Perioperative Outcomes and Complications After Primary Total Hip Arthroplasty in Patients With Disproportionately Short Stature: A Matched Cohort Analysis

BackgroundThis study compared (1) perioperative outcomes, (2) postoperative complications, and (3) reoperation rates after primary total hip arthroplasty (THA) between short stature patients and matched control patients.MethodsA review of primary THA patients from 2012 to 2017 using an institutional database was conducted. This yielded 12,850 patients of which 108 were shorter than 148 cm. These patients were matched 1:1 by age (P = .527), gender (P = .664), and body mass index (P = .240) to controls. The final study population with minimum 1-year follow-up that was included for analysis comprised 47 patients in the short stature cohort and 57 patients in the control cohort. The following outcomes/complications were compared: operative times, lengths of stay (LOSs), intraoperative fractures, minor complications, 90-day readmissions, and revisions.ResultsOperative times were significantly longer in the short stature cohort than in the matched control cohort (133 ± 65 minutes vs 104 ± 30 minutes, P = .005). In addition, hospital LOS was slightly longer in the short stature group than in the matched control groups (3.2 ± 1.5 days vs 2.6 ± 1.0, P = .017). Rates of intraoperative fractures (P = 1.000), minor complications P = .406), 90-day readmissions (P = .5000), and revision (P = .202) were similar between the short stature and control cohorts.ConclusionPatients with disproportionately short stature had longer operative times and slight longer LOS. However, complication and readmission rates were similar. Future studies with larger sample sizes are warranted to confirm these findings and further evaluate implant survivorship in this unique THA patient population.     

Cervical hyperostosis: A rare cause of dysphagia

Summary Dysphagia can be caused by disorders of the cervical spine. Very seldomly, prominent osteophytes of the ventral spine are responsible. The case of a 63-year-old patient with large anterior osteophytes from C3 to C7 is presented. The successful ablation of these spondylophytes relieved the patient of his swallowing difficulties. Up to now there have been many different opinions about the etiology of this disease. In this special case, a diffuse idiopathic skeletal hyperostosis, also known as Forestier's disease or diffuse idiopathic skeletal hyperostosis, seems to be the most likely cause.     

The Kathryn O. and Alan C. Greenberg Center for Skeletal Dysplasias: An Interdisciplinary Approach

Skeletal dysplasias are a group of over 300 genetic conditions often marked by short stature and a range of orthopedic problems. To meet the diverse medical, orthopedic, and psychosocial needs of individuals with skeletal dysplasias, the Kathryn O. and Alan C. Greenberg Center for Skeletal Dysplasias was organized at Hospital for Special Surgery in 2003. The center is the only one of its kind in the New York City metropolitan area and is dedicated to providing comprehensive medical care for individuals with skeletal dysplasias. The center is staffed by an interdisciplinary core team of health professionals consisting of an orthopedic surgeon, a medical geneticist, a genetic counselor/clinical coordinator, and a social worker. This interdisciplinary team of health professionals is committed to improving the quality of life for people with skeletal dysplasias through clinical care, research, education, and patient advocacy. Goals are achieved through a collaborative process that utilizes the expertise of the different professionals.     

Prostate biopsy free system for laparoscopic radical prostatectomy in a pituitary dwarfism: a case report

Prostate biopsy is the gold standard for the diagnosis of prostate cancer. However, not all patients are suitable for prostate biopsy. For example, some patients have anal stenosis, some patients are too old to withstand the pain caused by puncture, patients who are unwilling to undergo prostate biopsy. We found that there was currently no literature report on a specific solution to this problem. This is the first report of a laparoscopic radical prostatectomy (LRP) in a pituitary dwarfism who didn’t have a prostate biopsy before LRP due to anal stenosis. And this report added a new method to diagnose prostate cancer. We present a case of a 61-year-old pituitary dwarfism who had a prostate specific antigen (PSA) of 32.13 ng/mL by physical examination and didn’t perform prostate biopsy due to anal stenosis. Preoperative prostate MRI suggests a low-signal mass on the left side of the prostate and ⁶⁸Ga PSMA-11 PET/CT demonstrated that Abnormally high PSMA and CHO uptake on the left side of the prostate. Therefore, combined with the patient’s PSA, MRI and ⁶⁸Ga PSMA-11 PET/CT, our clinical diagnosis was prostate cancer. Surgery was difficult due to narrow pelvic space, but achievable through LRP. Histological analysis revealed multifocal prostate cancer, with negative surgical margins and no extraprostatic extension. Postoperative patient had no serious complications and was discharged. Based on this case, For the first time, we proposed to make full use of the results of clinical tests and imaging examinations for the diagnosis and treatment of diseases without prostate biopsy.     

Trichobezoar: A rare cause of bowel obstruction

A bezoar is an intraluminal mass formed by the accumulation of undigested material in the gastrointestinal tract. A trichobezoar is a bezoar made up of hair and is a rare cause of bowel obstruction of the proximal gastrointes-tinal tract. They are seen mostly in young women with trichotillomania and trichotillophagia and symptoms include epigastric pain, nausea, loss of appetite and bowel or gastric outlet obstruction. We herein describe a case of a trichobezoar that presented as a gastric outlet obstruction and was subsequently successfully removed via a laparotomy.     

A cross-sectional nationwide survey of osteosclerotic skeletal dysplasias in Japan

BackgroundThe osteosclerotic skeletal dysplasias (OSSDs) are a heterogeneous group of disorders characterized by systemic bone sclerosis. Little is known about OSSDs because of their rarity. We conducted a cross-sectional nationwide survey of OSSDs and examined the incidence, epidemiology, and therapeutic interventions on these disorders.MethodsThis study consisted of a two-step survey. The number of patients with OSSDs who had visited medical institutions between April 2017 and March 2018 was reported from a total of 341 facilities (1364 departments from pediatrics, orthopaedic surgery, neurosurgery, and otolaryngology in each facility) by the first questionnaire. In the secondary survey, their clinical features were assessed by collecting demographic data, diagnostic details, current status, family histories, therapeutic interventions, histories of bone fracture and osteomyelitis, severity assessed by the modified Rankin Scale (mRS) and recent lifestyle conditions of the patient by the EQ-5D.ResultsIn the first survey, 51 facilities (56 departments) reported one or more OSSDs patients, including 50 patients with osteopetrosis and 57 patients of other OSSDs. Among 87 patients eligible for inclusion in the analysis in the secondary survey, we investigated detailed information on the 42 patients with osteopetrosis. The number of initial visits of osteopetrosis patients during the surveillance period was five per year, indicating that the estimated incidence of osteopetrosis seemed to be 0.6 per 100,000 live births. Eighty-six bone fractures were reported in 22 patients (52%), and interventions of pseudarthrosis were conducted in five patients. Nine patients (23%) showed significant disabilities with the mRS of grade 3 or higher. Neurological complications and severe anemia were the factors that deteriorate patients’ quality of life.ConclusionsThis is the first study to examine the detailed epidemiology of OSSDs in Japan. We demonstrated that the incidence of OSSDs is extremely rare. Bone fragility and delayed fracture healing seem to be important orthopaedic problems for patients with osteopetrosis.     

A rare cause of ischemic gut: A case report

IntroductionMucormycosis is a fungal infection that is a rare cause of gastrointestinal ischemia, usually found in the immunocompromised or patients with extended surgical intensive care unit stay. This case report brings to light the rare presentation of a total gastric infarction secondary to a rare fungal infection where the overall outcome of the patient depends on timely diagnosis and management.Case presentationAn elderly Malay female patient in our institution developed severe sepsis. Radiological investigations revealed an intra abdominal source of sepsis likely secondary to total gastric ischemia. Both the abdominal X-ray and computed tomography scan showed evidence of gastric pneumotosis. She was diagnosed with gastric ischemia and underwent a total gastrectomy. However post surgically she continued to deteriorate and passed away 5 days later.ConclusionRecognition of mucormycosis infection is pertinent to commence anti fungal treatment early with timely implementation of subsequent surgical management. Early access to surgery is necessary to improve cure rates in patients with mucormycosis as antifungal treatment alone is usually not adequate for cure.     

A rare cause of abdominal pain

Pacemaker migration is a rare, but important, complication of pacemaker insertion mainly documented in children. We report the case of a 60-year-old woman who was admitted with right iliac fossa pain thought to be caused by appendicitis. She was noted to have both an epicardial and endocardial pacemaker in situ. Imaging and laparoscopy revealed migration of the epicardial pacemaker to the right iliac fossa. We describe the possible mechanisms of pacemaker migration.     

A rare cause of urinary obstruction: urogenital tuberculosis

The authors reported a rare cause of urogenital tuberculosis complicated by an obstructive acute renal failure in 44 years old man with solitary anatomic kidney. The authors insisted of using the upper urinary tract opacification by percutaneous nephrostomy for diagnosis, the urogenital tuberculosis with this exploration, we can suspected the tuberculosis by abnormalities of the radiologic imagine, and confirmed the koch bacilli urinary into urinary tract. The upper chance of positives of finding koch bacilli in higher than urinary bladder.     

A rare cause of peritoneal fistula

The abdominal pregnancy is an extremely rare variety of the ectopic pregnancy. The symptoms are atypical, which causes a delay in putting the diagnosis, which is established most of the times when complications appear, which are always severe, and endanger the patients lives. This paper presents a rare complication of the abdominal pregnancy, at about 6 months old, stopped in evolution, complicated by an abscess, generalised peritonitis and peritoneal fistula. The diagnosis and treatment of the abdominal ectopic pregnancy are discussed.