Lepirudin as an alternative to "heparin allergy" during cardiopulmonary bypass

A treatment strategy of a difficult and unusual problem is presented. We are reporting a case of a patient who had a documented allergy to heparin and required Cardiac surgery for an ASD closure. The anticoagulation regime used during cardiopulmonary bypass was lepirudin based.This report indicates that r-hirudin provides effective anticoagulation, however unless ECT is monitoring, post operative hemorrhage is encountered. Therefore this case is unique not only because of its rarity but also by the fact that it presents the caveats encountered when ECT is not available.     

Der "neue" Facharzt für Unfallchirurgie und Orthopädie: Wer profitiert—wer verliert?

As long ago as in 1997 there were demands for the field of trauma surgery, regarded up to then as a focus point within surgery, to be upgraded to the status of a specialty in its own right. About the same time, payers initiated discussions about the borderlines between orthopaedics and surgery/trauma surgery. The commission on future developments made up of specialists representing orthopaedic specialists and trauma surgeons has stressed that its appointment has provided a unique opportunity of merging these specialties. Comparisons with analogous mergers in commerce and biology to check on how legitimate this might be suggest, however, that such a merger will require a complicated and cost-intensive period of transition lasting for some years and that it will be to the detriment of more people than it helps. The revised arrangements for continuing education will lead to the emergence of a new specialist, who may well have a better basic surgical training than has so far been the case for orthopaedic specialists but on the other hand is not competent to treat polytraumatized patients. The best solution would be to include orthopaedics as the ninth subject in the new ordinance on continuing education in operative subjects and to leave trauma surgery as it is—with a basic training in surgical techniques, or perhaps in orthopaedic surgery and a 3-year training in any of the various branches of surgery.     

Survival and clinical results of a modified &quot;<Emphasis Type="Italic">crosse de hockey</Emphasis>&quot; procedure for chronic isolated patellofemoral joint osteoarthritis: mid-term follow-up

Background

The optimum treatment for isolated patellofemoral joint osteoarthritis (PFJ-OA) remains controversial. The aim of this study was to assess the mid-term clinical results of a modified crosse de hockey procedure for the treatment of isolated PFJ-OA.

Materials and methods

We assessed 37 knees in 31 patients treated by a modified crosse de hockey procedure. The mean age was 57.6 years (range, 46–75 years) and mean follow-up was 90.1 months (range, 24–216 months). We evaluated clinical and radiographic outcomes, as well as complication rates at the mid-term follow-up.

Results

The Kujala score (mean improvement of 46.7, P < 0.001) and the Fulkerson score (mean improvement of 19, P = 0.001) were significantly higher compared to preoperative values. Overall clinical results rated excellent in 24.3 %, very good in 21.6 %, good in 35.1 %, fair in 13.5 %, and poor in 5.4 % of knees. Patellar tilting (P = 0.015) and congruence angle (P = 0.018) significantly improved postoperatively. On the other hand, the Insall-Salvati index decreased at the time of follow-up, although it remained in the physiologic range. Postoperatively, consecutive disease progression in the tibiofemoral joint and patellofemoral joint osteoarthritis were 18.9 and 5.4 %, respectively. The operative complication rate was 5.4 % in this case series. These percentages were lower than those of alternative tibial tuberosity osteotomy techniques.

Conclusion

In most patients with chronic isolated PFJ-OA, tibial tuberosity osteotomy by modified crosse de hockey is a reliable procedure that provides good/excellent mid-term clinical results.

Level of evidence

Level IV.

     

Motion artifact on computed tomography scan suggesting an unstable 3-column spine injury: case report of a &quot;near miss&quot; root cause of unneeded surgery

Background

Polytrauma patients often present with altered mental status, thus making clinical examination challenging. Due to its reliability for detecting traumatic injuries to the spine, computed tomography (CT) is generally the imaging study of choice when the mechanism of injury and/or preliminary exam suggests spinal injury. However, motion artifact may lead to false diagnoses.

Case report

A 19-year-old intoxicated female involved in a high-speed motor vehicle crash suffered multiple spine, head, chest, and abdominal injuries. CT scan also suggested an unstable three column ligamentous injury at L2-3. Preparations were made for surgery the following morning, by which time her mental status had improved. She was re-examined in the operating room prior to induction by anesthesia and no focal lumbar pain or tenderness was detected. Imaging was further reviewed and motion artifact at the L2-3 level was noted. The surgery was cancelled.

Conclusion

Motion artifact mimicked an unstable three column ligamentous injury at the L2-3 level. Findings on CT scan should always be correlated to physical exam in order to avoid wrongful surgical intervention.