Femoral neck nonunion treatment

Femoral neck fracture nonunion is a challenging complication for the orthopaedic surgeon. The etiology of nonunion can be complicated and multifactorial. The diagnosis usually is established clearly with clinical and radiographic examinations. There are no clear guidelines for treatment, although multiple factors must be taken into account. Treatment options include refixation, solitary bone grafting, osteotomy (with and without bone grafting), and prosthetic arthroplasty. The relative indications, shortcomings, contraindications, and results of these different forms of treatment are discussed.     

Questions concerning low intensity reduction in lung compliance

From the very early stages of reduction in lung compliance, the thoracic organs may be forcibly displaced, be subject to attraction or be prevented from fully carrying out their normal movement. By evaluating these changes on a chest radiogram we may assess, at least broadly, the existence of reduced compliance and to some extent its degree. Given that reduction of lung compliance can constitute the initial sign of establishment of a secondary neoplasm or other pathological condition in the lung, the potential of chest radiograms becomes wider both in the diagnostic sphere and in that of pathophysiological research. The more frequent displacement of the trachea to the right is, we believe, due to the greater overall mass of the right lung, so that in homogenous reduction of the lung compliance the total attraction to the right may be greater. The rising of the hemidiaphragms usually starts in their frontal region. This, we consider, is due to the different resistance to the reduction in lung compliance of the adjacent areas of the lung resulting from their different structure. The reduction of compliance in segments or subsegments adjacent to the hemidiaphragms produces local rising of them. When these segments are adjacent to the osseous thoracic wall they cause pleural thickening by activating the suction mechanism. The reduction in lung compliance may cause S-shaped distortion of the bronchovascular bundles of the lower lobes, displacement of the hili, blunting of the angle of the carina, curvature of the main bronchi and of the intrathoracic part of the trachea. All these changes can be seen on a chest radiogram.     

Serum CA 125 combined with transvaginal ultrasonography for ovarian cancer screening

BACKGROUND: The aim of this study was to evaluate the combination of serum CA125 and Transvaginal Ultra Sonography (TVUS) score, as a screening procedure for ovarian cancer in premenopausal and postmenopausal women. PATIENTS AND METHODS: A retrospective case-control pilot study was conducted. The files of 120 women with ovarian neoplasia detected by TVUS and increased CA125 level, within the framework of a prevention program, were reviewed. The relationship between the above tests and epithelial malignancy was investigated using the SPSS-12 program for Windows. RESULTS: The combination of CA125 value exceeding 30U/ml and a TVUS score > or = 35 had a sensitivity of 81.7% and specificity of 100% in predicting ovarian cancer. Mathematical analysis of the logistic model of our variables revealed a mathematical model that can calculate the likelihood of ovarian cancer detection, by using a combination of CA125 > or = 30U/ml and TVUS score > or = 35. CONCLUSION: By combining TVUS and CA125, an accurate prediction for the presence of ovarian cancer may be achieved. Further investigation in a larger population is warranted.     

Impact of body mass index on fasting blood glucose concentration among Helicobater pylori carriers

BACKGROUND/AIMS: Despite the fact that Helicobacter pylori (Hp) is regarded as a major gastroduodenal pathogen, it has recently been suggested to be an important factor for non-gastroenterologic conditions such as diabetes mellitus. Accordingly, it seems that Hp infection may have implications in glycemic control and in fasting plasma glucose concentrations. As overnutrition and obesity are directly related to impaired glucose tolerance, the aim of the present study was to determine whether Hp infection leads to alterations in fasting plasma glucose concentrations of Hp carriers and especially in relation to their body mass index. METHODS: Serum was obtained from 224 young, male navy recruits. An enzyme-linked immunosorbent assay to detect Hp-specific IgG serum antibodies as well as gastroscopy along with biopsy was used to identify the infected individuals. Serum levels of glucose, urea, creatinine and uric acid were also determined. Non-fasting subjects and persons with abnormal oral glucose tolerance curve test were excluded. RESULTS: Among Hp-positive individuals, obese persons presented with a significantly lower mean blood glucose level than non-obese persons. Obese Hp-contaminated participants had significantly lower mean fasting blood glucose concentrations as well as a significantly smaller percentage of participants with abnormal elevated blood glucose levels than obese participants negative to Hp infection. CONCLUSIONS: Our data suggest that obesity in combination with Hp infection may induce an enhanced response to insulin leading to reduced fasting blood glucose levels, among Hp-positive obese persons in comparison to Hp-positive lean persons.     

Pathogenesis of endometriosis: the role of defective 'immunosurveillance'.

OBJECTIVE: To analyse the aetiopathogenesis and the role of defective 'immunosurveillance' in endometriosis. METHOD: Review of studies on the pathogenesis of endometriosis, focusing particularly on novel molecules which express adhesive or proteolytic properties. Hypotheses addressing the role of oxidative stress in endometriosis were also reviewed. RESULTS: Endometriosis is a multifactorial disease associated with a general inflammatory response aiming to clear the peritoneal cavity from the ectopic endometriotic cells and tissue. Modern theories suggest that this inflammatory response creates an environment that may promote implantation and proliferation due to defective 'immunosurveillance'. CONCLUSION: The modern interpretation of the theory of reflux menstruation holds that women destined to develop endometriosis have a deficient immune system, which cannot defend against regurgitated endometrial cells. New findings on genetics, immune modulation, and secreted products of endometriotic lesions of affected women have given insight into the pathogenesis of this disorder and may serve as the background for new treatments of endometriosis-associated pain and infertility.