Postoperative Flexion Analysis of 3 Rotating-platform Knee Designs

Rotating-platform knee implants have successively undergone modifications to improve postoperative flexion. The cruciate-sacrificing Low Contact Stress (LCS) implant (DePuy Orthopaedics, Inc, Warsaw, Indiana) was modified into the cruciate-substituting PFC Sigma RP (ΣRP) implant and further into the PFC Sigma RPF (ΣRPF) implant (DePuy Orthopaedics, Inc). The goal of this study was to determine whether these modifications improved postoperative flexion. Postoperative flexion at 2 years was compared against preoperative flexion with regard to the general demographics of each group.Statistical analysis showed that the pre- to postoperative flexion changes achieved by the ΣRP (14.6°) and the ΣRPF (2.9°) were better (P<.001) than that achieved by the LCS (-10.3°); however, between the ΣRP (14.6°) and the ΣRPF (2.9°), the change was statistically insignificant (P=.045). In subgroups with preoperative flexion less than 125°, postoperative flexion achieved was 100.1° with the LCS, 119.8° with the ΣRP, and 121.3° with the ΣRPF. The difference between the ΣRP and ΣRPF and the LCS was statistically significant (P<.001), but between the ΣRP and the ΣRPF was statistically insignificant (P=.621). In subgroups with preoperative flexion 125° or more, postoperative flexion was 125° with the LCS, 132° with the ΣRP, and 130° with the ΣRPF, with no significant difference between groups (P=.416). Both cruciate-substituting designs produced better postoperative flexion than the cruciate-sacrificing design. The ΣRP, despite less preoperative flexion (P=.004), achieved statistically better postoperative flexion than the LCS (P<.001). In subgroups with comparable preoperative flexion, no statistical difference in postoperative flexion was achieved by the ΣRP and the ΣRPF.     

Half-dose gadobenate dimeglumine versus standard-dose gadodiamide in dynamic magnetic resonance imaging of non-cirrhotic livers: a retrospective intra-individual crossover comparison

Purpose

The purpose of this study was to compare enhancement characteristics of half-dose gadobenate dimeglumine (0.05 mmol kg^?1) with standard-dose gadodiamide (0.10 mmol kg^?1), in the assessment of hepatic vessels and lesions, using retrospective intra-individual crossover comparison methodology.

Methods

Ethics committee approval was obtained. From 2004 to 2012, 21 patients underwent MRI examination with both standard-dose gadodiamide and half-dose gadobenate dimeglumine, using the same liver MRI protocol at 1.5 T. Eighteen patients whose scans showed no artifacts were selected. Quality of liver lesion [12 hemangiomas, 7 focal nodular hyperplasias (FNHs)] and liver vessel enhancement, and the global diagnostic quality of studies were ranked on a scale of 1–4 by two independent radiologists. Contrast-to-noise ratio (CNR) and % enhancement of liver vessels and lesions were calculated based on region of interest, signal intensity, and noise standard deviation measurements performed at 0, 20 s, 1, 3, and 5 min post-contrast injection. Qualitative and quantitative results were compared using the paired Wilcoxon signed rank and Student’s t-tests, respectively.

Results

No qualitative differences were noted in enhancement of liver vessels, hemangiomas, and FNHs. There was no statistically significant difference between the global diagnostic qualities of scans performed with the two contrast agents. Quantitatively, liver vessels and hemangiomas did not demonstrate statistically significant differences in contrast enhancement. At 20 s, FNHs achieved higher CNR (P = 0.02) with gadodiamide.

Conclusion

Half-dose gadobenate dimeglumine results in similar contrast enhancement compared to standard-dose gadodiamide in assessment of liver vessels, hemangiomas, and FNHs, and is a reasonable alternative to standard doses of extracellular agents in dynamic liver MRI.     

Psychopathology in substance abusing adolescents: gender comparisons

Few studies have explored gender comparisons of psychopathology in substance abusing adolescents. To expand the knowledge base in this area, we assessed 59 adolescents (34 males and 25 females) presenting for inpatient treatment in a university‐based adolescent dual diagnosis program. Subjects were interviewed for psychiatric disorders using the revised Child Schedule for Affective Disorder and Schizophrenia (K‐SADS). The Structured Clinical Interview DSM‐IV (SCID‐R) was used to diagnose substance use disorders. The subjects were primarily Caucasian, ages 12–18. Ninety‐four per cent of the sample used tobacco and females were more likely than males to meet criteria for alcohol abuse or dependence. Disruptive disorders were the most prevalent psychiatric diagnoses in both males and females. However, anxiety disorders were more prevalent in females, and social phobia was the most common anxiety disorder. Both groups had experienced physical and/or sexual abuse; however, there was a trend towards higher incidences of females than males having experienced sexual abuse. Significantly more females had a history of suicide attempt. Taken together, these data suggest that there are some gender differences in co‐morbidity that may have treatment implications for this population. Further exploration of gender comparisons of psychopathology in adolescent substance abusers is warranted.     

Microalbuminuria: A marker of severe disease activity in rheumatoid arthritis

ObjectiveMicroalbuminuria is associated with increased risk for renal and cardiovascular mortality and morbidity in diabetes mellitus, hypertension, patients with acute myocardial infarction and elderly patients but the significance of microalbuminuria in rheumatoid arthritis and its correlation with disease activity is not well studied. The present study is therefore aimed to determine the microalbuminuria in rheumatoid arthritis patients and to correlate it with indicators of disease activity like CRP and ESR.MethodsHundred confirmed cases of Rheumatoid arthritis (2010 ACR-EULAR criteria) and hundred age and sex matched controls were taken. Those suffering from hypertension, diabetes mellitus and renal disease were excluded. Microalbumin was assessed by immunoturbidimetric method on Delta nephelometer. Disease activity was assessed by CRP and ESR.ResultsThe relative frequency of microalbuminuria in patients with rheumatoid arthritis was 26% as compared to 4% in controls. The median level of microalbuminuria in rheumatoid arthritis patients was significantly greater than in the controls (17 vs. 3.29, p < 0.01). Microalbuminuria significantly correlated with CRP (p < 0.001, r = 0.457) and ESR (p < 0.001, r = 0.361). A significant correlation was found with duration of disease (p < 0.05, r = 0.231) and number of joints involved (p < 0.05, r = 0.240).ConclusionsWe found increased prevalence of microalbuminuria in rheumatoid arthritis patients and it correlated with acute phase reactants.     

Utilizing the Retrograde Flow of Internal Mammary Vessels as a Donor Pedicle

Introduction  The aim of this study is to assess the results of retrograde flow of internal mammary artery and vein (IMA/V) as a donor vessel for free flap microvascular anastomosis (MVA). This need arises with bipedicle deep inferior epigastric perforator (DIEP) flaps, when all four zones with extra fat need to be harvested for unilateral breast reconstruction coupled with poor midline crossover of circulation naturally or because of midline scar. Large anterolateral thigh flaps for chest wall cover, with multiple perforators from separate pedicles, also need supercharging. This needs an additional source of donor vessels, antegrade IMA/V being the first one. Materials and Methods  Retrospective study of microvascular breast reconstruction using retrograde internal mammary donor vessels. Results  Out of 35 cases, 20 cases had distal IMA/V, with retrograde flow, as donor vessel for second set of arterial and venous anastomosis. In two cases, retrograde IMA/V was used for the solitary set of MVA. In remaining 13 cases, either retrograde IMA or V was utilized either as a principal or accessory donor. No flap was lost. Venous and arterial insufficiency happened in one case each, both were salvaged. Two cases developed partial necrosis, needing debridement and suturing. One case developed marginal necrosis. Only one case developed fat necrosis with superadded infection on follow-up. Conclusion  Distal end of IMA and IMV on retrograde flow is safe for MVA as an additional or sole pedicle. It is convenient to use being in the same field. It enables preservation of other including thoracodorsal pedicle and latissimus dorsi flap for use in case of a complication or recurrence.     

Causes of Missed Referrals to Low-Vision Rehabilitation Services: Causes in a Tertiary Eye Care Setting

Purpose: To identify the referral pattern and identify causes of missed referrals to low-vision services in a tertiary eye care center. Methods: A retrospective review of all the hospital records of patients seen from September-December 2012 was done to identify patients with visual impairment. Low vision was defined as has a best-corrected visual acuity (BCVA) in the better eye of <20/60 to light perception (as per WHO definition); or a visual field of <20° from the point of fixation. The frequency of referrals in this database was used to identify referral patterns of physicians and also causes for missed referrals for these patients. Results: Of 14,938 hospital medical records reviewed during the period, 499 patients missed low-vision services with a mean age of 46?±?18.2 years, including 158 females. Among those missed, 12.07% were in the age group 0-15 years, while 30.9% of the patients were >60 years, with 157 requiring rehabilitative services and training. Causes for missed referrals were clear misses or non-referrals by the physician (39%), non-acceptance of services by the patient (53%), loss from appointment desks (4.5%), and loss to follow-up (3.5%). Conclusion: Missed referral to low-vision services in tertiary centers can be considerable; these need to be identified for optimal utilization and delivery of these services to patients with low vision.     

Three-dimensional transesophageal echocardiographic delineation of ventricular septal aneurysm producing right ventricular outflow obstruction in an adult

We report three-dimensional echocardiographic delineation of a congenital aneurysm of the membranous interventricular septum causing right ventricular outflow tract obstruction in an adult patient. To our knowledge, these findings have not been described before.