Evaluation of the reliability of classification systems used for distal radius fractures

The objective of this investigation was to evaluate the reliability of classification systems by determining inter- and intraobserver agreement in displaced distal radius fractures. Radiographs of 32 patients (21 men and 11 women with a mean age of 41.6 years) who presented with a displaced distal radius fracture were classified by 9 orthopedic surgeons (5-25 years experience) using 5 different classification systems (Fernandez, AO, Frykman, Melone, and Universal Classification systems) twice with 20-day intervals. The results were processed with kappa statistics and used in assessment of inter- and intraobserver agreement of the classification systems. When classification systems were compared, the highest kappa coefficient in intraobserver agreement was determined in Universal classification (0.621). Fernandez (0.474), AO (0.309), Frykman (0.305), and Melone classification systems (0.262) followed the Universal system respectively. Kappa statistical results were evaluated using the Landis Koch score system for the assessment of interobserver agreement. According to the Landis Koch score system, the results were insufficient in all classification systems. Fernandez classification system had the highest interobserver agreement (0.235) and Melone classification system had the lowest interobserver agreement (0.056). According to the results of our study, the systems used to classify the displaced distal radial fractures are insufficient. A new classification system that ensures the 3-dimensional assessment of the fracture is more user-friendly and a high inter- and intraobserver agreement is necessary.     

Re-redo cervical mediastinoscopy for a recurrent lung cancer

Indian Journal of Thoracic and Cardiovascular Surgery -     

The effect of citrate replacement in hypocitraturic cases on the results of SWL: a preliminary prospective randomized study

Purpose

To evaluate the possible effects of citrate replacement on the efficacy of shockwave lithotripsy (SWL) in the management of kidney stones in cases with hypocitraturia.

Methods

Forty hypocitraturic cases with renal pelvic stones were randomized into two groups; while citrate replacement has been done before and at the time of SWL in Study Group I (n: 20), SWL was performed without any additional specific management for hypocitraturia in Study Group II (n: 20). Twenty normocitraturic cases were also chosen as the control group (Group III). Data of the patients were evaluated comparatively.

Results

Patient, stone, and urinary pH characteristics of the groups were similar. Pre-SWL urinary citrate levels were 0.71 (0.1?C1.3), 0.86 (0.1?C1.4), and 3.12 (1.8?C4.4)?mmol/24?h in Group I, II, and III, respectively. Urinary citrate value increased from 0.71 (0.1?C1.3) to 1.96 (1.6?C4.1)?mmol/24?h following replacement therapy (before and at the time of SWL) in Group I. Mean number of SW (p?=?0.461), rate of stone-street formation (p?=?0.146), and Double-J placement (p?=?0.291) were similar in Group I and Group II. While the mean number of SWL sessions (2.27?±?0.71 in Group I vs. 2.94?±?0.59 in Group II; p?=?0.027), and time to stone-free status [29.1 (16?C47) days in Group I vs. 38.4(21?C63) days in Group II; p?=?0.043], was significantly different between study groups, these parameters were found similar between Group I and Group III.

Conclusions

In our study, the patients with hypocitraturia, who did receive replacement therapy, tended to require lower number of SWL sessions and became stone free in a shorter period than the others who underwent SWL without any specific management of hypocitraturia.     

A double-orifice atrioventricular valve case: intraoperative transesophageal echocardiography in diagnosis and treatment

We describe a 45-yr-old woman with an intermediate type atrioventricular septal defect associated with a double-orifice left atrioventricular valve (DOLAV). We diagnosed this exceptional anomaly by intraoperative transesophageal echocardiography (TEE) during surgery that was scheduled for only a primum type atrial septal defect (ASD) repair. Preoperative transthoracic echocardiography and angiography revealed the ASD but could not demonstrate the DOLAV. We were able to repair this rare and challenging abnormality successfully under the guidance of TEE imaging during the operation. TEE provides valuable information about both anatomy and functional aspect of the valvular structures. Besides its proven role in cardiac surgery, intraoperative use of TEE also serves as a useful tool for diagnosis of such unexpected and potentially missed abnormalities.     

A new update for radiocontrast-induced nephropathy aggravated with glycerol in rats: the protective potential of epigallocatechin-3-gallate

Contrast media (CM) is known to have nephrotoxic adverse effects. Epigallocatechin-3-gallate (EGCG) is the most abundant and active catechin in green tea, and has strong antioxidant and anti-inflammatory properties. This study investigated whether EGCG can reduce contrast-induced nephrotoxicity (CIN), alone or with glycerol (GLY)-induced renal damage, and to understand its mechanisms of protection against toxicity, using models of GLY and CIN in rats. The rats were separated into eight groups (n?=?6 in each), as follows: Healthy, GLY, CM, GLY?+?CM, CM?+?EGCG 50?mg/kg (po), GLY?+?CM?+?EGCG 50?mg/kg (po), CM?+?EGCG 100?mg/kg (po), and GLY?+?CM?+?EGCG 100?mg/kg (po). Both doses of EGCG protected against CM-induced renal dysfunction, as measured by serum creatinine and blood urea nitrogen (BUN). In addition, EGCG treatment markedly improved CIN-induced oxidative stress, and resulted in a significant down-regulatory effect on tumor necrosis factor (TNF)-α and nuclear factor (NF)-κB mRNA expression. Moreover, histopathological analysis showed that EGCG also attenuated CM-induced kidney damage. Considering the potential clinical use of CM and the numerous health benefits of EGCG, this study showed the protective role of multi-dose EGCG treatment on CIN and GLY-aggravated CIN through different mechanisms.     

In vitro effect of lemon and orange juices on calcium oxalate crystallization

Aim  In recent years significant progress has been made in identifying and quantitating physico-chemical processes involved in urinary stone formation. The ability of urine to inhibit calcium oxalate crystallization is an important mechanism against stone formation. Dietary factors appear to affect the ability of urine to inhibit calcium oxalate crystallization. These factors encouraged us to study the effects of lemon and orange juices on calcium oxalate crystallization in vitro. Material and methods  The nucleation and aggregation of calcium oxalate monohydrate crystals were studied using turbidimetric 30-min time course measurements of optic density at 620 nm after mixing solutions containing calcium chloride and sodium oxalate at 37°C, pH 5.7. The formation of crystals is induced by the addition of the oxalate and calcium solution. The effects on calcium oxalate crystal growth of trisodium citrate, lemon and orange juices were examined. The effects of lemon and orange juices were evaluated by the addition of 50 ml of juices. The optical density is measured at physiological conditions. The maximum increase of optic density with time, termed S_N, reflects maximum rate of formation of new particles. After an equilibrium has been reached, a progressive decrease of optic density with time is observed. Rate of aggregation, S_A, is derived from the maximum decrease in optic density. Results  Among the modifiers studied, citrate decreased both S_N and S_A (P < 0.001). Lemon juice was also found to inhibit the rate of crystal nucleation and aggregation. But orange juice did not have any effect on the calcium oxalate crystallization (P > 0.05). Conclusion  These results show that effective prevention of urinary stone formation should aim at restoring the urine’s ability to inhibit calcium oxalate crystallization and more emphasis should be given to dietary measures.