Long-term results of intertrochanteric varus osteotomy for arthrosis of the dysplastic hip (over 10 years' follow-up)

We performed a retrospective clinical and radiographic review of the long-term results of 64 hips in 53 patients who underwent intertrochanteric varus osteotomy for arthrosis of the hip at the pre- or early stage with acetabular dysplasia. Their average age at operation was 26 years. The average duration of follow-up was 18 years and 10 months. The mean Harris hip score was 77 ± 9 points pre-operatively, and improved significantly to 84 ±13 points at the final follow-up. The acetabular coverage influenced the final outcome, and the postoperative prognosis was predictable from the acetabular head index (AHI) on a pre-operatively done hip maximum abduction radiograph (abd XP). We conclude that varus osteotomy for a dysplastic hip should be considered when the acetabular coverage is sufficient, and that a good prognosis can be expected when AHI on abd XP is greater than 60%.     

Molecular principles of induction and progression of arthrosis

From a morphological point of view, osteoarthritis is characterized by continuous loss of the cartilage matrix, an increased density of the subchondral bone, and partial involvement of the synovial compartment. Research activities are focussing on gene expression and gene regulation in normal and osteoarthritic cartilage to develop prognostic markers and new therapeutic strategies. In general, chondrocytes from normal adult articular cartilage show low metabolic activity. However in osteoarthritis, activation and differentiation of chondrocytes occur. Activation involves anabolic pathways such as an enhanced expression of type II collagen as well as catabolic patterns such as the increased expression of matrix metalloproteinases. These metabolic pathways are unbalanced, leading to insufficient cartilage architecture, unable to meet the requirements for mechanical stability and load compensation. In osteoarthritis, chondrocyte differentiation is characterized by the expression of type X collagen. Further differentiation stages have been observed as shown for the expression of osteocalcin, osteopontin, or alkaline phosphatase in articular cartilage. This altered expression pattern of chondrocytes is likely to influence the biochemical and biomechanical properties of the cartilage matrix. In conclusion, new analytic and comparative methods to analyze gene and protein expression offer powerful tools to elucidate candidate genes in osteoarthritis. Detailed information on the regulatory pathways will be the basis for modulation of chondrocyte behavior and, therefore, may lead to new therapeutic approaches in the treatment of osteoarthritis.     

Early results of surgical treatment of dysplastic hip arthrosis with CDH prosthesis]

The paper presents the early results of surgical treatment of osteoarthritis secondary to hip dysplasia with CDH hip prosthesis. Between 2001 and 2002 fourteen cases of hip arthritis secondary to dysplasia were treated with CDH prosthesis. Surgery was performed in women, age ranging from 22 to 52 years (average age: 40 years). In 8 cases a cementless CDH femoral component was used. In all cases cementless Taperloc (Biomet) acetabulum components were used. Weight-bearing was allowed 7-14 days post-op. Final patient assessment was done 6-26 months post-op, using the Merle d'Aubigne classification. Patient satisfaction was also taken into account. Functional assessment using this classification yielded 7 points (range: 5-9 points) pre-op, and 11 points post-op (range: 10-12 points). In the post-op assessment, patients reported less pain and an increased range of motion of the hip. No infections were noted. In 1 case deep rein irritation was noted on the second day post-op. In 10 cases there was no limb length discrepancy post-op, while in 4 cases it ranged from 1.5 cm to 3.0 cm. CDH prosthesis allows secure hip replacement procedure, especially in cases with narrow femoral canals.     

Lhermitte-Duclos disease (dysplastic cerebellar gangliocytoma)

This case report describes an adult male presenting with ataxia. Dysplastic cerebellar gangliocytoma, the Lhermitte-Duclos disease, was diagnosed on neuroimaging. Diagnosis was confirmed on histopathology of surgically removed lesion. Patient underwent an uneventful recovery following operative treatment.     

Lhermitte-Duclos disease (dysplastic gangliocytoma of the cerebellum)

Summary The authors report the third published case of a Lhermitte-Duclos disease diagnosed preoperatively with the help of MRI, stressing its possible extension beyond the limits of the posterior fossa. The pertinent literature is reviewed concerning the clinical and radiological picture of this disease, as well as the different pathogenic hypothesis.     

Impact of a surveillance and prevention program on the incidence of wound infections in general surgery. A prospective study

A prospective study on wound infections incidence was performed using a computer archive program. Data of 7000 patients submitted to surgical procedures from 1980 to 1988 were evaluated regarding a surveillance and a prevention program that was performed at 1984 (short term prophylaxis in contaminated and any clean-contaminated procedures; skin washing before the operation with a soapy solution of povidone iodine; regular report of all data about wound infection incidence to staff). Results were evaluated in four classes and regarding nutritional status. The reduction of wound infection incidence was statistically significant (1.8% vs 5.4%; chi square 63.70, p less than 0.001) and an important reduction was recorded in the malnourished patients (3.0% vs 15.4%; chi square 36.91, p less than 0.001).     

A screening and counseling program for prevention of osteoporosis

Prevention of osteoporosis is an increasingly salient public health concern as our society ages. This report describes the procedures used at an osteoporosis center to which people come for screening and counseling. The patients on whom this report is based were 53 non-smoking women, 1–10 years postmenopausal at the time of their first visit to the center, who chose not to undertake estrogen therapy, and who returned for a second visit in 12–18 months. They were classified as to adequacy of calcium intake (at least 750 mg/day) and exercise (at least 3 h/week of weight-bearing exercise) at both visits; complete data on calcium intake and exercise were available on 46 of the women. Bone densities were measured at the femoral neck and lumbar spine with dual energy X-ray absorptiometry, and at the distal radius with single photon absorptiometry. At the first visit, 67% of the women reported adequate exercise and 43% reported adequate calcium intake. At the second visit, the percentages in the adequate categories had increased to 74% for exercise (p=0.06) and 70% for calcium intake (p=0.02). Age at the first visit was inversely correlated with femoral (r=–0.40,p=0.003) and spinal (r=–0.36,p=0.009) bone densities; the correlation with radial bone density did not achieve significance (r=–0.27,p=0.55). Rather than declining, as would be expected in early postmenopausal women, bone density rose slightly, but not significantly, between visits for all three sites. Neither the first visit values nor the changes between visits were significantly different between groups divided on the basis of adequacy of calcium intake or exercise. These data suggest that bone density is related to age, that a visit to an osteoporosis center may help early postmenopausal women to maintain and improve healthy exercise and eating behaviors, and that bone density does not necessarily decline over a 12–18 month period in women who maintain such behaviors.     

Lhermitte-Duclos disease (dysplastic gangliocytoma): A case report with CT and MRI

A 31 year old female was admitted with a one month history of left foot drop and diplopia. CT of the posterior fossa revealed gross displacement of the 4th ventricle by a large non-enhancing cerebellar mass but gave no indication of its nature. MRI sequences showed two masses within the left cerebellar hemisphere extending into the vermis and demonstrated a very unusual septation within the lesion. In addition both cerebellar tonsils were displaced below the foramen magnum and there was a syrinx extending from C2 to the conus. At operation a demarcated lesion was excised from the apparently normal surrounding cerebellar tissue and proved histologically to be Lhermitte-Duclos disease. We believe that these are the first diagnostic magnetic resonance images of this condition.     

Surgical residents' knowledge of injury prevention principles

BACKGROUND: Injury prevention is not routinely taught in medical school or surgical residency curricula. Because of the integral role surgeons play in the diagnosis and treatment of trauma, we sought to determine the knowledge base of injury prevention concepts of surgical residents training in a state's level 1 trauma centers. METHODS: A written survey was given to general surgery residents at our state's three level 1 trauma centers. Twenty-one questions related to injury prevention were asked in addition to demographic data. Basic concepts of injury prevention, statistical knowledge of injury patterns, and knowledge of intentional violence were tested. RESULTS: Sixty-two residents completed the survey. Only 9 respondents reported prior formal instruction in injury prevention. Overall performance was (mean +/- SD) 10.6 +/- 2.5 of 31 possible points, for a mean average score of 34% correct answers. Postgraduate year level, prior medical school instruction in injury prevention or months of experience on a trauma service did not correlate with improved scores. Specific question performance ranged from 2% to 82% correct responses. Questions regarding domestic violence (60%), risk of burns (65%), and incidence of trauma deaths (82%) were answered correctly most often, while injury prevention theory questions, such as components of the Injury Prevention Triangle (5%), definition of YPLL (2%), and annual cost attributable to injury (19%) were least often answered correctly. CONCLUSIONS: These data indicate that general surgery residents are poorly educated regarding basic concepts of injury prevention. Importantly, a majority of respondents (69%) felt formal instruction in injury prevention should be included in their surgical residency curriculum.