Short-term effects of partial meniscectomy on the clinical results of anterior cruciate ligament reconstruction

Purpose

This study aims to analyse the short-term effects of partial meniscectomy on the clinical results of anterior cruciate ligament reconstruction surgery.

Methods

Clinical outcomes of 19 patients who had partial medial meniscectomy and anterior cruciate ligament reconstruction during the same surgery (Group 1) were compared with the outcomes of 25 patients who had also reconstruction but did not have any meniscal lesion (Group 2). Median follow-up time was 29 months (range 12–67 months) in Group 1 and 27 months (range 12–70 months) in Group 2. Feeling of apprehension in sports activities, International Knee Documentation Committee (IKDC) score, KT-2000 Arthrometer^® measurements and post-operative time to return to sports activity were the criteria for data analysis.

Results

Eight patients (42 %) in Group 1 and 5 patients (20 %) in Group 2 stated feeling of apprehension in sports activities. IKDC score improved to A in 11 patients (58 %) from Group 1, and 18 patients (72 %) from Group 2. Mean anterior translation according to KT-2000 arthrometer measurements was 5.2 ± 1.3 mm in Group 1, and 4.6 ± 1.3 mm in Group 2. Post-operative time to return to sports activity was 8.5 ± 3.0 months in Group 1, and 6.5 ± 2.2 months in Group 2.

Conclusion

Partial meniscectomy for irreparable medial meniscal tears, applied during the same surgery with anterior cruciate ligament reconstruction, negatively affects the clinical outcomes in the short-term follow-up. This study may be a reference for long-term clinical trials and also future investigations of new methods in the treatment of similar cases.

Level of evidence

IV.

     

Pediatric Fractures Through the Eyes of Parents: An Observational Study

The present study is an observational cross-sectional study. The main purpose of this research was to analyze the perception and behaviors of parents in a series of pediatric upper extremity fracture cases.Hundred and seventeen patients younger than 12 years who were conservatively treated for the upper extremity fracture were included in our study. Parents of the patients were requested to answer a family-centered questionnaire related to their child''s fracture and its treatment.When the parents were asked whether they believe casting would be sufficient or not as the treatment of their child''s fracture, 84.6% answered ‘yes’, 13.7% answered ‘I am not sure,’ and 1.7% answered ‘no.’ Sixty-four of the parents were not worried about any residual defect in joint or extremity functions related to fracture, whereas 21 were worried and 32 were not sure on this. The rate of searching further information about the child''s fracture was 34.2% and the mostly used source was the Internet. Twenty-eight of the 117 respondents (23.9%) emphasized that they would reduce the time their child spend outside the home at least for a while after the removal of cast.When conservatively treating a child''s fracture, physicians dealing with traumatology should always consider the parents’ perception and behaviors as critically important.     

Clinical spectrum of the pseudotumor cerebri in children: Etiological,clinical features,treatment and prognosis

Objective: Pseudotumor cerebri (PTC) is a clinical condition characterized by signs and symptoms of increased intracranial pressure, such as headache and papilledema. Our aim was to investigate the etiological and clinical features of pseudotumor cerebri (PTC) in children. Materials and method: We performed a comprehensive analysis of epidemiology, diagnostic work-up, therapy, and clinical follow-up in 42 consecutive patients. Results: Totally 42 patients diagnosed with PTC [27 (64.3%) females and 15 (35.7%) males] were included in the study. The average age of the symptoms onset was 10.79 ± 3.43 years (range from 12 months to 17 years). Obesity was found in eleven (26.2%) of them. Two of the patients had familial mediterranean fever, two of them had posttraumatic PTC. The following diseases were one patient, respectively; mycophenolate mofetil-induced PTC, hypervitaminosis A induced PTC, corticosteroid induced withdrawal due to nephritic syndrome, use of oral contraceptives, Guillain–Barre syndrome, urinary tract infection, varicella-zoster virus infection and dural venous sinus thrombosis associated with otitis media. The most common symptom was headache, recorded in 76.2% of the patients. All patients were treated medically. Three patients in our group also required a ventriculoperitoneal shunt. Conclusion: Pseudotumor cerebri is an avoidable cause of visual loss, both in adults and children. Pre-pubertal obese girls are more common. Medical therapy appeared to be successful in treating pediatric PTC in most patients. Nevertheless, despite adequate treatment, children can rarely experience loss of visual field and acuity; thus, prompt diagnosis and management are important.     

Ectopic varices in portal hypertension: computed tomographic angiography instead of repeated endoscopies for diagnosis

Ectopic varices (EcV) accounting for 1-5% of all varices in portal hypertension are composed of dilated portosystemic collaterals located in unusual sites instead of the most known gastroesophageal region. The difficulty in localization of bleeding is a great burden on the management of these patients. Herein, we present patients with EcV as well as with portal hypertension and recurrent intestinal bleeding. The sites of EcV were identified with computed tomographic angiography, after a series of inconclusive endoscopies, and moreover a selective celiac arteriographic examination of one of the patients.     

Quantitative evaluation of brain edema by radionuclide imaging technique

The objective of the present investigation was to quantify metabolic cerebral edema in dogs with impaired monoamine oxidase (MAO) function and liver disease using dynamic imaging of the brain with 99mTc-diethylenetriamine pentacetic acid (99mTc DTPA). Data acquisition was started following a rapid intracarotid injection of 99mTc DTPA (5 mCi), and sixty 0.5-s images of the left or right hemisphere were taken. First-pass time-activity curves were obtained by selecting regions of interest for the appropriate brain hemisphere. The results of this study demonstrated that in phenelzine-treated animals there was a 6 to 38% reduction in brain washout slopes of 99mTc DTPA (24.0 +/- 11.5% reduction). These washout slopes were further reduced (range 24.0-86.0; 50.6 +/- 18.5% reduction) following the oral administration of tyramine (1 mg/kg). A significant correlation was noted between changes in washout slopes and the development of coma in these animals.     

CEFEPIME VERSUS CETAZIDIME AMIKACIN AS EMPIRICAL THERAPY FOR FEBRILE NEUTROPENIA IN CHILDREN WITH CANCER: A Prospective Randomized Trial of the Treatment Efficacy and Cost

The efficacy, safety, and cost of cefepime and ceftazidime + amikacin as empirical therapy in children with febrile neutropenia is compared. A prospective randomized study in children with cancer was conducted. Patients were randomly assigned to receive either cefepime 150 mg/kg/day or ceftazidime 150 mg/kg/day combined with amikacin 15 mg/kg/day. Treatment modification was defined as all the changes in the empirical antimicrobials after the first 72 h. Overall treatment success was defined as cure of febrile episode with or without modification. Costs of hospitalization, antimicrobial drugs, and supportive therapy were calculated. Fifty febrile netropenic episodes were evaluated. Infectious agents were microbiologically identified in 28% of episodes. The incidence of gram-negative and gram-positive isolates was equal. Overall treatment success was 100% and success of initial empirical therapy without modification was 52 and 40% in the cefepime and cefepime + amikacin groups, respectively. The response rate after glycopeptides were added to the regimen was 64 and 52% in the cefepime and cefepime + amikacin arms, respectively. Glycopeptide and antifungal drugs were added more frequently in the ceftazidime + amikacin group. Duration of fever, hospitalization, and antimicrobial drug administration were longer in the ceftazidime + amikacin arm. The costs of the antimicrobial drugs, hospitalization, and total cost were lower in the cefepime arm. Cefepime monotherapy is as effective as ceftazidime + amikacin combination in febrile neutropenia of pediatric cancer patients and must be preferred due to shorter defervescence of fever, shorter hospitalization, and lower therapy cost.