Social determinants associated to chronic pain after total knee arthroplasty.

AIM OF THE STUDY: Analyze the association between social health determinants (SHD) and chronic post-surgical pain (CPSP) after total knee arthroplasty (TKA). METHOD: A cross-sectional study was performed in 58 TKA patients. The subjects were classified in two groups: with (n = 22) or without (n = 36) CPSP. SHD considered were gender, age, educational level, economic income, and labour conditions. RESULTS: Significant differences were found concerning educational level when comparing subjects with or without CPSP, with a low educational level of 22.4% and 19%, respectively. 15.5% of patients with persistent pain had a high educational level compared with 43.1% of the patients without persistent pain (p = 0.032). No significant differences were found for the other categories (p > 0.05). The odds ratio (95% confidence interval) was 3.28 (1.09-9.93) for lower educational level compared with high educational level. DISCUSSION: CPSP must be considered a severe health problem. In addition to SDH, there are multiple factors associated with chronic pain after TKA that must be considered for an effective treatment. CONCLUSIONS: Patients with lower educational level showed a three-time higher association to develop CPSP. Considering SHD could be of relevance when elaborating new interventions or health strategies and more specialized counseling for patients with persistent pain after TKA.

Successful initial experience with a novel outpatient total hip arthroplasty program in a public health system in Chile.

PURPOSE: The aim of the present study was to assess the first experience with outpatient total hip arthroplasty (THA) in a public health environment in Chile. METHODS: Prospective series of the first 69 patients/72 hips. Surgery was performed in a public university-affiliated hospital. The patients were 64 (31-84) years old and healthy (ASA I-II) candidates for a primary hip arthroplasty. RESULTS: The outpatient track had 52.2% of arthroplasty candidates included and 94.4% (68/72 hips) were successfully discharged the same day. There were no emergency room visits during the first week after surgery. Two patients had single dislocation episodes, one requiring stem revision. There was one deep vein thrombosis. There were no other complications. All the patients reported to be satisfied with the outpatient track. INTERPRETATION: An outpatient track can be developed in a safe manner in this healthcare setting and population. This track of care was well accepted by the patients.

Optimización en el uso de mesa ortopédica e intensificador de imágenes para fracturas proximales de fémur: a propósito de un caso clínico / Use of the orthopedic table and image intensifier in patients with proximal femoral fractures and a stiff hip

Para el adecuado tratamiento de las fracturas proximales de fémur, se utilizan mesa ortopédica e intensificador de imágenes. El presente trabajo expone la solución empleada en una paciente, cuya abducción de extremidades inferiores estaba limitada por una artrodesis de cadera y que se fractura el fémur proximal contralateral. Para resolver este caso, se recurre a un montaje en mesa ortopédica alternativo al tradicional y se modifica la ubicación del intensificador de imágenes. Se deja a la paciente con extremidades inferiores en posición neutra, pasando el arco en C por debajo de ambas extremidades para obtener proyecciones AP y axial. Con esto, se obtiene una imagen axial con clara definición del espacio coxofemoral, sin que se produzca superposición de ambos fémures, como prodría suponerse. Se resuelve el caso sin complicaciones, obteniendo una adecuada reducción y estabilización con un tornillo placa tipo DHS. Las modificaciones empleadas no se han descrito previamente en la literatura, lo que es motivo de interés, dado que la solución empleada es posible de aplicar en todas las fracturas proximales de fémur, incluyendo casos de excepción como el descrito y su uso puede extenderse a fracturas diafisiarias de fémur

Stress-induced hyperglycemia and hypoinsulinemia are suppressed by sulfonylurea: predominant role of insulin

Based on the in vitro blockade of adrenal catecholamines release by sulfonylurea, we searched for an anti-stress activity of this drug. Stress-induced hyperglycemia and insulin inhibition were employed sadrenergic stress indicators. A standard dose of the oral sulfonylurea glipizide (200 micrograms/100 g), administered 15 min before a 1-h restraint stress to intact or 80 percent pancreatectomized rats, produced otalsuppression of the stress-induced hyperglycemia-hypoinsulinemia, an effect followed by a significant post-stress hypoglycemia of 1 h duration. The latter effect was elicited by all the sulfonylureas assayed. In the 80 percent pancreatectomized rats, glipizide nearly halved the increases in plasma catecholamines at 30 min of stress, but did not modify those attained at 60 min, when glycemia was decreasing and insulinemia was still increasing. Moreover, behavioral experiments in intact stressed rats showed that the adrenergic overt behavior inhibition caused by propranolol was not produced either by glipizide or insulin, reinforcing that glipizide affect was not mediated by catecholamine inhibition. These findings suggest a blockade of...