Effect of anesthesia type on limb length discrepancy after total hip arthroplasty

A retrospective study of 132 patients (63 spinal anesthesia and 69 general anesthesia) undergoing total hip arthroplasty was performed by 4 fellowship-trained adult reconstructive surgeons to determine the influence of anesthesia type on postoperative limb length and medial offset. Limb length discrepancy occurred in 87.0% of patients who received regional anesthesia as opposed to 47.6% patients who had general anesthesia (P<.001). Differences in postoperative medial offset measurements between the 2 groups were not statistically significant. It was concluded that surgeons operating on patients who receive regional anesthesia should supplement intraoperative tests for assessing hip stability with meticulous preoperative templating to avoid overlengthening the operative limb.     

Click chemistry reactions in medicinal chemistry: applications of the 1,3-dipolar cycloaddition between azides and alkynes

In recent years, there has been an ever-increasing need for rapid reactions that meet the three main criteria of an ideal synthesis: efficiency, versatility, and selectivity. Such reactions would allow medicinal chemistry to keep pace with the multitude of information derived from modern biological screening techniques. The present review describes one of these reactions, the 1,3-dipolar cycloaddition ("click-reaction") between azides and alkynes catalyzed by copper (I) salts. The simplicity of this reaction and the ease of purification of the resulting products have opened new opportunities in generating vast arrays of compounds with biological potential. The present review will outline the accomplishments of this strategy achieved so far and outline some of medicinal chemistry applications in which click-chemistry might be relevant in the future.     

Risk factors of endoleak following endovascular repair of abdominal aortic aneurysm. A multicentric retrospective study

Endoleak (EL) represents the most common complication following endovascular abdominal aortic aneurysm repair (EVAR). Unfortunately, the long-term results of EVAR and its durability have been questioned, and EL are variably associated with a risk of late failure. The aim of this retrospective study was to identify risk factors for this complication of aneurysm-endograft complex in patients who underwent EVAR. A group of 104 consecutive patients (99 men, 5 women; median age, 74 years; range, 50-89 years) were enrolled in the study. Both preoperative and follow-up imaging studies were obtained using helical computed tomography scanning at 1, 6, 12, 24, 36 months after EVAR and blindly reviewed by a surgeon and a radiologist. Twenty-seven (25.9%) patients developed EL during follow-up, of which 10 (37%) were primary (<30 days from EVAR), and 17 (63%) were secondary EL. Age and smoking did not affect the EL onset, while a body mass index >25 and a history or presence of arterial hypertension represented significant (p<0.05) risk factors. Moreover, both greatest diameter and maximum length of the aneurysm were significantly higher (p<0.01) in patients who developed EL. No relationship was found with the anatomical features of the aortic neck (i.e. length and diameter), and between the initial size of the aneurysm and the dimension at the time of EL. In conclusion, in our study, being overweight, arterial hypertension and the initial size of the aneurysm represent risk factors for EL development.     

Complicated diverticular disease of the colon: 5 years' experience in a provincial hospital

Colon diverticular disease presents in 10%-25% of cases when a complication arises. Helped by Hinchey's classification, the surgeon can choose from among the following therapeutic strategies: a) medical treatment; b) one-stage resection and anastomosis with or without a protective colostomy; and c) resection according to Hartmann. The increasingly widespread use of laparoscopic techniques, though generally improving surgical outcomes, has perhaps made the choice of treatment more difficult, because it has extended the range of indications, both in the elective and emergency setting. From January 1999 to December 2004 411 patients (174 men and 237 women) affected by symptomatic diverticular disease were admitted to our surgical department and 94 of these (22.8%) underwent surgery: 41 of them (43.6%) underwent a true emergency operation, while for 53 of them surgery was delayed (within one week). None of the patients undergoing resection-anastomosis had a protective colostomy. The total morbidity was 3.7% and total perioperative mortality 1% (one patient undergoing surgery with the Hartmann procedure). More than one year after the end of the research there was no need for operation of any of the non-surgical patients and no deaths due to diverticular disease were recorded. On the basis of our experience we may conclude that a one-stage resection, even in the emergency situation, is possible and yields excellent results, while preventive resection would not currently seem justified.     

Brachial artery aneurysm in a patient with HIV infection. A case report

The authors present a case of a brachial artery aneurysm in a patient with HIV infection. Aneurysms of unusual arteries, such as the common carotid, brachiocephalic, subclavian, superior mesenteric arteries and arteries of the upper extremity distal to the axillary artery, may be related to HIV infection. Chronic inflammatory infiltrate (plasma cells, B and T lymphocytes) around the vasa vasorum is noted in many reports. This condition may represent a "distinct clinicopathology entity". The best therapeutic option is operative repair. Reconstruction with autologous material is preferable since bacterial involvement of synthetic grafts is possible in individuals with an immunocompromised condition.