Deformity: It’s the position of a limb/Joint, from which it cannot be brought back to its normal anatomical position.
Described as abnormalities of :
Length
Angulation
Rotation
Translation
Combination
Deformity: It’s the position of a limb/Joint, from which it cannot be brought back to its normal anatomical position.
Described as abnormalities of :
Length
Angulation
Rotation
Translation
Combination
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Effect of bacteria on partial replacement of concrete with fly ash and ggbseSAT Publishing House
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A Compatibility Study on Different Types of Cement and Plasticizerijsrd.com
It has long been a concrete technologist's dream to discover method of making concrete at the lowest possible water/cement ratio while maintaining a high workability. To a considerable extent this dream has been fulfilled with the advent of super plasticizers. It has added a new dimension to the application of admixtures with regards to production of high strength and flow able concretes. It is now possible to produce concrete with compressive strength of the order of 90Mpa (90 N/mm2). In the wake of energy conservation policy and diminishing supplies of high quality raw materials, there is a need to use marginal quality cements and aggregates for the production of concrete. In such instances the use of plasticizers/super plasticizers permits the production of concrete at low water/ cement ratios. We have taken ultra tech opc cement & coromandal ppc cement to find the compatibility by adding perma plast (plasticizer). The water cement ratio was maintained as 0.40 &0.45 for OPC & PPC respectively. To study the effect of these PP on various properties of concrete. The dosage of plasticizers/super plasticizers was measured as 1.5% for Perma plast for OPC & 1.3% for PPC by the weight of cement.
In this presentation, the chemical composition of rigid polyurethane foams was studied using FTIR microscopy and diffuse reflectance Fourier transform spectroscopy (DRIFTS) FTIR.
For more information, go to ssi.shimadzu.com and follow Shiamdzu on Twitter @ShimadzuSSI. Thanks for viewing!
Similar to Bone cement,Cementing Generations, Complications & Recent advances (20)
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
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O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
2. HISTORY
1933- Otto Rohm put PMMA in the market.
Initially it was used to make dentures
and used in cranioplasty
1943- German chemists discovered that
addition of dimethyle-para-toludine
(DMPT ) along with benzoyl peroxide
(BPO)polymerization can take place at
room temperature
2
3. HISTORY
The success of PMMA in
orthopaedics is attributed
to Sir John Chrnley, son of a
Dentist.
He did research in judet
prostheses
He is well known for his low
friction arthroplasty
3
4. While Charnley credited Kiar and Jansen for first use
of methyl methacrylate in 1951 ,they used very small
amount and did not created secure fixation
Charnel first used methyl methacrylate to “cement”
femoral and acetabular components in place in 1958
which was a turning point in total hip replacement.
HISTORY
4
5. PROPERTIES OF BONE CEMENT
Bone acts as “grout” and not as “glue” ,fixation is
achieved with interdigitations not with adhesion
It is viscoelastic and Behaves like both fluid and
solid so it has four characteristics:
(1) Creep (2) stress relaxation (3)Damping (4)
Strain rate dependence of its mechanical
properties.
It undergoes volumetric shrinkage after
polymerization.
5
6. CREEP
In materials science, creep (sometimes
called cold flow) is the tendency of a
solid material to move slowly or deform
permanently under the influence of
mechanical stresses.
Small amount of creep is desirable in early post
operative period but excessive amount is
undesirable.
PROPERTIES OF BONE CEMENT
6
7. At the implant level the trend towards
polished tapered stem designs has been
facilitated by the visco-elastic properties of
PMMA. Robust evidence from both finite
element analysis and laboratory studies
indicates that the subsidence of a stem within
the cement mantle by the process of creep
protects the vital bone/cement interface and
hence the replacement overall.
PROPERTIES OF BONE CEMENT
JCJ Webb :J Bone Joint Surg Br July 2007 vol. 89-B no. 7 851-857
7
8. PROPERTIES OF BONE CEMENT
STRESS RELAXATION
Stress relaxation is defined
as the change in stress with
time under constant strain
(deformation) . Just as with
creep, stress relaxation is
important for polymers at
body temperature, not
important for metals.
The Well-Cemented Total Hip Arthroplasty:
Theory and Practice 8
9. COMPOSITIONS OF BONE CEMENT
Most bone cements have three similarities:
1) They based mainly on the same chemistry-PMMA
2) They are two part products-one part powder
polymer and other one liquid monomer
3) In term of constituents in most brand powder has
polymerised PMMA, an initiator of polymerization –
BPO and a radiopacifier similarly in liquid they have
MMA, an accelerator of polymerization-DMPT, and a
stabilizer-hydroquinone
9
12. PHASES
• On the use of bone cements different phases are distinguished:
mixing phase, waiting phase, application phase and setting
phase:
▬ MIXING PHASE: (up to 1 minute)
wetting and polymerization, cement relatively
liquid (low viscous), few chains, very movable;
At the end mixture is homogenous sticky mass
▬ WAITING PHASE: ( variable up to several minutes )
chain propagation, cement less liquid, more chains,
less movable; cement is neither “sticky” nor ‘hairy”.
▬ WORKING PHASE: ( 2-4 minutes )
chain propagation, reduced movability, increase
of viscosity heat generation;
▬ SETTING PHASE:
chain growth finished, no movability, cement
hardened, high temperature gradually settles and
undergoes volumetric shrinkage 12
13. VISCOSITY OF THE BONE CEMENT
• Low. These have a long waiting phase of three minutes, also known
as a sticky phase. The viscosity rapidly increases during the
working phase and the hardening phase is one to two minutes
long.
• Medium. There is a long waiting phase of three minutes, but during
the working phase, the viscosity only increases slowly.
Hardening takes between one minute 30 seconds, and
two minutes 30 seconds.
• High. A short waiting/sticky phase is followed by a long working
phase. The viscosity remains constant until the end of the
working phase. The hardening phase lasts between one
minute 30 seconds and two minutes.
13
14. PMMA polymer powder
60 sec-nitrogen freeze
specimen ,monomer on the
surface of polymer
2 min specimen
Draenert k,Draenert y, properties of bone cement. In
Breusch S,Malchau H The well cemented total hip
arthroplasty. Sturtz, Wurzburg, Germany: Springer
:2005. p. 93-102 14
15. FACTORS AFFECTING BONE CEMENT
The ambient temperature - higher the temperature,
the shorter the phase and the colder the temperature,
the longer the phases.
The mixing process - Mixing cement too quickly or too
aggressively can hasten the polymerization reaction
resulting in a reduced setting time.
The powder to liquid ratio
If more liquid, or less powder, than required is
used, setting time will be prolonged; on the
other hand, if less liquid,ormore powder is used,
setting time will be shortened
18. VACCUM MIXING
VARIOUS VACCUM SYSTEMS
ADVANTAGE OF VACCUM MIXING IS –Reduction in micropores, better homogeneity and
thus prolonged life of implant
--Vertical paddles are better than horizontal
-- vacuum level of 0.25 to 0.05 is optimal for various
cements
-- cement collection under vacuum is an essential
part of porosity reduction
18
19. ANTIBIOTIC LOADED CEMENT
In 1970 Bucholz mixed Gentamicin in PMMA for treatment of
prosthetic joint infection
In 2003, FDA has approved three commercial antibiotic loaded
cement for revision for prosthetic joint infection.
In their guidelines, AAOS has advised it’s use as prophylactic
measure only in cases where patient has significant risk
factors for infection.
Intensions to add antibiotic to PMMA are to prevent bacterial
colonization on implant or to control an established infection.
19
20. ANTIBIOTIC LOADED CEMENT
DESIRED PROPERTIES OF ANTIBIOTICS FOR BONE CEMENT
PHYSICAL PROPERTIES
- Heat stable
- Water soluble
- Doesn’t affect
polymerization and
cement strength
- Good release from
cured cement
CHEMICAL PROPERTIES
-Broad spectrum of action
- Bactericidal at low
concentration
- Non toxic to humans and
lower incidence of drug
resistance
- Low protein binding
20
22. ABLC may be defined as “low dose”—containing less than 2 g
of antibiotic per 40 g cement—or “high dose,” with greater
than 3.6 g of antibiotic per 40 g of cement.
Use high-dose ABLC—at least 3.6 g of antibiotic per 40 g of
cement—as a spacer in stage one of a two-stage
reconstruction.
.
Penner MJ, Duncan CP, Masri BA: bone cements. J Arthroplasty14:209, 1999
Doses as high as 6 to 8 g of antibiotic per 40 g of cement have
also been proven safe and effective.
Springer BD, Lee BC, Osmon D,. Clin Relat Res427:47-51, 2004.
22
ANTIBIOTIC LOADED CEMENT
23. CONCERNS ABOUT ALAC
Induction of antibiotic resistance
Prolonged release of antibiotics :- potential for drug
resistance
Unsuitable antibiotics :-
• Heat labile-penicilins ,Tetracycline
• Affecting bone cement-Rifampicin affects settling of
cement
Hypersensitivity and toxic side effects
ANTIBIOTIC LOADED CEMENT
23
24. COMPLICATIONS OF CEMENTING
MOST SERIOUS REACTIONS
Pulmonary embolism
Cardiac arrest
Myocardial infarction
CVA
MOST FREQUENT REACTION
Transient fall in blood pressure
ATTRIBUTED TO
Absorption of MMA
Embolization of bone marrow
Lysis of blood cell and
marrow during exothermic
reaction
Conversion of methyl
methacrylate to methacrylate
acid
Joint replacement
arthroplasty;2011
•OTHER ADVERSE REACTIONS ARE
• Thrombophlebitis
• Surgical wound infection
• Trochenteric bursitis
• Short term irregularities in
cardiac conduction
24
25. COMPLICATIONS OF CEMENTING
Hypotensive episodes occur more in-
Elevated or high normal blood pressure, Hypovolemia,
Pre existing cardio-vascular abnormaly
Onset :- usually within 10-20 seconds
Lasts for :- 30 secs to 5-6 mins
Adequate hydration and maximizing inhalational oxygen will
minimize hypotension and hypoxemia following cementing
Vigilance from an anaesthesiologist is of paramount
importance during this phase of procedure.
25
26. PERI-OPERATIVE MORTALITY AND METHYLMETHACRYLATE
TOXICITY
Potential direct toxic effect of absorbed liquid monomer methyl
methacrylate is investigated in great detail during previous years by
various workers including Wilert et al,Sir Charnley and homsey et al.
etc.
However recent evidences suggest that only cement is not necessary
for all adverse reactions**
Based on these and other similar studies focus is now on material
released and embolization to lungs as a result of preparation of bone
COMPLICATIONS OF CEMENTING
**
•Modig J, Busch C, Olerud S, et al:. Acta Anaesthesiol Scand 19:28,1975
•Byrick RJ, Forbes D, Waddell JP: . Anesthesiology 65:213, 1986.
•Fahrney NR, Chandler HP, Danychuk K, J Bone Joint Surg 72A:19, 1990.
•Breusch SJ, Reitzel T, Schneider U, Volkmann M, Ewerbeck V,
Lukoschek M: Cemented hip prosthesis. Orthopade29:578–86, 2000 26
30. RADIOLOGY
The thickness of the
cement mantle should
not drop below 2 mm at
anyplace if at all
possible. It also should
be complete, i.e., it
should not allow metal-
bone contact
“WHITE OUT”
30
31. RADIOLOGY
Barrack et al. in 1992 emphasised the quality of cementing,
and described four grades in postoperative radiographs:
A: complete filling of the medullary canal by bone cement,a so-called
≫white out≪ at the bone-cement interface,
B: slight radiolucency at the bone-cement interface,
C: radiolucency involving 50–99% of the bone-cement interface or a
defective or incomplete cement mantle,
D: definite radiolucency at the cement-bone interface of 100% in any
projection, or a failure to fill the canal with cement such that the tip
of the stem is not covered.
31
32. technical problems that contribute to stem loosening:
1. Failure to remove the soft cancellous bone from the medial
surface of the femoral neck;.
2. Failure to provide a cement mantle of adequate thickness around
the entire stem; a thin column cracks easily
3. Removal of all trabecular bone from the canal, leaving a smooth
surface with no capacity for cement intrusion or failure to roughen
areas of smooth neocortex that surrounded previous implants.
4. Inadequate quantity of cement and failure to keep the bolus of cement
intact to avoid lamination.
5. Failure to pressurize the cement, resulting in inadequate flow of cement
into the interstices of the bone.
6. Failure to prevent stem motion while the cement is hardening.
7. Failure to position the component in a neutral alignment or centralized
within the femoral canal.
8. The presence of voids in the cement as a result of poor mixing or injecting
technique or allowing blood or fragments of bone to be mixed in the cement
32
RADIOLOGY