Total hip arthroplasty with acetabular reconstruction using a bulk autograft for patients with developmental dysplasia of the hip results in high loosening rates at mid-term follow-up

Purpose

Managing a deficient acetabulum in patients with developmental dysplasia of the hip (DDH) can be challenging. The purpose of the study was to determine the mid-term results of total hip arthroplasty (THA) using a bulk structural autograft for reconstruction of the acetabular roof in patients with DDH.

Methods

Between 1982 and 1999, 112 patients underwent THA with acetabular roof-plasty using a bulk structural autograft for secondary osteoarthritis related to DDH. A total of 106 patients (115 hips) met inclusion criteria and were followed for an average of 11.6 years (seven to 24 years). The mean age was 52.5 years at the index operation. Clinical and radiological evaluations were performed according to the methods of Merle d’Aubigné and Postel, Johnston et al. and DeLee and Charnley.

Results

The overall Merle d’Aubigné hip score significantly improved (3.7 vs 10.4, p < 0.01). The limb length discrepancy decreased from 30 to 6 mm (p < 0.01). The average distance that the hip centre was distalised was 22.3 mm (0–56 mm). However, radiolucent lines were observed in 27 % of patients at final follow-up, and the overall rate of revision for aseptic loosening was 16 %. Further, Kaplan-Meier survivorship curves predicted a rapid increase in the failure rate at 15 years.

Conclusions

The mid-term functional outcome of THA with an acetabular roof-plasty using a bulk autograft is satisfactory; however, the long-term results are questionable.     

Tumor differentiation as related to sentinel lymph node status in gastric cancer

AIM:To investigate the influence of tumor grade on sentinel lymph node(SLN)status in patients with gastric cancer(GC).METHODS:We retrospectively studied 71 patients with GC who underwent SLN mapping during gastric surgery to evaluate the relationship between SLN status and tumor grade.RESULTS:Poorly differentiated tumors were detected in 50/71 patients,while the other 21 patients had moderately differentiated tumors.SLNs were identified in 58/71 patients(82%).In 41 of the 58 patients that were found to have stained nodes(70.7%),the tumor was of the poorly differentiated type(groupⅠ),while in the remaining patients with stained nodes 17/58(29.3%),the tumor was of the moderately differentiated type(groupⅡ).Positive SLNs were found in22/41 patients in group I(53.7%)and in 7/17 patients in groupⅡ(41.2%)(P=0.325).The rate of positivity for the SLNs in the two groups(53.7%vs 41.2%)was not statistically significant(P=0.514).CONCLUSION:Most of our patients were found to have poorly differentiated adenocarcinoma of the stomach and there was no correlation between tumor grade and SLN involvement.     

Update on Clostridium difficile infections

Clostridium difficile infections (CDI) occur primarily in hospitalized patients with risk factors such as concomitant or recent use of antibiotics. CDI related additional costs are important for the global population and health-care facilities. CDI epidemiology has changed since 2003: they became more frequent boosted by large outbreaks, more severe, more resistant to antibiotic treatment, and spread to new groups of population without any risk factor. This is partly due to the emergence and worldwide dissemination of new and more virulent C. difficile strains such as the epidemic clone 027/NAP1/BI. The host immune response plays a central role in the pathogenesis of CDI and could also be involved in the occurrence of recurrent or severe forms. New guidelines including new molecular tests (NAAT) have recently clarified and simplified the diagnostic strategies for the microbiological diagnosis of CDI. The CDI incidence was proven to be related to the level of clinical suspicion and the frequency of microbiological screening for C. difficile. The current recommendations for the treatment of CDI mention oral metronidazole as the first line treatment for mild to moderate diarrhea. Oral vancomycin use should be restricted to severe cases. In the absence of consensus, the treatment of multiple recurrences remains a major concern. New and more targeted antibiotics and innovative therapeutic strategies (fecal transplantation, monoclonal antibodies, and vaccination) have emerged as new therapies for CDI.     

Pharmacological Study of Cefoxitin as an Alternative Antibiotic Therapy to Carbapenems in Treatment of Urinary Tract Infections Due to Extended-Spectrum-β-Lactamase-Producing Escherichia coli

Cefoxitin could be an alternative to carbapenems in extended-spectrum-beta-lactamase-producing Escherichia coli (ESBL-EC) infections. However, pharmacological and clinical data regarding cefoxitin are limited. Using a recent pharmacological model and the MICs of ESBL-EC collected from pyelonephritis, we determined the probabilities to reach four pharmacological targets: free cefoxitin concentrations above the MIC during 50% and 100% of the administration interval (T>MIC = 50% and T>MIC = 100%, respectively) and free cefoxitin concentrations above 4× MIC during 50% and 100% of the administration interval (T>4MIC = 50% and T>4MIC = 100%, respectively). Cefoxitin could be used to treat ESBL-EC pyelonephritis, but administration modalities should be optimized according to MICs in order to reach pharmacological targets.     

Dislocation after total hip arthroplasty

Dislocation remains one of the most common complications after total hip arthroplasty, regardless of the surgical approach. While multiple reasons as laxity, implant position, improper implant choice, and impingement etc. might be leading factors for dislocation, an exact identification of the exact reason is of major importance, to plan for a proper surgical or nonsurgical correction. This article describes in detail the definition, etiology, reduction, and possible treatment options for dislocation after primary and revision total hip arthroplasty that are currently used at the Endo Klinik in Hamburg. It furthermore includes a distinct overview of possible surgical treatment options, based on the main pathology leading to dislocation.     

Surveillance strategy for small asymptomatic non-functional pancreatic neuroendocrine tumors – a systematic review and meta-analysis

Background

Non-functional pancreatic neuroendocrine tumors (NF-PNET) are rare neoplasms being increasingly diagnosed. Surgical treatment or expectant management are both suggested for small NF-PNETs. The aim of this study was to evaluate the outcome of surveillance strategy for small NF-PNETs.

CT and MR imaging of central nervous system effects of therapy in patients treated for hematological malignancies

The purpose of this article is to present the imaging appearance of central nervous system effects of therapy that may occur in patients treated for hematological malignancies. Imaging in these patients relates to complications of high-dose therapy, bone marrow transplantation, infections occurring in immunocompromised patients, central nervous system dysfunction due to failure of other organ systems, or cerebral hemorrhages due to platelet refractoriness. Rapid and accurate diagnosis is essential but often difficult, as neurological manifestations are rarely disease specific. Neurological imaging, in combination with electrophysiological studies as well as blood and cerebrospinal fluid investigations, may be helpful for diagnosing most of these complications, as well as in differentiating between the manifestations of the underlying disease and complications of the treatment.

     

Impact of a family information leaflet on effectiveness of information provided to family members of intensive care unit patients: a multicenter, prospective, randomized, controlled trial

Comprehension and satisfaction are relevant criteria for evaluating the effectiveness of information provided to family members of intensive care unit (ICU) patients. We performed a prospective randomized trial in 34 French ICUs to compare comprehension of diagnosis, prognosis, treatment, and satisfaction with information provided by ICU caregivers, in ICU patient family representatives who did (n = 87) or did not (n = 88) receive a family information leaflet (FIL) in addition to standard information. An FIL designed specifically for this study was delivered at the first visit of the family representative: it provided general information on the ICU and hospital, the name of the ICU physician caring for the patient, a diagram of a typical ICU room with the names of all the devices, and a glossary of 12 terms commonly used in ICUs. Characteristics of the ICUs, patients, and family representatives were similar in the two groups. The FIL reduced the proportion of family members with poor comprehension from 40.9% to 11.5% (p < 0.0001). In the representatives with good comprehension, the FIL was associated with significantly better satisfaction (21 [18 to 24, quartiles] versus 27 [24 to 29, quartiles], p = 0.01). These results indicate that ICU caregivers should consider using an FIL to improve the effectiveness of the information they impart to families.