factor for postoperative cardiovascular complications and death. Recognizing this, the American Society of Anesthesiologists urges clinicians to implement special considerations in the perioperative care of OSA patients. However, as the volume of patients presenting for TJA increases, resources to implement these recommendations are limited. This necessitates mechanisms to efficiently risk stratify patients having OSA who may be susceptible to post-TJA cardiovascular complications. We explore the role of perioperative measurement of cardiac troponins (cTns) and brain natriuretic peptides (BNPs) in helping determine which OSA patients are at increased risk for post-TJA cardiovascular-related morbidity.
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