The safety of tranexamic acid administration in total knee arthroplasty: a population-based study from Taiwan.

Tranexamic acid is an effective treatment to reduce blood loss. We performed a retrospective observational study to evaluate safety in unilateral total knee arthroplasty. We utilised Taiwan's national health insurance database to identify relevant patients and to retrieve information on peri-operative blood transfusions and tranexamic acid administration within 60 days of follow-up. We examined changes in the rate of transfusions and adverse events with respect to tranexamic acid administration using logistic regression. We observed a total of 226,719 knee arthroplasty cases during 2010-2019. Transfusion and tranexamic acid administration rates were 38.9% (88,258) and 42.9% (97,237), respectively. Tranexamic acid was associated with a 50% decrease in blood transfusions (RR: 0.50, 95%CI: 0.48-0.51). After propensity-score matching, tranexamic acid was not associated with pulmonary embolism; deep vein thromboembolism; artery vein thromboembolism; acute myocardial infarction; ischaemic stroke; or in-hospital mortality, but was significantly associated with acute kidney injury. Patients with existing chronic kidney disease suffered a high absolute risk of kidney injury irrespective of tranexamic acid administration (832 per 10,000, 95%CI 797-869). Tranexamic acid was also associated with surgical site infection. There was strong interaction between blood transfusion; tranexamic aid administration; and development of surgical site infection. In conclusion, tranexamic acid use was associated with decreased blood transfusion and was not associated with thromboembolic events. However, careful consideration is required before use in patients with pre-existing renal disease. Further, our observed interaction between patients given tranexamic acid who subsequently require transfusion requires careful consideration with respect to enhanced prophylaxis against surgical site infection.

Lower urinary tract changes in young adults using ketamine.

PURPOSE: We identified the profile of lower urinary tract changes in ketamine users in the community. In addition, we identified the relative risks of dose, frequency of ingestion and duration of ketamine use for changes in lower urinary tract function. MATERIALS AND METHODS: A mobile medical assessment service was established at specific youth centers, and subjects who were known to social workers and who had a history of ketamine use were invited to participate in health screening. Lower urinary tract function was evaluated using the Pelvic Pain, Urgency and Frequency questionnaire, and uroflowmetry and ultrasonography. RESULTS: Use of ketamine more than 3 times weekly was significantly associated with lower voided volumes. Pelvic Pain, Urgency and Frequency questionnaire scores were significantly higher for ketamine use for more than 24 months compared to use for short durations (7.82 vs 6.00). The scores on the symptom and bother subscales of the Pelvic Pain, Urgency and Frequency questionnaire decreased progressively with increased duration of abstinence. For individuals after 1 year of abstinence the Pelvic Pain, Urgency and Frequency questionnaire scores were significantly lower and voided volumes were higher than those for active users. CONCLUSIONS: Ketamine users with at least a 2-year habit of 3 or more hits per week have altered bladder function that can be recognized and that causes bother. These early functional changes have the potential to normalize after 1 year of ketamine abstinence. This study provides a basis for the development of health promotion material that can be used in the community by welfare workers seeking to encourage drug cessation.

[Research progress of different bowel reconstructions for postoperative functional protection during low anterior resections of rectal cancer].

Straight coloanal anastomosis (SCA), colonic J-pouch anastomosis (CJP), transverse coloplasty pouch anastomosis (TCP), and side-to-end anastomosis (SEA) are the most commonly used procedures of bowel reconstructions in the low anterior resections (LAR) of rectal cancer. Different bowel reconstruction procedures greatly affect postoperative bowel function, urinary function and sexual function. SCA is the most traditional procedure. CJP has been studied extensively and well-developed reconstruction method; however, recent studies have shown that CJP has the highest morbidity of complications, so the clinical application of CJP is limited. SEA is not inferior to CJP and SCA in the short-term and long-term defecation function, urination function, and sexual function, with reliable operational safety, so it is expected to become an alternative to SCA and CJP. The research on TCP is lacking, but there are some related clinical trials currently underway, and the results are worth expecting. The improvement and innovation of bowel reconstructions provide a bright prospect for better functional prognosis in patients with rectal cancer.

[Clinical study on traumatic anterior instability of shoulder].

OBJECTIVE: To study the clinical diagnosis, conservative and surgical treatment of traumatic anterior instability of the shoulder. METHOD: Based on the experience in diagnosis and treatment of 41 patients, we put forward criteria for diagnosis and treatment of traumatic anterior instability of the shoulder. RESULT: Diagnostic criteria: (1) history of injury to the shoulder; (2) sharp pain in the anterior aspect of the shoulder and weakness and limitation of range of motion of the shoulder; (3) the positive apprehension sign and or anterior drawer test; (4) a Hill-Sachs bony lesion on roentgenogram and abnormal double contrast CT. TREATMENT: (1) rehabilitation program for the patients having symptoms less than 3 months and without anterior capsular rupture; (2) capsular repair and imbrication procedure for the patients having symptoms more than 3 months, or not satisfied to the rehabilitation treatment, or severe anterior capsular rupture on double contrast CT. The results of the treatment were satisfactory with average 16-month follow-up. CONCLUSION: The diagnostic criteria and the treatment principles help improve the results of treatment of shoulder injuries, further clinical study is needed for traumatic anterior instability of the shoulder.

[Measure of vibration protection effect of driver's corset and analysis of its biomechanical effect].

The purpose of this study was to evaluate the vibration protection and biomechanical effect of driver's corset. The frequencies of vertfical and horizontal vibrations were measured at low back of driver. The vehicle driven was ISUZU truck (loading capacity 8 tons). Vibration of the driver's lumbar back was measured real time with wear corset and without wear corset when the truck loaded with 6 tons was driven at the spead of ten, thirty and sixty kilometers an hour on the asphalt road. The results showed: 1. Vibration frequencies at driver's low back was under 10 Hz. It is a low frequency vibration. 2. The value of vertical vibration was higher than the value of horizontal (back and forth) vibration. 3. The vibration value of wear corset was higher than un-wear corset. These indicate the driver's corset is effective for protecting lumbar spine by means of change in the biomechanical characteristics and the resonace requencies of lumbar spine. So the driver's corset is one of the good methods for preventing the back pain of drivers.

Safety and efficacy of low-potassium dialysate.

To evaluate the safety and efficacy of low-potassium dialysate, 11 patients with stable end-stage renal disease and with no history of arrhythmia or digitalis use were studied. All were treated with hemodialysis three times per week. Dialysates with potassium concentrations of 2 mEq/L, 1 mEq/L, or 0 mEq/L were compared. Each patient (exceptions noted in text) was studied once at each bath potassium concentration. Cardiac rhythm was recorded by Holter monitor during and for six hours following dialysis. Single PVCs and APCs were common with all potassium concentrations. Only one patient had high-grade ventricular ectopy. It was seen with each of the three potassium concentrations, but was most severe with the potassium-free dialysate. The potassium-free dialysate removed significantly more potassium (78.5 +/- 2.6 mEq) than the 1-K dialysate (62.9 +/- 5.1 mEq) or the 2-K dialysate (50.6 +/- 6 mEq), and the 1-K dialysate removed significantly more potassium than the 2-K dialysate. There were small but significant differences in serum potassium concentrations with the three different dialysates. It was concluded that (1) in all but one of our patients potassium-free dialysate did not produce new ectopy; (2) potassium-free dialysate was 24% more effective than 1-K dialysate and 50% more effective than 2-K dialysate in removing body potassium; and (3) 1-K dialysate was 20% more effective than 2-K dialysate in removing body potassium.

Locked nailing for displaced surgical neck fractures of the humerus.

OBJECTIVE: To report experience with a newly devised humeral locked nail for treating surgical neck fractures of the humerus. This device has the advantages of a small diameter for minimal tissue trauma and transfixing locking screws for reliable fixation. METHODS: From 1993 to 1996, 21 consecutive severely displaced surgical neck fractures of the humerus were antegrade nailed with humeral locked nails; 2 fractures were associated with dislocation and 1 fracture was a comminuted metaphyseal fracture with a failed plating. The average age of patients was 65.8 years; average follow-up time was 19.2 months. The proximal screws were applied upward in 5 patients and downward in 16 patients. Static locking was performed in 8 patients, dynamic locking in 13 others. RESULTS: The average operation time was 55 minutes. No patients needed blood transfusion. All fractures eventually achieved union with an average time to union of 14.8 weeks. On the basis of Neer criteria for outcome analysis, excellent or satisfactory results were obtained for 86% of the patients (18 of 21 patients). No patients had deep infection, implant failure, malunion, osteonecrosis, or nail migration that interfered with joint motion. Due to technique errors, one patient had shoulder joint impingement caused by protrusion of the proximal nail tip. CONCLUSION: The operative method reported here has the advantages of minimal tissue trauma, minimal hardware application, sufficient fixation, and easy operative technique, and it can be a worthy alternative for the treatment of severely displaced surgical neck fractures of the humerus.