Hydatid cyst of the abdominal aorta and bilateral common iliac arteries. A case report.

Hydatid disease, a parasitic infestation, is endemic in live-stock raising countries where the custom of feeding offal to dogs prevails. Though infestation of any part of the human body can occur, arterial involvement is a rare affliction. We report here the first case in which abdominal aorta and bilateral iliac arteries were totally occluded with intraluminal cysts.     

Congenital clubfoot associated with an accessory soleus muscle

A 16-month-old male with previously untreated bilateral clubfeet was admitted to S.B. Izmir Tepecik Education and Research Hospital, Izmir, Turkey. Both feet underwent surgical treatment. During surgery, an accessory soleus muscle was detected on the right side. The accessory soleus muscle had a distinct distal insertion at the superior anteromedial border of the calcaneus and also anterior and medial to the Achilles tendon. He was treated by bilateral complete subtalar release with Cincinnati incision, and the accessory soleus was also cut and the distal part resected. At the final follow-up visit, when the patient was 6 years and 9 months old, both feet had a normal appearance and appeared normal on radiograph and magnetic resonance imaging, with no presence of the accessory soleus muscle or its remnant. In our opinion, awareness of the association between an accessory soleus muscle and clubfoot, and sectioning of this muscle during surgery may improve surgical results.     

Hepcidin is not a marker of chronic inflammation in atherosclerosis.

OBJECTIVE: To investigate the relationship between atherosclerosis, an inflammatory disease and hepcidin, which is reported as an indicator of inflammation. METHODS: A total of 75 subjects between 40 and 70 years of age were included in the study. The patient group consisted of 40 stable patients who had previously experienced an atherosclerotic event (18 women, 22 men; mean age 56.4+/-7.1 years). There were two control groups. The first control group consisted of 19 healthy subjects (11 women, 8 men; mean age 52.6+/- 7.4 years), while the second group included 16 patients (11 women, 5 men; mean age 56.5+/-9.3 years) with rheumatoid arthritis and anemia (diseased control group). Hepcidin measurement was performed using Hepcidin Prohormone ELISA (Solid Phase Enzyme-Linked Immunosorbent Assay) test kit. RESULTS: Mean serum hepcidin levels were 243.2+/-48.8 ng/ml, 374.5+/-86.4 ng/ml, and 234+/-59.9 ng/ml in the patient group, in diseased controls, and in healthy controls, respectively. Hepcidin levels were higher in diseased controls compared to the patient group and healthy controls (p=0.001). There were no significant differences between the patient group and healthy controls. CONCLUSION: These findings did not support the hypothesis that hepcidin levels could be increased in atherosclerotic cardiovascular diseases as a marker of chronic inflammation.     

Can major amputation rates be decreased in diabetic foot ulcers with hyperbaric oxygen therapy?

Although hyperbaric oxygen therapy has been used for diabetic foot ulcer since the 1980s, there is little information on its efficacy. The aim of this study is to evaluate whether hyperbaric oxygen can decrease major amputation rates and to determine the predictive factors. A total of 184 consecutive patients were treated with hyperbaric oxygen therapy as an adjunct to standard treatment modalities for their diabetic foot ulcer. Of these patients, 115 were completely healed, 31 showed no improvement and 38 underwent amputation. Of the amputations, nine (4.9%) were major amputations (below knee) and 29 were minor. Major amputations were associated with the Wagner grade (p < 0.0001), with the age of the patients (p = 0.028) and with the age of the wounds (p = 0.018). Hyperbaric oxygen therapy can help to reduce the major amputation rates in diabetic foot ulcer. However, further large, multicentre, randomised controlled studies are needed to make more accurate conclusions.     

Transverse process wiring for thoracic scoliosis

We describe a method of reducing neurological risk by avoiding neural elements when performing segmental spinal fixation for scoliosis. This was done by making use of the transverse processes of the thoracic vertebrae 1-11 and wired plates. The wires are prevented from cutting the bone by attaching them to rectangular plates. These wired plates on the two sides of each segment should be firmly fixed to the base of the transverse process by tying them to each other. Maximum correction is obtained by spreading the force applied by stabilizing each thoracic vertebra from both sides. Derotation is attempted when all the wires have been tightened. Tension forces are spread to all fixated vertebrae simultaneously and the correction should be carried out at all levels at the same time. On the convex side, each wire connects over the rod to the next one above it and, tightened one by one, provides compression.

We treated 15 patients having a thoracic curve with this method and followed them for 25-39 months. In 2 cases of congenital scoliosis, a 50% correction was obtained. In 3 cases of neurofibromatosis scoliosis, a 55% correction was achieved. In 10 cases of idiopathic scoliosis, the correction was 60%. When the thoracic sagittal contour was evaluated, thoracic kyphosis, which had been between -20" and +90°, had improved to between +8° and +43° in all cases. No infection or neurological complications occurred.     

Prevalence and Preventability of Drug‐Related Hospital Readmissions: A Systematic Review

Objectives

To summarize the evidence on the prevalence and preventability of drug‐related hospital readmissions.

Design

A systematic review was performed of studies that examined drug‐related hospital readmissions. PubMed, EMBASE, and the Cochrane Library were searched from inception through August 2016. Reference lists and a citation analysis on Web of Science and Scopus were also consulted. Two reviewers extracted study data with dual assessment of risk of bias. Prevalence and preventability of readmission due to drugs were calculated. Data were qualitatively summarized according to outcome.

Results

Nineteen studies met the eligibility criteria. Nine measured readmissions due to drug‐related problems, seven due to adverse drug reactions, two due to adverse drug events, and one due to drug‐drug interactions. Rates of readmissions due to drugs varied from 3% to 64% (median 21%, interquartile range (IQR) 14–23%). Readmissions were deemed preventable in 5% to 87% of cases (median 69%, IQR 19–84%). Evidence regarding the risk factors for drug‐related readmissions and drugs causing these readmissions was inconsistent.

Conclusion

Although studies show high variability in prevalence and preventability of drug‐related hospital readmissions, readmissions due to drugs seem to occur often, especially in older adults. Further research is needed to specify the causes of preventable readmissions and implement effective interventions to reduce medication‐related hospital admissions.