Is It Possible to Treat Developmental Dysplasia of the Hip with Anterior Open Reduction and Pemberton Osteotomy Under 18 Months of Age?

Purpose of the StudyThe purpose of the present study is to determine the outcome success of anterior open reduction with Pemberton osteotomy in patients under 18 months of age with developmental dysplasia of the hip.MethodsWe retrospectively reviewed the clinical and radiological results of 27 developmental hip dysplasia patients under 18 months of age (26 girls, 1 boy) who underwent anterior open reduction with Pemberton osteotomy. Bilateral surgery was performed in 18 patients and unilateral in nine patients. At the final follow-up, the clinical results were evaluated according to the McKay’s clinical evaluation criteria, the radiological results according to the Severin’s radiological evaluation criteria, and the presence of avascular necrosis according to the Kalamchi-MacEwen’s classification criteria.ResultsWe treated 36 hips of 27 patients who were younger than 18 months of age (range 10–18 months) at the time of surgery and followed up a minimum of 5 years (mean 6.5 years). At the final follow-up, 34 (94.4%) were assessed clinically as excellent, one hip (2.7%) as good and one hip (2.7%) as fair according to the McKay’s clinical classification. Radiological classification revealed that, 97.2% of the hips were Severin Type-1 and 2.8% Severin Type-3. Avascular necrosis was observed in 5 of 36 hips (13.8%). Two hips were assessed as Type-2, two hips Type-3 and one hip Type-4 according to the Kalamchi-MacEwen’s classification.ConclusionWe conclude that Pemberton osteotomy with anterior open reduction is useful technique for developmental hip dysplasia treatment of patients under the age of 18 months with good clinical and radiological results as well as with low complication rates.     

Seckel syndrome associated with atrioventricular canal defect: a case report

Seckel syndrome is a rare autosomal recessive disorder and its characteristic features are marked growth and mental retardation, significant microcephaly and a convex nose. We report a boy with this syndrome who also had severe cardiac anomalies. Although his parents were non-consanguineous, it is suggested that he had autosomal recessive inheritance.     

Successful treatment with linezolid of meningitis complicated with subdural empyema in a 6-month-old boy

Recent findings have focused on the possible role of linezolid as a suitable candidate for the treatment of central nervous system infections. The linezolid treatment for meningitis was sporadically reported in adults but there was no report in children. Here, we present a 6-month-old boy with meningitis and subdural empyema which was unresponsive to more conventional agents but successfully treated with linezolid therapy. A previously healthy 6-month-old boy was referred to our clinic for deteriorating general condition with fever, vomiting and seizures. He had fever and tense-bulging anterior fontanelle. Based on his first cerebrospinal fluid (CSF) results, empirical antibiotic therapy for bacterial meningitis consisting of vancomycin and ceftriaxone was started. However, CSF culture yielded no micro-organisms but blood culture showed coagulase-negative Staphylococci. On the 7th day, he still had high fever and the erythrocyte sedimentation rate (ESR) and serum CRP levels had risen by 105 mm/h and 36.2 mg/dl, respectively. On 10th day, computerized cranial tomography showed bilateral frontoparietal subdural empyema. Purulent material was evacuated by burr hole, and gram stains of the material showed polymorphonuclear leukocytes and no microorganisms. Clinical and CSF findings of our case were, unresponsiveness to vancomycin, ceftriaxone and consecutive meropenem treatment while we still observed subdural empyema during these treatments. For this reason we started linezolid 10 mg/kg twice daily. Clinical signs improved dramatically, with both completely normal neurological findings and normalization of CSF and radiological findings. To the of our best knowledge, linezolid treatment of meningitis in children has not been reported previously. Clinical and CSF findings of our case were improved completely with linezolid treatment. Also, control cranial computerized tomography showed the total recovery of subdural empyema. Here we present the youngest case with meningitis which was successfully treated with linezolid treatment.     

Subfascial drainage and clipping technique for treatment of cerebrospinal fluid leak following spinal surgery

Objectives:To investigate the treatment of iatrogenic cerebrospinal fluid (CSF) leak that develops after degenerative lumbar spinal surgery with a subfascial drainage and clipping (SDC) technique.Methods:This study retrospectively reviewed the medical records of 46 patients who developed iatrogenic CSF leak after surgery for lumbar degenerative spine disease from 2007 to 2019. Twenty-five patients were treated with the SDC procedure (SDC group), whereas 21 were not (control group). Outcomes were compared between the two groups.Results:CSF leakage ceased within 6–9 days (average 7.4±1) after the procedure in the SDC group. In the control group, CSF leakage was controlled with conservative measures in 14 patients, and in 7 patients, lumbar external drainage was performed. Among these 7, the CSF leak was controlled by lumbar external drainage in 3, and 4 required reoperation to repair the dural defect. No infection occurred in either group. Length of hospital stay was also shorter in SDC group (8.4±1 vs 10.0±1.3 days, p < 0.001).Conclusion:The SDC technique is effective for the treatment of iatrogenic CSF leak that develops after degenerative lumbar spinal surgery.

Iatrogenic cerebrospinal fluid (CSF) leaks are one of the most common surgical complications of spinal surgery. Incidental dural injury is common during spinal surgery, epidural injection, and myelography. Previous studies have reported incidence rates ranging between 1% and 17% for incidental durotomy during surgery,¹ and Gerardi et al² reported a 6.8% incidence of intraoperatively undiagnosed CSF leak. As many patients with this condition are asymptomatic, it is difficult to predict CSF leaks that are not diagnosed at the time of surgery. Patients with symptomatic CSF leaks may suffer intracranial hypotension-related vertigo, posture-related headache, photophobia, double vision, neck stiffness and dizziness.Patients who are not diagnosed at the time of surgery or undergo inadequate dural repair may develop a postoperative dural leakage or pseudomeningocele.³In 1983, Teplick and Haskin⁴ reported a pseudomeningocele incidence of 1.6% detected by computerised tomography imaging among 750 patients who underwent lumbar spinal surgery and remained free of dural leak. When they occur, cutaneous leakage usually develop between the first and seventh days after surgery.In spinal CSF leaks, oversuturing the incision and application of a pressure dressing may suffice in most cases. When these measures fail, bed rest in the semi-Fowler’s position is recommended. The main target of bed rest is to reduce the CSF hydrostatic pressure in the lumbar region. In 2 previous studies, Wang et al² systematically prescribed short-term (2.9 days) bed rest, and Camisa et al² prescribed bed rest for 3–5 days. In addition, acetazolamide,⁵ repair with blood patch, and closed lumbar subarachnoid CSF drainage can be used. Kitchel et al reported that closed subarachnoid CSF drainage is an effective technique for treatment of postoperative CSF leaks and can prevent a repeat surgical intervention.⁶ Despite this, the outcomes are not always favourable. When these measures fail, a second surgery for primary dural repair can be performed.Cain et al⁷ examined the biology of a dural CSF leak repair in a canine model. They reported that fibroblastic bridging started on the 6th day and dural defects were healed on the 10th day.We did not encounter any other study in the literature that described the subfascial drainage and clipping (SDC) technique that we perform to treat CSF leaks after degenerative lumbar spinal surgery and report our experience herein.     

Differentiated and undifferentiated adipose-derived stem cells improve function in rats with peripheral nerve gaps

The effect of differentiated and undifferentiated adipose-derived stem cells on the repair of peripheral nerve gaps was studied. Adipose-derived stem cells were maintained in differentiation medium for 2 weeks. The expression of Schwann cell proteins S-100, nerve growth factor receptor (NGFR) p75 and integrin β4 was examined by immunofluorescence staining and real time-polymerase chain reaction (real time-PCR) at the end of the differentiation period. A 10-mm gap on the left sciatic nerves of 20 Fischer rats was created and bridged with silicone tube (group I), silicone tube filled with collagen gel (group II), nerve graft (group III), silicone tube filled with adipose-derived stem cells (group IV) and silicone tube filled with differentiated adipose-derived stem cells (group V). In vitro, the positivity of differentiated adipose-derived stem cells for S-100, NGFR p75 and integrin β4 by immunofluorescence staining was 31%, 27% and 12%, respectively. Fold changes by real time-PCR in comparison with undifferentiated cells were 48.4, 168.7 and 284.85, respectively. In vivo, a walking track analysis did not yield any statistically significant differences after 3 months postoperatively; however, after 6 months, group IV (sciatic function index (SFI) = -49.1 ± 13.1) and V (SFI = -52.6 ± 5.7) showed significant improvement compared to other groups (I: -73.3 ± 5.07, II: -79.6 ± 12.01, III: -74.8 ± 12.89) (p < 0.05). Nerve conduction velocity after 6 months was higher in groups IV (4.44 ± 0.3 mm ms(-1)), V (4.25 ± 0.3 mm ms(-1)) and III (4 ± 0.3 mm ms(-1)) than in groups I (2.5 ± 2.25 mm ms(-1)) and II (2.35 ± 1.58 mm ms(-1)) (p > 0.05). Myelin fibre density and myelinated fibre/unmyelinated fibre ratio were significantly higher in the midnerve and the distal nerve in groups IV and V (p < 0.05). These results reveal the therapeutic potential of adipose-derived stem cells in nerve reconstruction.     

Surface topography and wetting modifications of PEEK for implant applications

Polyetheretherketone (PEEK) is considered as a substitute for metallic implant materials due to its extremely low elastic modulus (3–4 GPa). Despite its good mechanical properties, PEEK exhibits a slow integration with the bone tissue due to its relatively inert surface and low biocompatibility. We introduced a dual modification method, which combines the laser and plasma surface treatments to achieve hierarchically patterned PEEK surfaces. While the plasma treatment leads to nanotopography, the laser treatment induces microstructures over the PEEK surface. On the other hand, plasma and laser treatments induce inhomogeneity in the surface chemistry in addition to the tailored surface topography. Therefore, we coated the structured PEEK surfaces with a thin alumina layer by pulsed laser deposition (PLD) to get identical surface chemistry on each substrate. Such alumina-coated PEEK surfaces are used as a model to investigate the effect of the surface topography on the wetting independent from the surface chemistry. Prepared surfaces bring advantages of enhanced wetting, multiscaled topography, proven biocompatibility (alumina layer), and low elastic modulus (PEEK as substrate), which together may trigger the use of PEEK in bone and other implant applications.     

Retrograde intrarenal surgery in patients with isolated anomaly of kidney rotation

The purpose of the study was to investigate feasibility of retrograde intrarenal surgery (RIRS) in patients with isolated anomaly of kidney rotation with kidney stones. We retrospectively reviewed the medical records of patients who underwent RIRS due to kidney stones in three referral hospitals. Twenty-four patients who had kidney rotation were included in this study. The patients with horseshoe kidney or pelvic kidney were not included in the study. The patients were evaluated for final success 1 month after surgery. Success was defined as stone-free or fragment smaller than 3 mm. Mean age of patients was 39.5 years (1–71 years) and male/female ratio was 3:1. Mean stone size was 13.46 mm (5–30 mm). Twelve (50 %) patients had the operation on the right side and other 12 (50 %) patients had on the left side. Eighteen (75 %) patients were stone-free after single procedure. And stone-free rate increased to 83.3 % after additional treatment procedures. When we compared the successful and failed procedures, gender, stone side and size, preoperative hydronephrosis, access sheet usage, ureteral double-J stent insertion were not statistically significant in two groups. We did not confront major complication. RIRS seems to be an effective and safe treatment option for renal stones in patients with isolated anomaly of kidney rotation.