RESUMEN
Twenty-four wrist arthrodeses were performed on 18 patients with rheumatoid arthritis using a bioabsorbable self-reinforced poly-L-lactide rod as the fixation device. There was one nonunion which required a re-operation and two nonunions which did not need further treatment. The position of the arthrodesis was ulnar deviation and extension in most patients, and there was high patient satisfaction with 21 of the 24 wrists and satisfactory pain relief in 22 of the 24 wrists. This method for fusing the wrist in patients with rheumatoid arthritis appears reliable and simple to perform.
Asunto(s)
Implantes Absorbibles , Artritis Reumatoide/cirugía , Artrodesis/métodos , Fijadores Internos , Articulación de la Muñeca/cirugía , Adulto , Anciano , Artritis Reumatoide/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Poliésteres , Radiografía , Articulación de la Muñeca/diagnóstico por imagenRESUMEN
Self-reinforcing polylevolactic acid (SR-PLLA) implants have been used in arthrodeses of patients with rheumatoid arthritis. No long-term evaluation has been published so far. Two patients (three ankles) with destruction of the ankle joint and seven with destruction of the subtalar joint received ten arthrodeses. One out of three ankle arthrodeses healed and nonunion developed in two. Five out of seven triple arthrodeses attained bony union. Two patients with malunion of the subtalar and talonavicular joints are free of symptoms and need no reoperation. One superficial wound infection healed by oral antibiotics. In one patient, an ankle arthrodesis was performed 6 years after the triple arthrodesis of the left foot. SR-PLLA implants can be used in triple arthrodesis in rheumatoid arthritic patients with good results comparable to those of other studies. The problems with nonunion of ankle arthrodeses noticed in former studies are also attributable to this fixation method.
Asunto(s)
Implantes Absorbibles , Articulación del Tobillo/cirugía , Artritis Reumatoide/cirugía , Materiales Biocompatibles , Prótesis Articulares , Ácido Láctico/uso terapéutico , Ensayo de Materiales , Polímeros/uso terapéutico , Adulto , Anciano , Articulación del Tobillo/fisiopatología , Artritis Reumatoide/diagnóstico , Artrodesis/métodos , Femenino , Estudios de Seguimiento , Deformidades Adquiridas del Pie/diagnóstico , Deformidades Adquiridas del Pie/cirugía , Humanos , Ácido Láctico/análogos & derivados , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Rango del Movimiento Articular , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
OBJECTIVE: Implants made of self-reinforcing polylevolactic acid (SR-PLLA) have been successfully used in arthrodeses of patients with rheumatoid arthritis. No lone-term evaluation on bioabsorbable fixation in patients with rheumatoid arthritis has been published so far. METHODS: In this study 21 wrist fusions were performed on 18 patients with rheumatoid arthritis by using SR-PLLA rods as fixation devices. The follow-up time was 3-8 years (mean 5.4 years). RESULTS: The results showed one non-union but no infections or problems associated with the bioabsorbable implants used. CONCLUSION: According to this study, fixation of wrist arthrodesis in patients with rheumatoid arthritis can be performed by using SR-PLLA implants with favourable results. The benefit of this method is the avoidance of the removal operation of fixation devices.
Asunto(s)
Implantes Absorbibles , Artritis Reumatoide/cirugía , Artrodesis , Articulación de la Muñeca/cirugía , Adulto , Artritis Reumatoide/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Radiografía , Resultado del Tratamiento , Articulación de la Muñeca/diagnóstico por imagenRESUMEN
We studied the genotoxic and apoptosis-inducing properties of ganciclovir (GCV) and penciclovir (PCV) using Chinese hamster ovary cells stably transfected with the thymidine kinase (tk) gene of herpes simplex virus-1 (HSV-1). Cells expressing HSVtk were 300 and 100 times more sensitive than their isogenic HSVtk- counterparts to the cytotoxic effects of GCV and PCV, respectively. Using radiolabeled drugs, GCV was found to be incorporated into the genomic DNA much more effectively than PCV. GCV was highly potent in inducing chromosomal aberrations compared with PCV, which provoked less sister chromatid exchanges and chromosomal changes using equimolar or equitoxic doses. For both agents, apoptosis was shown to be the major route of cell killing. Time course experiments revealed that neither genotoxicity nor apoptosis were induced within the cell cycle exposed to the drug; they are late events provoked in the following cell cycle(s). This indicates that the incorporation/exposure step of GCV or PCV into DNA is not decisive for triggering genotoxicity and apoptosis, but that events occurring subsequently, presumably during replication of a DNA containing the nucleotide analogs, are of major importance. Because PCV, unlike GCV, induced highly effectively apoptosis without exerting much genotoxicity, the use of PCV as a relatively safe alternative drug for suicide gene therapy of malignant diseases is recommended.
