Treatment of severe late-onset Perthes’ disease with soft tissue release and articulated hip distraction: revisited at skeletal maturity

Purpose  Late-onset Perthes’ disease is diagnosed after 9 years of age. Conservative treatment and conventional surgical techniques have limited ability to reduce the pressure in the joint or change the shape of the femoral head. We used a combination of soft tissue release and joint distraction with a hinged mono-lateral external fixator for these patients. Ten of our patients reached skeletal maturity and were evaluated. Methods  Clinical assessment included: Harris hip score, hip range-of-motion (ROM), limb length discrepancy, and the Oxford hip questionnaire for pain and function. Radiographic assessment included: Sharp transverse acetabular inclination, the uncoverage percentage, the epiphyseal index before surgery (modified Eyre–Brook), at frame removal, and, at last follow-up, the epiphyseal quotient (of Sjovall) and the Stulberg classification. Results  Our study included eight boys and two girls (mean age at surgery 12.3 years, range 9.4–15.1, mean age at last follow-up 18.1 years, range 15.2–22.8). The mean follow-up was 5.7 years (range 4.3–7.8). The mean Harris hip score was 86.3/100 (range 48.5–96); one patient had <85 points. The hip ROM was slightly limited in most patients, and seven patients had limb shortening between 1–4 cm. The mean Oxford hip questionnaire score was 17.4/60 (range 12–31). The mean Sharp transverse acetabular inclination of the affected side was 42° (range 36–54) compared to 39° for the unaffected side (P = 0.045). The mean uncoverage percentage was 37% (range 27–47) compared to 20% for the unaffected side (P = 0.017). The mean epiphyseal index was 0.71 (range 0.31–0.92) before surgery, 0.79 (range 0.50–0.93) at frame removal (P = 0.012), and 0.72 (range 0.51–0.89) at last follow-up (P = 0.646). The epiphyseal quotient for the eight unilateral cases was 0.72 (range 0.49–0.91), and the Stulberg classification was type III for three cases and type IV for seven. Conclusion  Patient satisfaction for function and pain following the combined procedure was good. Radiographic parameters did not change significantly. This should be regarded as a salvage procedure.     

Determination of the normal position of the anus (with reference to idiopathic constipation)

The position of the normal anus was numerically defined by the ano-genital index, which is the distance from the anus to the vagina or scrotum divided by the distance between the vagina or scrotum and the coccyx. In idiopathic constipation, one must look for an anterior displacement of the anus, which might be the cause of the constipation.     

Locking plastic tie--a simple technique for securing a chest tube

A quick and simple technique for securing a chest tube in the prehospital setting is described. The technique makes use of a plastic tie with a self-locking mechanism that is wrapped around the tube and sutured to the skin. The use of a plastic tie is recommended as a valuable component to chest tube kits for use in the prehospital setting.     

Runtime application of Hybrid-Asbru clinical guidelines

Clinical guidelines are a major tool in improving the quality of medical care. However, to support the automation of guideline-based care, several requirements must be filled, such as specification of the guidelines in a machine-interpretable format and a connection to an Electronic Patient Record (EPR). For several different reasons, it is beneficial to convert free-text guidelines gradually, through several intermediate representations, to a machine-interpretable format. It is also realistic to consider the case when an EPR is unavailable. We propose an innovative approach to the runtime application of intermediate-represented Hybrid-Asbru guidelines, with or without an available EPR. The new approach capitalizes on our extensive work on developing the Digital electronic Guideline Library (DeGeL) framework. The new approach was implemented as the Spock system. For evaluation, three guidelines were specified in an intermediate format and were applied to a set of simulated patient records designed to cover prototypical cases. In all cases, the Spock system produced the expected output, and did not produce an unexpected one. Thus, we have demonstrated the capability of the Spock system to apply guidelines encoded in the Hybrid-Asbru intermediate representation, when an EPR is not available.     

The effect of the copper chelator tetraethylenepentamine on reactive oxygen species generation by human hematopoietic progenitor cells

Clinical observations suggest that copper (Cu) plays a role in regulating hematopoietic progenitor cell (HPC) development. Cu is known to generate oxidative stress in cells which in turn affects proliferation, differentiation and apoptosis. To study this role of Cu, we used double staining flow cytometry to measure reactive oxygen species (ROS) generation by neonatal cord blood-derived CD34(+)CD38(-) cells. ROS was increased by Cu and was decreased by the Cu chelator tetraethylenepentamine (TEPA). Previously, we showed that TEPA reduces the free Cu content of HPCs and stimulates their ex vivo expansion. The present results suggest that TEPA affects expansion of HPCs by lowering their oxidative stress.     

Patient and provider determinants of breast cancer screening among Ontario women aged 40–49: a population-based retrospective cohort study

Breast Cancer Research and Treatment - Equivalent efficacy was demonstrated for the biosimilar CT-P6 and trastuzumab following neoadjuvant therapy for patients with human epidermal growth factor...     

Circulating erythroid progenitors in patients with 'spent'polycythaemia vera and myelofibrosis with myeloid metaplasia

S ummary . The ability of circulating progenitor cells from patients with polycythaemia vera (PV) and myelofibrosis with myeloid metaplasia (MMM) to develop erythroid colonies was studied in cultures with and without erythropoietin. In all normal controls, patients with secondary polycythaemia and MMM, erythroid colonies developed only after the addition of erythropoietin. Only in patients with PV, both in the active and spent phases of the disease, erythroid colonies developed in the absence of erythropoietin. The results indicate the perpetuation of erythropoietindependent, as well as erythropoietin-independent progenitors in both phases of this disease. Although spent PV often clinically resembles MMM, there is a basic difference in the behaviour of the circulating erythroid progenitors in these diseases which may serve as a useful tool in discriminating MMM from spent PV, when there is no history of active PV.     

Prognostic implications of preserved bile duct confluence after iatrogenic injury

BACKGROUND/AIMS: Biliary reconstruction is performed according to the level of the injury. A comparative study between patients in whom the biliary junction was preserved and another group where the biliary junction was not preserved was done. METHODOLOGY: A retrospective review of the biliary reconstructions performed at our institution after iatrogenic lesions between 1990-2002 was done. Postoperative outcome, functional status of the anastomosis, recurrent cholangitis, need for radiological instrumentation and/or reoperation were analyzed. RESULTS: We reviewed 204 cases, 130 cases had a preserved biliary junction while in 74 the injury included the junction. All patients were treated with a Roux-en-Y hepatojejunostomy. In the first group, 4% required reoperation, 4% underwent radiological percutaneous instrumentation, 8% had anastomotic dysfunction and 4% cholangitis. In the second group, 24% needed reoperation and 80% radiological instrumentation. Anastomotic dysfunction was observed in 64% and cholangitis in 55%. It is important to note that 52 of the 74 cases in the second group had a history of more than two reconstruction attempts. CONCLUSIONS: When the biliary junction is preserved after a iatrogenic injury we found a significantly better outcome. The results of biliary reconstruction in this type of patient are better long-term compared to those where the junction was not preserved, evidenced by a lower reoperation and radiological instrumentation rate.     

Improved radionuclide method for assessment of pulmonary artery pressure in COPD

An improved method of noninvasive assessment of pulmonary arterial pressure is presented. The already existing radionuclide method for assessment of pulmonary arterial pressure based on right ventricular ejection fraction, although having a relatively good positive predictive accuracy (75 percent), lacks in specificity and correlates only weakly with pulmonary arterial pressure, r = .66. In the present study a diastolic index of the ventricular performance (right atrial early diastolic emptying rate) was used to improve the predictive value of the right ventricular ejection fraction. Phase image analysis was used to differentiate the right atrium from the rest of the cardiac structures, and right atrial emptying rate was calculated after time activity curves were generated. A reasonably good correlation was found between right atrial emptying rate and pulmonary arterial pressure, r = .75. This diastolic index, however, was limited in its ability to detect patients with COPD and normal pulmonary arterial pressure (negative predictive value 62 percent). In order to improve the predictive value of right ventricular ejection fraction, having low specificity (33 percent) but high sensitivity (93 percent), a score index was constructed, combining right ventricular ejection fraction with right atrial emptying rate (having high specificity 100 percent, but modest sensitivity 78 percent). Score index proved to be an excellent indicator of pulmonary arterial hypertension (positive predictive value 93 percent, negative predictive value 100 percent.