Tourniquets commonly are used during total knee arthroplasties to reduce intraoperative blood loss, despite their various side effects. The goal of this study was to determine whether tourniquet use could be avoided using epinephrine-augmented hypotensive epidural anesthesia during a total knee arthroplasty without negative effects on perioperative hemoglobin values. One hundred patients having total knee arthroplasties were included in a prospective, observer-blinded, controlled, and randomized study. Forty-nine patients received epinephrine-augmented hypotensive epidural anesthesia without use of a tourniquet (Group A), and 51 patients received normotensive epidural anesthesia with use of a tourniquet (Group B). Hemoglobin was evaluated and is reported preoperatively, immediately and 6 hours postoperatively, and on Days 1, 2, 3, 5, and 6 in absolute and relative values. Data were not collected for Day 4. Greater absolute and relative postoperative hemoglobin values were observed in Group A immediately postoperative, on Day 5, and on Day 6. In patients who did not have transfusions, the mean relative hemoglobin values were greater in Group A at all times evaluated (except on Day 1). Epinephrine-augmented hypotensive epidural anesthesia is an effective method to avoid the use of a tourniquet during total knee arthroplasty without the negative effects on perioperative hemoglobin values. Level of Evidence: Therapeutic study, Level I-1a (randomized controlled trial, significant difference). See the Guidelines for Authors for a complete description of levels of evidence.
The aim of the current study was to reveal whether 7 days of indomethacin treatment sufficiently prevents heterotopic ossification after cementless total hip arthroplasty. One group received indomethacin for 14 days (n = 102), and the second for 7 days (n = 99) after cementless total hip arthroplasty. At followup 1 year postoperatively, the average Harris Hip Score was 91 points in the 14-day treatment group and 89 points in the 7-day treatment group. The incidence of heterotopic ossification as outlined by Brooker was similar in both groups. Ninety-six patients in the 14-day treatment group had heterotopic ossification Grades 0 or 1, and 6 patients had Grade II heterotopic ossification; whereas in the 7-day treatment group, 95 patients had Grades 0 or 1 heterotopic ossification and 4 patients had Grade II ossification. None of the patients had Grades III or IV heterotopic ossification. In the 14-day treatment group, headache, dizziness, or gastritic disorders develop in 10 patients, and in the 7-day treatment group, 7 patients had these effects. This study shows that treatment with 100 mg indomethacin daily for 7 days is not significantly different than 14 days of treatment for the prevention of formation of severe heterotopic ossification after cementless hip arthroplasty.
Data on histochemical and biochemical characteristics of the human oviduct are scarce. The exact mechanisms of ovum transport and pickup are not fully understood.Human fallopian tubes were obtained and prepared for histochemistry. We analyzed the distribution of negatively charged groups on the oviduct epithelium and cumulus cells and examined the distribution of glycoconjugates by means of lectin histochemistry. We tested the possible influence of poly-L-lysine and considered ABO blood group expression since these characteristics are determined by specific terminal sugar residues.A negatively charged glycocalyx exists on tubal epithelial cells and cumulus cells. Adherence by affinities similar to sugar-lectin binding forces could be disproven in case of commonly used lectins. Poly-L-lysine inhibited the cationic binding reaction but did not influence lectin binding. The blood group A glycoprotein presents terminal D-N-acetyl-galactosamine residues, which are demonstrated by HPA lectin binding.Our study indicates that it is unlikely that electrostatic interactions play a major role in ovum transport or pickup. Since poly-L-lysine has been described as inhibiting ovum transport, sugar-lectin binding affinities seem not to operate in ovum transport or pickup.
