Clinical and radiological factors predicting recurrence of chronic subdural hematoma: A retrospective cohort study

BackgroundChronic subdural hematoma (CSDH) is commonly encountered in the elderly patients and the recurrence rate is still high, therefore, identifying risk factors for CSDH recurrence is essential. The present study aimed to identify clinical and radiological factors predicting the recurrence of CSDH.MethodsWe retrospectively identified 461 patients with CSDH who underwent surgical evacuation in our department. Univariable analyses were performed at first, variables with a P-value of <0.05 were entered into multivariable logistic regression model. Kendall's tau-b test was used to evaluate the relationship between brain atrophy and postoperative pneumocephalus.ResultsUnivariable analyses revealed that patients with the following characteristics have a higher recurrence rate, including age ≥80 years, antiplatelet and/or anticoagulant use, GOS = 3, the volume of drainage ≥100 ml, midline shift ≥10 mm, severe brain atrophy, severe postoperative pneumocephalus. Multivariable logistic regression demonstrated that midline shift ≥10 mm, severe brain atrophy, severe postoperative pneumocephalus, and volume of drainage ≥100 ml were independent risk factors for CSDH recurrence. Kendall's tau-b test revealed that there was no correlation between brain atrophy and postoperative pneumocephalus.ConclusionsMidline shift ≥10 mm, severe brain atrophy, severe postoperative pneumocephalus, and volume of drainage ≥100 ml were independent risk factors for CSDH recurrence, CSDH patients with these characteristics should be taken precautions of recurrence and a closely follow-up should be carried out.     

Synovectomy of the knee in juvenile chronic arthritis. A retrospective, consecutive follow-up study

We report 60 synovectomies of the knee in 51 children with juvenile chronic arthritis. Synovitis had been present for an average of 5 years and the average age at operation was 13 years. Results were evaluated in terms of pain, knee movement, relapse of synovitis and radiological change during a follow-up averaging 7.5 years. The relief of pain was rewarding and there was a slight postoperative gain in range of knee movement in most cases. The older the patient at onset of disease, the greater the risk of pain during follow-up. Progressive joint destruction was more common in younger patients, those with systemic or polyarticular disease, and those with highly active disease at the time of operation. Recurrence of synovitis was more frequent in patients who had their operation in a phase of high disease activity; this occurred most often in patients with polyarticular disease.     

Clinical and radiological results of the collarless polished tapered stem at 15 years follow-up

We prospectively followed 191 consecutive collarless polished tapered (CPT) femoral stems, implanted in 175 patients who had a mean age at operation of 64.5 years (21 to 85). At a mean follow-up of 15.9 years (14 to 17.5), 86 patients (95 hips) were still alive. The fate of all original stems is known. The 16-year survivorship with re-operation for any reason was 80.7% (95% confidence interval 72 to 89.4). There was no loss to follow-up, with clinical data available on all 95 hips and radiological assessment performed on 90 hips (95%). At latest follow-up, the mean Harris hip score was 78 (28 to 100) and the mean Oxford hip score was 36 (15 to 48). Stems subsided within the cement mantle, with a mean subsidence of 2.1 mm (0.4 to 19.2). Among the original cohort, only one stem (0.5%) has been revised due to aseptic loosening. In total seven stems were revised for any cause, of which four revisions were required for infection following revision of the acetabular component. A total of 21?patients (11%) required some sort of revision procedure; all except three of these resulted from failure of the acetabular component. Cemented acetabular components had a significantly lower revision burden (three hips, 2.7%) than Harris Galante uncemented components (17 hips, 21.8%) (p < 0.001). The CPT stem continues to provide excellent radiological and clinical outcomes at 15?years following implantation. Its results are consistent with other polished tapered stem designs.     

Risk factors in follicular thyroid carcinomas. A retrospective follow-up study covering a 14-year period with emphasis on morphological findings

One hundred sixty-seven patients with follicular carcinomas and 88 with atypical adenomas of the thyroid have been followed up for up to 14 years. The influence of tumor invasiveness; tumor extent at time of presentation, including degree of metastatic spread; and age of patients have been evaluated by determining the rate at which distant metastases or deaths occurred during the later course of disease after surgery had been performed. The degree of tumor invasiveness has been found to be of great prognostic weight. Atypical adenomas did not show recurrences during the time of observation. The most important diagnostic distinction made with regard to prognosis was found to be between minimally invasive (encapsulated) and extensively invasive carcinomas.     

Neck sprain not arising from car accidents: a retrospective study covering 25 years

During the 25-year period 1970–1994, 680 patients were diagnosed with neck sprain due to causes other than car accidents at the Emergency Room of the University Hospital Groningen. The purpose of the present study was to analyse the prevalence, groups at risk and trends in patients with neck sprain. We defined the population as patients diagnosed with neck sprain that was not due to a car accident (NCA). The binominal test was used to obtain measures of statistical significance, Δx was used to obtain both the total increase in the number of neck sprain victims over the whole period (1970–1994) and the relative contribution of successive 5-year periods. Over the 25-year period a steady increase in the number of patients was observed from 55 in 1970–1974 to 241 in 1990–1994. The highest prevalence was found among 15- to 19-year-olds (3.92 per 10,000), followed by 10- to 14-year-olds (3.40 per 10,000). The major causes of neck sprain NCA were accidental falls (25%), sports injuries (24%) and bicycling injuries. Across the life span, the male: female ratio was 0.63. Ten percent of patients were treated as inpatients. The increase in neck sprain NCA can be only partly attributed to increased media attention. The reduction of working hours resulting in more leisure time activities, which in turn increases the exposure time in at risk situations, and the awareness of both patients and physicians is discussed. Received: 26 May 1997 Revised: 17 December 1997 Accepted: 10 January 1998     

Synoviorthesis with radioactive gold in hemophiliacs. Clinical and radiological follow-up

Twenty-seven patients with hemophilia treated with intra-articular injection of radioactive gold were followed up clinically and radiologically for 3 to 9 years after treatment. To assess the radiological changes, a new classification was designed, with a score describing the severity of the changes in a more accurate manner than the methods previously used. The treatment decreased the bleeding frequency and stopped the progress of the arthropathy if applied at an early stage when the arthropathy was still reversible. If the treatment was begun at a later stage, the arthropathy seemed to progress independently of the effect on the bleeding frequency. No negative effect of the radioactive gold was observed on the joint or the growing zone.     

Femoro-patellar prosthesis. A retrospective study of 45 consecutive cases with a follow-up of 3-12 years]

Forty-five consecutive patients operated between 1986 and 1995 were evaluated to assess the long term results of patellofemoral arthroplasty. Revision had to be performed in 8 cases for the following reasons: loosening (3), lateral impingement (3), malposition (1) and persistent patella instability (1). Two groups of patients were identified based upon the preoperative assessment: 21 had primary osteoarthritis without anatomic malalignment (group C) and 24 had a history of patellofemoral instability and trochlear dysplasia demonstrated by clinical and radiological evaluation (group D). Only 43% of good results were found in group C whereas in group D, the percentage of good results was close to 83%. The most common cause of poor results in group C was the degenerative involvement of the femorotibial compartments (5 patients had to undergo total knee arthroplasty subsequently). For group D patients, femorotibial osteoarthritis was not a determinant factor as regards the outcome of patellofemoral arthroplasty. To the authors, it appears that the best indication for patellofemoral arthroplasty is femoropatellar osteoarthritis with malalignment in patients having a normal femorotibial axis even in the presence of femorotibial osteoarthritis as long as the latter does not exceed grade II.     

The progression of radiological hand osteoarthritis over ten years: a clinical follow-up study

The natural history of hand osteoarthritis (OA) is poorly understood. The aim of the study was to ascertain the extent and pattern of radiological progression of hand OA over a 10-year period. A follow-up study was carried out on 169 consecutive patients who initially presented with OA of the hands or knees between 1975-1977. Fifty-nine subjects (45 women and 14 men) were recontacted who had paired hand radiographs, a mean of 10 years apart, and were a mean 69 (range 53-86) years old at follow-up. X-rays were scored blind, in three joint areas--distal and proximal interphalangeal joints (DIP and PIP) and first carpo-metacarpal (CMC) joints--using the method of Kellgren and Lawrence (K&L) (0-4), and for osteophytes and narrowing (0-3). Using the highest score for right and left hands (N = 118), K&L changes at the three areas were similar with 47-50% deteriorating, 45-46% unchanged, and 6-8% improving. Similar deterioration was seen when scoring the three joint areas for osteophytes (38-39%) and narrowing (39-48%). New osteophytes appeared in 48% of DIP joints during the 10 years. There was a weak correlation between progression at the DIP and PIP joints, but no relationship between DIP and CMC, or CMC and PIP. Virtually all subjects (97%) deteriorated when the total scores of all joints were calculated. No significant differences were seen between 'severe progressors' and 'minor' in terms of age or body mass index (BMI). A nonsignificant increase in the proportion of knee progressors in the severe progressor hand group was seen and there was a higher rate of baseline DIP OA in knee progressors. These results suggest that the majority of patients with OA of the hands attending a rheumatology outpatients clinic deteriorate radiologically over a 10-year period, about half developing new changes in DIP joints. There were no obvious features distinguishing those with rapid deterioration, although DIP OA appears to be a risk factor for knee progression.     

Clinical outcomes after ACL reconstruction with free quadriceps tendon autograft versus hamstring tendons autograft. A retrospective study with a minimal follow-up two years

ObjectiveThe aim of this retrospective study was to compare the clinical outcomes of anatomic single bundle ACL reconstruction using either a free quadriceps tendon autograft or a quadrupled hamstring autograft with a minimum follow-up of 24 months.MethodsConsecutive patients undergoing ACL reconstruction using either a free quadriceps tendon autograft or hamstring tendon autograft from January 2013 to December 2014 were included. ACL reconstruction was done in all patients due to isolated ACL tears. Patients with associated cartilage lesions > Outerbridge III, meniscal lesions in need of meniscectomy or repair as well as patients with prior knee surgery on the affected or contralateral knee were excluded. The primary outcome evaluation was the side-to-side difference in instrumented Lachman testing. Secondary outcome evaluation consisted in the Lysholm, modified Cincinnati and SF-36 scores. Side-to-side difference in range of motion and thigh diameter was also documented.ResultsAfter applying the inclusion/exclusion criteria, a total of 82 patients were identified and 72 (87.8%) presented to the hospital for follow-up. There were 39 patients with quadriceps graft (30.64 ± 8.71, range: 18–53 years) and 33 patients with hamstrings (28.60 ± 6.74, range: 18–46 years). No statistically significant difference between groups was detected with regard to KT-1000 measurements (p = 0.326). No significant difference was found between the mean postoperative Lysholm (p = 0.299), the modified Cincinnati (p = 0.665) and the general SF-36 scores between groups (p = 0.588). Less side-to-side thigh diameter difference was noted in the quadriceps graft group (p = 0.026).ConclusionIn conclusion, similar clinical results, in terms of stability and subjective measures, can be obtained after ACL reconstruction both with a free quadriceps and a 4-strand hamstring tendons autograft.Level of evidenceLevel III, Therapeutic Study.     

Results of Charnley total hip arthroplasty at a minimum of thirty years. A concise follow-up of a previous report

The purpose of the current study was to update the results of a prospective, single-surgeon series of primary Charnley total hip arthroplasties performed with cement. This investigation is one of the first studies in which hips treated with total hip arthroplasty with cement were followed for a minimum of thirty years. Twenty-seven patients (thirty-four [10.3%] of the hips in the initial study group) were alive at a minimum of thirty years postoperatively. These patients served as the focus of the present study. Revision because of aseptic loosening of the acetabular component was performed in 7.3% (twenty-three) of the hips from the original study group (excluding those revised because of infection or dislocation) and 26% (eight) of the hips in the living cohort. Revision because of aseptic loosening of the femoral component was performed in 3.2% (ten) of the hips from the original study group (excluding those revised because of infection or dislocation) and 10% (three) of the hips in the living patients. Since the twenty-five-year review, three hips were revised (one because of acetabular loosening, one because of femoral loosening, and one because of instability). This end-result study demonstrated the remarkable durability of cemented Charnley total hip replacements over a span of three decades, with 88% of the original prostheses intact at the time of the final follow-up or at the patient's death.     

Acetabular revisions using porous tantalum components: A retrospective study with 5-10 years follow-up

AIM To evaluate the clinical and X-ray results of acetabular components and tantalum augments in prosthetic hip revisions.METHODS Fifty-eight hip prostheses with primary failure of the acetabular component were reviewed with tantalum implants. The clinical records and X-rays of these cases were retrospectively reviewed. Bone defect evaluations were based on preoperative CT scans and classified according to Paprosky criteria of Radiolucent lines and periprosthetic gaps; implant mobilization and osteolysis were evaluated by X-ray. An ad hoc database was created and statistical analyses were performed with SPSS software(IBM SPSS Statistics for Windows, version 23.0). Statistical analyses were carried out using the Student's t test for independent and paired samples. A P value of 0.05 was considered statistically significant and cumulative survival was calculated by the KaplanMeier method.RESULTS The mean follow-up was 87.6 ± 25.6 mo(range 3-120 mo). 25 cases(43.1%) were classified as minor defects, and 33 cases(56.9%) as major defects. The preoperative HHS rating improved significantly from a mean of 40.7 ± 6.1(range: 29-53) before revision, to a mean of 85.8 ± 6.1(range: 70-94) at the end of the follow-up(Student's t test for paired samples: P 0.001). Considering HHS only at the end of follow-up, no statistically significant difference was observed between patients with a major or minor defect(Student's t test for independent samples: P 0.05). Radiolucent lines were found in 4 implants(6.9%). Postoperative acetabular gaps were observed in 5 hips(8.6%). No signs of implant mobilization or areas of periprosthetic osteolysis were found in the x-rays at the final follow-up. Only 3 implants failed: 1 case of infection and 2 cases of instability. Defined as the end-point, cumulative survival at 10 years was 95%(for all reasons) and 100% for aseptic loosening of the acetabular component.CONCLUSION The medium-term use of prosthetic tantalum components in prosthetic hip revisions is safe and effective in a wide variety of acetabular bone defects.     

A study of thirty right hepatic arteries.

Thirty right hepatic arteries discovered among 137 celiomesenteric angiographies show the high frequency (22%) of this variation. Radiologic anatomy of the right hepatic artery was discussed; with the exception of one atheromatous stenosis, the pathologic findings of the right hepatic artery and its terminal branches illustrate the development of a regional disease (12 cases or 40%). This assumed pathology is divided half in pancreatic causes (neoplasm, pancreatitis, pseudocysts) and half in hepatobiliary causes (metastatic cancer of the liver, cancer of the hilus, cirrhosis, hydatid cyst, alveolar echinococcosis or angioma). Five times the surgical technic was modified because of the right hepatic artery. Since these observations were made, we are studying the consequences of this hepatic artery over surgical technics and the approach to the various segments of this artery.     

Collarless polished tapered stem: clinical and radiological follow-up over 5 years

The clinical and radiologic outcome of a cemented, polished, tapered stem (CPT), implanted using contemporary cementing techniques in 108 consecutive operated hips in 100 patients (68 women and 32 men, aged 19 to 83 years at the time of surgery [mean, 65 years]) was assessed after >5 years. The Harris hip scores were good or excellent in 96% of the patients. Stem subsidence measured by the computer-assisted method described by Braud and Freeman was at a mean rate of 0.44 mm/y, 1.08 mm during the first year, and stabilizing to a mean total of 2.18 mm at >5 years. Subsidence was related inversely to the completeness of the cement mantle but did not correlate with the clinical or radiologic outcome. This study confirms that collarless, polished, tapered stems subside within the cement mantle but without loosening and that the CPT performs at least as well as the Exeter stem.