Does Severity or Specific Joint Laxity Influence Clinical Outcomes of Anterior Cruciate Ligament Reconstruction?

It generally is believed generalized joint laxity is one of the risk factors for failure of anterior cruciate ligament (ACL) reconstruction. However, no consensus exists regarding whether adverse effects on ACL reconstruction are attributable to joint-specific laxity or are related to the severity of generalized joint laxity. We therefore asked whether knee stability and functional outcomes would be related to joint-specific laxity and would differ according to the severity of generalized joint laxity. The Beighton and Horan criteria were used to assess joint laxity in 272 subjects. All elements are added to give an overall joint laxity score ranging from 0 to 5. Knee translation did not increase in proportion to the severity of the generalized joint laxity. Patients with scores less than 4 showed similar knee stability. When all variables, including the severity of generalized joint laxity, were considered, only hyperextension of the knee independently predicted knee stability and function. In patients with knee hyperextension, a bone-patellar tendon-bone autograft provided superior stability and function compared with a hamstring tendon autograft. Our data suggest knee hyperextension predicts postoperative stability and function regardless whether patients have severe generalized joint laxity.     

Use of 2.0 mini plate system as reduction plate

Fracture stabilization and reduction using temporary plates during intramedullary tibial nailing was introduced as a novel concept in fracture surgery by Benirschke et al. (Orthop Trans 18:1055–1056, 1995). The concept of temporary reduction using one-third tubular plates proved useful in aiding metaphyseal and periarticular fracture fixation also. However, planning the strategic location of final plate was the main limitation with this technique using one-third tubular plates. We used 2.0 mini plates as provisional reduction plates that solved the issue of planning and placement of plates. The main advantage of our technique is that the final definitive plate can be applied directly over the mini plates. Here, we will describe our technique using relevant fracture case in metaphyseal–periarticular location.     

Factors affecting femoral varus osteotomy in cerebral palsy: a long-term result over 10 years

The present study was conducted to review the long-term results of femoral varus osteotomy with/without pelvic osteotomy of spastic cerebral palsy. We also evaluated the spastic hip score with following factors: migration index of Reimer's, Shenton's line, shape of the femoral head, shape of the roof of the acetabulum, and presence of windblown effect. Of the 31 children (61 hips) reviewed, 49 hips (80%) had satisfactory outcomes after 10 years of follow-up. Twelve hips showed unsatisfactory outcomes with recurrent dislocation or significant osteoarthritis. A low preoperative spastic hip score was more indicative of a better outcome.     

Two cases of spontaneous middle cerebral arterial dissection causing ischemic stroke

Spontaneous middle cerebral arterial dissection (MCAD) is a rare cause of ischemic stroke. We report two cases of isolated spontaneous MCAD causing ischemic stroke. MCAD should be considered when a young patient has a middle cerebral artery territory infarct with stenosis at the origin of the middle cerebral artery. We discuss noninvasive radiological techniques for the diagnosis of MCAD.     

Low prevalence of HBV DNA in the liver allograft from anti‐HBc‐positive donors: a single‐center experience

Pan J‐J, Oh S‐H, Soldevila‐Pico C, Nelson DR, Liu C. Low prevalence of HBV DNA in the liver allograft from anti‐HBc‐positive donors: a single‐center experience.
Clin Transplant 2011: 25: 164–170. © 2010 John Wiley & Sons A/S. Abstract: Allografts from donors positive for antibody to hepatitis B core antigen (anti‐HBc⁺) can transmit hepatitis B virus (HBV) to the recipients. We aimed to study the prevalence of HBV DNA in liver allografts from anti‐HBc⁺ donors. Between January 2003 and December 2008, this retrospective study identified 18 patients who received a liver from an anti‐HBc⁺ donor. Pre‐ and post‐transplantation HBV serology and serum HBV DNA level of the study subjects were reviewed. DNA extracted from liver biopsy tissue was used for PCR assay. Immunohistochemistry was also performed to determine viral protein expression. We observed a low prevalence of HBV DNA in allografts from anti‐HBc⁺ donors even among patients who did not receive prophylaxis. Only one of 18 patients had detectable HBV DNA in the liver allograft. This recipient was seronegative for HBV before transplantation and did not receive prophylaxis after transplantation, and developed de novo hepatitis B. Of the five patients who were positive for both antibody to hepatitis B surface antigen and anti‐HBc before transplantation and did not receive prophylaxis after transplantation, none developed HBV infection. Prophylaxis for HBV is important for seronegative recipients receiving a liver from an anti‐HBc⁺ donor. Such prophylaxis may not be necessary for recipients who do not have detectable HBV DNA in the liver allograft.     

Single‐nucleotide polymorphisms within the antioxidant defence system and associations with aggressive prostate cancer

What’s known on the subject? and What does the study add? Prior studies have identified potential interaction effects between antioxidant nutrients and germline gene variants with regards to prostate cancer risk. In particular, the rs4880 gene variant in SOD2 (or MnSOD) has been linked to several cancers, including prostate, and appears to interact with antioxidant status and cancer risk. We identified additional variants in SOD2 and SOD1 that may affect risk of prostate cancer, or interact with selenium status to affect prostate cancer risk.

OBJECTIVE

To study the effects of oxidative stress on prostate cancer development as the exact biological mechanisms behind the relationship remain uncertain. We previously reported a statistically significant interaction between circulating selenium levels, variants in the superoxide dismutase 2 gene (SOD2; rs4880), and risk of developing prostate cancer and presenting with aggressive prostate cancer.

PATIENTS AND METHODS

We genotyped men with localized/regional prostate cancer for 26 loci across eight genes that are central to cellular antioxidant defence: glutathione peroxidase (GPX1, GPX4), peroxisome proliferator‐activated receptor γ coactivator (PPARGC1A, PPARGC1B), SOD1, SOD2, and SOD3, and ‘X‐ray repair complementing defective repair in Chinese hamster cell 1’ (XRCC1). Among 489 men, we examined the relationships between genotypes, circulating selenium levels, and risk of presenting with aggressive prostate cancer at diagnosis, as defined by stage, grade and prostate‐specific antigen (PSA) level (213 aggressive cases).

RESULTS

Two variants in SOD2 were significantly associated with the risk of aggressive prostate cancer (rs17884057, odds ratio 0.83, 95% confidence interval 0.70–0.99; and rs4816407, 1.27, 1.02–1.57); men with A alleles at rs2842958 in SOD2 had lower plasma selenium levels (median 116 vs 121.8 µg/L, P= 0.03); and the association between plasma selenium levels and risk of aggressive prostate cancer was modified by SOD1 (rs10432782) and SOD2 (rs2758330).

CONCLUSION

While this study was cross‐sectional and these associations might be due to chance, further research is warranted on the potential important role of antioxidant defence in prostate cancer.     

Gastropericardial fistula-induced pyopneumopericardium after esophagectomy with esophagogastrectomy

Gastropericardial fistula is an acquired disorder presenting as an abnormal communication between the stomach and the pericardium, with a rare incidence and extremely high mortality rate. We recently experienced a case of life-threatening gastropericardial fistula occurring as an unusual complication after an esophagectomy with an esophagogastrostomy for esophageal cancer treatment. A 68-year-old man with a history of esophagectomy and esophagogastrostomy using the gastric pedicle for the esophageal cancer 13 years ago, visited the hospital with a complaint of dyspnea for 3 days. Chest roentgenogram, computed tomographic scan, and endoscopy showed a pneumopericardium and huge ulcer with central perforation in the posterior wall of the gastric pedicle.     

Anterior plating and percutaneous iliosacral screwing in an unstable pelvic ring injury

Background This study was carried out to evaluate the effectiveness of anterior plating with subsequent percutaneous iliosacral screwing for the management of unstable pelvic ring injuries. Methods Nineteen patients with unstable pelvic ring injuries were included in this retrospective study. All patients were followed up for at least 1 year, and their mean age was 43 years. According to the Association for Osteosynthesis-Orthopaedic Trauma Association (AO-OTA) classification, there were 5 B2 injuries, 11 C1 injuries, and 3 C2 injuries. After anterior fixation by means of plating, an iliosacral screw fixation was carried out percutaneously using a C-arm fluoroscope. Results All fractures healed, except for 1 case of nonunion at the pubic ramus. Radiological results showed that there were 9 anatomic, 7 nearly anatomic, 2 moderate, and 1 poor reduction. Sixteen of the 19 patients had good or excellent results for function, and all these had satisfactory (anatomic or nearly anatomic) reductions. The two moderate and 1 poor result were from an unsatisfactory reduction in a type-C injury with residual neurological signs. A screw misplacement with a neurological compromise occurred in 1 patient, but there were no adverse sequelae after its removal. The complications encountered were 2 cases of screw loosening, 2 cases of anterior metal failure, and 1 deep infection. Conclusions Anterior plating with subsequent percutaneous iliosacral screwing may be a useful method of treatment for unstable pelvic ring injuries, and the reduction quality and residual neurological signs were important in its functional outcome.