Evaluation of patellar height and measurement methods after valgus high tibial osteotomy

Several controversies exist regarding the surgical difficulties and the results of total knee arthroplasty performed after failed valgus high tibial osteotomy (HTO), and the main subject is the change in patellar height that results as patella baja or infera. The purpose of this retrospective study was to evaluate patellar height after valgus HTO and the measurement methods that were actually used. Eighty-five knees that were subjected to valgus HTO were evaluated both preoperatively and postoperatively according to the Insall-Salvati Index (ISI), Blackburne-Peel Index (BPI), and Caton Index (CI) to assess any alteration of patellar tendon height that was present. All cases underwent closing wedge osteotomy with three staples or plate internal fixation and were allowed early range of motion. Significant decrease in mean patellar height ratios was detected according to all three indexes at 85 months of mean follow-up. The percentages of the decrease were 8.26% in ISI, 9.08% in BPI, and 6.34% in CI. Two knees showed patella infera according to ISI, one according to BPI and three according to CI. There were no significant correlations between the indexes and clinical status of the patients. Elevation of patella relative to the femur in closing wedge valgus HTO procedure due to the shortening of the segment between tibial tuberosity and joint line is normally expected. A significant decrease in patellar height according to ISI suggests that there should be patellar tendon shortening as patellar height cannot be changed. BPI and CI for determining patellar height in valgus HTO do not accurately measure the alteration of patella because they may affect the tibial inclination and antero-posterior translation of the proximal fragment. Another measuring system based on femoral reference points should be proposed to determine the exact change of patellar height in the valgus HTO procedure.     

Cockayne syndrome: Review of 25 cases

Clinical and laboratory findings of 25 patients with classical Cockayne syndrome (CS) are reviewed. A history of consanguinity was present in 21 patients, and 15 patients had at least 1 affected sibling. Apart from the cardinal features of dwarfism, microcephaly, and mental retardation, the most consistent clinical features included photosensitivity (84%), gait disturbances (84%), progeroid appearance (84%), and ocular abnormalities (88%). The most consistent laboratory findings comprised abnormal nerve conduction (slowed conduction in 13 of the 16 cases with an ENMG), and an abnormal brainstem auditory evoked response (BAER) and/or audiometry (abnormal in 13 of the 17 cases in whom either one of them were available). Cerebral atrophy and calcification of the basal ganglia were the next more common laboratory findings. Clinical criteria are useful in most instances in the diagnosis of CS. In patients in whom the clinical features are controversial for a diagnosis of Cockayne syndrome, studies directed to disorders of myelination involving both peripheral and central nervous systems in conjunction with audiometry may aid in the diagnosis.     

Prevalence of angina, myocardial infarction and intermittent claudication assessed by Rose Questionnaire among patients with Behcet's syndrome

Objective. To determine the risk of clinical cardiovasculardisease in middle-aged patients with Behcet's syndrome (BS)compared with gender-matched non-BS subjects. Methods. The prevalence of angina, myocardial infarction (MI),doctor diagnosed ischaemic heart disease (IHD) and intermittentclaudication were sought by the Rose Angina Questionnaire in225 (141 M/84 F) BS patients (mean age: 52 ± 8) withBS and 117 (74 M/43 F) controls (mean age: 50 ± 5). Informationon atherosclerotic risk factors was also collected. Results. The prevalence of angina, MI and doctor-diagnosed IHDwere not different between BS patients and non-BS controls inthe whole study population and when males and females were separatelyanalysed. Angina tended to be more common among females comparedwith males among both patients and controls. Intermittent claudicationwas found to be significantly more common among BS patients,especially in males with venous disease. Conclusions. The findings in this cross-sectional clinical studyare in line with previous observations not indicating acceleratedatherosclerosis in BS. Intermittent claudication might not bea suitable tool for the detection of peripheral atheroscleroticdisease especially among BS patients having venous disease. KEY WORDS: Behcet's syndrome, Atherosclerosis, Cardiovascular disease, Angina, Myocardial infarction, Peripheral arterial disease, Claudication Submitted 30 September 2007; revised version accepted 20 December 2007.     

Ultrasonographic maturation of native arteriovenous fistulae: a follow-up study

BACKGROUND/AIMS: Ideal time needed for arteriovenous fistula (AVF) maturation is still controversial. In this study, we aimed to investigate the natural course of AVF maturation and also investigated the factors affecting AVF maturation. METHODS: We studied 31 (21M/10F, mean age 55.8 +/- 16.2) chronic renal failure patients. We evaluated the patients with color Doppler ultrasound examination before the fistula operation, at the first day, and at the first, second, third, and sixth months. Radial artery (RA) diameter, flow velocity, flow, resistance index, fistula vein diameter, flow velocity, and flow were measured. RESULTS: Patency rates at the first post-operative day and the sixth month were 87.1% and 67.1%, respectively. Cephalic vein flow was 451.2 +/- 248.6 mL/min at the first month and 528.6 +/- 316.5 mL/min at the sixth month. Baseline RA diameter was lower in failing fistulas than that of patent fistulas. Failing fistulas were more common in women. CONCLUSION: Blood flow was enough for hemodialysis at the end of the first month. However, fistula maturation had continued until the end of the study; women and patients with low RA diameter are particularly prone to fistula failure. Therefore, especially in these patients, AVF must be created at least three or four months before the predicted hemodialysis initiation time.     

Association of interleukin-1 receptor antagonist gene polymorphisms with early onset periodontitis in Japanese

BACKGROUND/AIMS: Early onset periodontitis (EOP), newly 'aggressive periodontitis', is considered to have genetic basis, which have not been clearly defined. The interleukin-1 (IL-1) gene cluster polymorphism as one of genetic factors may influence the expression of several chronic inflammatory diseases. The aim of this study is to investigate the frequency of single nucleotide polymorphisms (SNPs) in the genes encoding IL-1alpha, IL-1beta and a variable number of tandem repeat (VNTR) polymorphisms in the IL-1 receptor antagonist gene (IL-1RN) in 47 generalized EOP (G-EOP) patients and 97 periodontally healthy controls. MATERIAL AND METHODS: All subjects were of Japanese descent and systemically healthy. They were identified according to established clinical criteria. SNPs in the IL-1alpha (+ 4845) and IL-1beta (- 511, + 3954) genes were analyzed by amplifying the polymorphic region using polymerase chain reaction (PCR), followed by restriction-enzyme digestion and agarose gel electrophoresis. IL-1RN (VNTR) polymorphisms were then detected by PCR amplification and fragment size analysis. RESULTS: There was no significant difference in the IL-alpha (+ 4845) and IL-1beta (- 511, + 3954) genotypes and allele frequencies between G-EOP patients and healthy controls. However, the frequency of IL-1RN (VNTR) polymorphic alleles was found to be significantly increased in G-EOP patients (chi2 test, P = 0.007; odds ratio = 3.40). Additionally, the carriage rate of IL-1RN (VNTR) polymorphisms was significantly higher in G-EOP patients than in healthy controls (chi2 test, P = 0.005; odds ratio = 3.81). CONCLUSION: These findings suggest that IL-1RN (VNTR) polymorphisms are associated with G-EOP in Japanese.     

Latarjet procedure using subscapularis split approach offers better rotational endurance than partial tenotomy for anterior shoulder instability

Purpose

Latarjet, which is a coracoid bone block procedure, is an effective treatment for anterior shoulder instability with glenoid bone loss. During this reconstructive procedure the subscapularis may be tenotomized or be split to expose the glenoid neck. The aim of this study was to assess the effect of subscapularis management on functional outcomes and internal and external rotation durability and strength. Hypothesis is that the subscapularis split approach will result in better functional results and superior internal rotation strength and endurance.

Methods

The study included 48 patients [median age 30 (range 16–69); 42 males, 6 females], who underwent a modified Latarjet procedure for anterior shoulder instability. There were 20 patients in the subscapularis tenotomy group and 28 patients in the subscapularis split group. The groups were compared isokinetically using a computerized dynamometer for internal and external rotation durability and strength. At the latest follow-up, the patients were evaluated with the American Shoulder and Elbow Surgeons (ASES) and ROWE scores for functional outcomes.

Results

At a median follow-up period of 25 (range 12–73) months after the Latarjet procedure, the internal rotation durability was significantly higher in the split group (p?=?0.045). However, a statistically significant difference could not be found for internal and external rotational strengths (n.s.). There was also no significant difference between the final ASES and ROWE scores (n.s.).

Conclusion

Although both approaches offer promising results, the subscapularis split approach appears to provide better internal rotation durability compared to subscapularis tenotomy. Therefore, the subscapularis split approach may be more preferable for the management of the subscapularis muscle during Latarjet procedure.

Level of evidence

Retrospective cohort study, Level III.