Biochemical stress evaluation after medial parapatellar and subvastus approach in total knee replacement.

INTRODUCTION: Even if different surgical approaches for total knee arthroplasty are well known since decades, the standard medial parapatellar incision remains the most common one; general agreement about significant advantages with minimally invasive techniques is lacking. Furthermore, the surgical stress effect on the organism has always been analyzed through blood inflammatory parameters. This study aim was to compare the standard and subvastus approaches, using the salivary cortisol in particular as measure for systemic surgery-related stress. METHODS: Fifteen operations were performed in a consecutive series; clinical (Knee Society Knee Scoring System., a questionnaire score, range of motion, tourniquet time, intra-operative bleeding) and biochemical factors (salivary and hematic cortisol, C-reactive protein, muscular creatine phosphokinase levels) were evaluated. The final follow-up was at two months after the operation. RESULTS: No significant differences were observed in most of the parameters; however, the subvastus group had a sharper and earlier functional improvement trend than the standard one. On the other side, it increased the CPK levels significantly. CONCLUSIONS: In our experience, the medial subvastus approach, firstly associated with greater surgical stress, has then been characterized by a more favorable functional improvement trend. Moreover, the salivary cortisol measurement has proved to be a non-invasive and reliable method to evaluate the systemic surgery-related stress.

In vitro biocompatibility evaluation of a heparinizable material (PUPA), based on polyurethane and poly(amido-amine) components.

The biocompatibility of a new heparinizable material based on polyurethane and poly(amido-amine) (PUPA) was evaluated both in the heparinized and non-heparinized forms. The quantity of heparin present on the material was measured using radiolabelled heparin and biological tests. Heparin release in plasma from heparinized PUPA was investigated using in vitro methods. The behaviour of PUPA towards cellular and plasmatic blood components was studied. The influence of sterilization on the cytocompatibility response of both heparinized and non-heparinized PUPA was investigated; gamma-rays were found to be a suitable method of sterilization as no toxic response was noticed.

[An outpatient regimen for dental improvements in patients with valvular cardiopathies and oral anticoagulant therapy (a preliminary note)]. / Regime ambulatoriale per bonifiche dentarie in pazienti con cardiopatie valvolari e terapia anticoagulante orale (nota preliminare).

The purpose of this paper is to verify the level of confidence of a new approach to the management of patients with cardiovalvular prosthetic and oral treatment with anticoagulants during high level risk oral surgery procedures. The new protocol includes: interrupted oral anticoagulant treatment; ambulatory regimen instead of hospital regimen; special dentistry management. No hemorrhagic complications occurred in the study sample. This paper concludes with a review of the role of Quick test in the management of patients with cardiac prostheses.