Assessment of the general surgical patient
Sam Mehta, Andrew Hindmarsh, Leila Rees in Handbook of General Surgical Emergencies, 2018
A surgical site infection (SSI) is a post-operative complication occurring within 30 days of a surgical procedure. Prevalence is roughly 10% but this is higher for acute surgery. The National Institute for Clinical Excellence is currently working on guidelines for managing SSIs. A clearly written, dated and signed account in the medical notes is a legal requirement and your only defence if there is a problem later. If you have requested a test you should make sure the results are checked and documented. The transcellular fluid compartment includes bone, synovial fluid, gastrointestinal luminal fluid, cerebrospinal fluid and the aqueous humor of the eye. Colloids contain higher molecular weight molecules than crystalloids and will therefore remain longer in the intravascular compartment. They are used as a short-term measure to expand plasma volume and improve blood pressure. In order to minimise errors when taking a sample, blood should be taken from only one patient at a time.
Diagnosis in orthopaedics
Ashley W. Blom, David Warwick, Michael R. Whitehouse in Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Orthopaedics is concerned with bones, joints, muscles, tendons and nerves. The symptoms of orthopaedics are injury, pain, stiffness, swelling, deformity, instability, weakness and loss of function or inability to do certain things. If the symptoms include weakness or incoordination or a change in sensibility, or if they point to any disorder of the neck or back, a complete neurological examination of the related part is mandatory. Acquired deformities in children may be due to fractures involving the physis. Acquired deformities of bone in adults are usually the result of previous malunited fractures. The contrast media used in orthopaedics are mostly iodine-based liquids which can be injected into sinuses, joint cavities or the spinal theca. Arthrocentesis and synovial fluid analysis is a much neglected diagnostic procedure; given the correct indications, it can yield valuable information. In orthopaedic surgery, magnetic resonance imaging (MRI) of the hip, knee, ankle, shoulder and wrist is now fairly commonplace.
Friction, Lubrication, Wear and Corrosion
Manoj Ramachandran, Tom Nunn in Basic Orthopaedic Sciences, 2018
Tribology is defined as the science that deals with the interaction between surfaces in motion and consequences of that interaction, i.e. friction, lubrication and wear. This chapter aims to define tribology in normal synovial joints and in joint replacements, with reference to corrosion in the latter. Synovial fluid is a dialysate of blood plasma, without clotting factors, erythrocytes or haemoglobin. Studies have shown that fluid-film lubrication dominates in synovial joints. In hydrodynamic (HD) lubrication, there is no contact between surfaces and hence no wear. In elastohydrodynamic (EHD) lubrication, elastic deformation of the bearing surface enlarges the area of the bearing surface and traps pressurized fluid. The micro-elastohydrodynamic (MEHD) lubrication model assumes that the asperities of articular cartilage are deformed under high loads. Boosted lubrication assumes that, under squeeze-film conditions, the water in the synovial fluid is pressurized into the cartilage, leaving behind a more concentrated pool of hyaluronic acid-protein complex to lubricate the surfaces.
Detection of cobalt in synovial fluid from metal-on-metal hip prosthesis: correlation with the ion haematic level
Published in Biomarkers, 2013
Alina Beraudi, Simona Catalani, Monica Montesi, Susanna Stea, Alessandra Sudanese, Pietro Apostoli, Aldo Toni
Hip replacement with large metal-on-metal (MoM) coupling has recently been under attention for its metal ions release, inducing several disorders. Since the blood level toxicity threshold for cobalt is known, the aim of this work is to determine whether Co serum and blood levels correlate with the synovial fluid level. Beside this, the synovial fluid Co from patients without prosthesis has also been measured. Co has been determined in 54 samples (32 unilateral MoM and 22 controls) with inductively coupled plasma mass spectrometry in the three matrices. In the prosthesized group, cobalt was significantly higher compared with controls and in the synovial fluid it strongly correlated with whole blood Co (p = 0.847) and serum (p = 0.855). Moreover, the Co levels into whole blood and serum were significantly different. In conclusion, haematic Co concentration correctly reflects Co local level.
Plasma and synovial fluid connective tissue growth factor levels are correlated with disease severity in patients with knee osteoarthritis
Published in Biomarkers, 2012
Sittisak Honsawek, Pongsak Yuktanandana, Aree Tanavalee, Chintana Chirathaworn, Wilai Anomasiri, Wanvisa Udomsinprasert, Natthaphon Saetan, Tanyawan Suantawee, Saran Tantavisut
Background: Connective tissue growth factor (CTGF) has been implicated in development of osteoarthritis (OA). Objective: To determine the correlation between plasma and synovial fluid CTGF levels and the severity in knee osteoarthritis patients. Methods: A total of 100 subjects were recruited into this study (75 OA patients and 25 controls). CTGF concentrations in plasma and synovial fluid were analyzed by enzyme-linked immunosorbent assay. Results: Plasma and synovial fluid CTGF concentrations were correlated with radiographic severity. There was a positive correlation between plasma and synovial fluid CTGF levels. Conclusion: CTGF could be useful for monitoring the severity and progression of OA.
Plasma and Synovial Fluid Soluble CD23 Concentrations in Children with Juvenile Chronic Arthritis
Published in Autoimmunity, 1998
Necil Kutukculer, Suat Caglayan
Since increased levels of sCD23 were demonstrated in patients with autoimmune diseases, plasma and synovial fluid sCD23 levels were examined in 22 patients with juvenile chronic arthritis (JCA) and in 10 children undergoing arthrocentesis for orthopedic disorders. There was no significant difference in plasma sCD23 concentrations between patients with pauciarticular and polyarticular onset. Plasma and synovial fluid sCD23 concentrations were found to be significantly increased in JCA patients as compared to controls. However, plasma sCD23 levels were not positively correlated with laboratory parameters showing disease activity such as erythrocyte sedimentation rate, C-reactive protein, serum lgG and IgA. It was concluded that increased production of sCD23 in peripheral blood and synovial fluid might be important in the pathogenesis of JCA. However, determination of this immunological parameter provides no useful clinical information about disease activity and management.