Галерея 2549869
Галерея 2549869
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1 Department of Medicine, School of Public Health, University of California, Los Angeles 90024.
N M Elsayed et al.
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1989 Sep .
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1 Department of Medicine, School of Public Health, University of California, Los Angeles 90024.
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Cell injury from hyperoxia is associated with increased formation of superoxide radicals (O2-). One potential source for O2- radicals is the reduction of molecular O2 catalyzed by xanthine oxidase (XO). Physiologically, this reaction occurs at a relatively low rate, because the native form of the enzyme is xanthine dehydrogenase (XD) which produces NADH instead of O2-. Reports of accelerated conversion of XD to XO, and increased formation of O2- formation in ischemia-reperfusion injury, led us to examine whether hyperoxia, which is known to increase O2- radical formation, is associated with increased lung XO activity, and accelerated conversion of XD to XO. We exposed 3-month-old rats either to greater than 98% O2 or room air. After 48 h, we sacrificed the rats and measured XD and XO activities and uric acid contents of the lungs. We also measured the activities of the two enzymes in the heart as a control organ. We found that the activity of XD was not altered significantly by hyperoxia in rat lungs or hearts, but XO activity was markedly lower in the lung, whether expressed per whole organ or per milligram protein, and remained unchanged in the heart. Lung uric acid content was also significantly lower with hyperoxia. The decrease in lung XO activity may reflect inactivation of the enzyme by reactive O2 metabolites, possibly as a negative feedback mechanism. The concomitant decrease in uric acid content suggests either decreased production mediated by XO due to its inactivation or greater utilization of uric acid as an antioxidant. We examined these postulates in vitro using a xanthine/xanthine oxidase system and found that H2O2, but not uric acid, has an inhibitory effect on O2- formation in the system. We therefore conclude that hyperoxia is not associated with increased conversion of XD to XO, and that the exact contribution of XO to hyperoxic lung injury in vivo remains unclear.
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Replacing a Worn-Out Joint of the Finger
Jonathan Cluett, MD, is a board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery.
Yaw Boachie-Adjei, MD, is a board-certified, double-fellowship Orthopedic Surgeon.
Arthritis commonly affects the joints of our fingers. When is finger joint replacement an option? Finger joints are important for many activities, and severe arthritis of the hands and fingers can cause significant disability.
Arthritis is a condition that occurs when there is inflammation of a joint, a point in your body where two bones connect and movement takes place. The most common types of arthritis to occur in the hands are osteoarthritis and rheumatoid arthritis. Osteoarthritis typically occurs in the knuckle joints of the finger. Rheumatoid arthritis is most common at the knuckle at the base of the finger where it joins the hand. The typical symptoms of arthritis include pain, swelling, and loss of mobility. As arthritis progresses, deformities of the finger become common, and a crooked finger is typical.
Treatment of finger arthritis is usually focused on trying to manage symptoms with simple steps. Because we don't walk on our hands, unlike hips and knees, many people can manage their symptoms with simple treatments. These conservative treatments for finger arthritis may include:
If these treatments do not provide sufficient relief of your symptoms, then surgical treatments may be considered. There are several surgical options, but a finger joint replacement may be a reasonable treatment consideration. Just like more commonly performed hip and knee replacements , a finger joint replacement involves removal of the damaged joint surface and replacement with an artificial implant designed to replicate normal joint function .
Finger joint replacement is intended to accomplish three specific goals. First, the replacement should relieve pain. Second, the finger joint should be stable. And finally, the finger should have good mobility. If these goals cannot be met, because of the condition of the finger, the activities of the patient, or for other reasons, then alternatives to finger joint replacement should be considered.
Finger joint replacement should be considered when simpler treatments described above do not sufficiently relieve discomfort. Finger joint replacement is generally reserved for older patients who do not perform heavy labor activities. Because finger replacement implants may wear out or loosen over time, they are not appropriate for younger, more active patients. In these patients, alternative surgical procedures may be considered (see below).
Finger joint replacement surgery is performed by first removing the damaged and deformed joint surface. Once the damaged portion of the joint is removed, the bone ends are shaped to accommodate the artificial implant. Finger implants may be made of metal, ceramic, or plastic. The implants are positioned and held tightly in the hollow center of the bone. Care is taken to protect the tendons and ligaments that surround the joint.
After surgery, you will work with a hand therapist to regain mobility and strength of the joint. Total recovery after finger joint replacement can take several months. Risks of finger joint replacement include infection, nerve injury, joint instability , and implant problems including wearing out and loosening. As stated before, generally finger joint replacements are best suited for individuals who do not stress the fingers with heavy lifting or repetitive tasks. There are other surgical procedures that are better suited to holding up to these types of activities.
There are other surgical options to consider if finger joint replacement is not the right option for you. Probably the most common alternative is called joint fusion . Joint fusion is a surgical procedure to permanently remove the joint, and stimulate the bone to grow where the joint once was. Often the joint is held in proper position with plates, screws, pins, or wires until the bone is fully healed. The advantage of a fusion procedure is that once healed, this is a permanent solution -- there are no implants to wear out or loosen over time. The disadvantage is that finger mobility is limited, although with many finger joints this only minimally impacts the function of the finger.
Adkinson JM, Chung KC. Advances in small joint arthroplasty of the hand . Plastic and Reconstructive Surgery . 2014;134(6):1260-1268. doi:10.1097/PRS.0000000000000733
Zhu AF, Rahgozar P, Chung KC. Advances in proximal interphalangeal joint arthroplasty . Hand Clinics . 2018;34(2):185-194. doi:10.1016/j.hcl.2017.12.008
Papalia R, Tecame A, Torre G, D'Adamio S, Maffulli N, Denaro V. Small joints replacement for hand osteoarthritis: a systematic review . Br Med Bull . 2015;116(1):55-68. doi:10.1093/bmb/ldv024
Spies CK, Langer M, Hahn P, Müller LP, Unglaub F. The treatment of primary arthritis of the finger and thumb joint . Dtsch Arztebl Int . 2018;115(16): 269–275. doi:10.3238/arztebl.2018.0269
By Jonathan Cluett, MD
Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.
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