10 years results of an uncemented metaphyseal fit modular stem in elderly patients

Background:

There are concerns with regard to the femoral fixation in cementless total hip arthroplasty in elderly patients. We report a retrospective analysis of clinical and radiological results of uncemented metaphyseal fit modular stem in elderly patients irrespective of anatomic characterstics of proximal femur.

Materials and Methods:

This study reviews the outcomes of 60 primary hip replacements using a metaphyseal fit modular stem (third-generation Omniflex stem) conducted in 54 patients, of age 75 years or older. After a mean follow-up of 10,4 years, complete clinical and radiographic records were available for 52 hips of 48 patients. The patients were evaluated by Harris Hip Score (HHS).

Results:

There was a significantly improved pain score and Harris Hip Score (41,6 to 83,2). Six stems (11.53%) were revised: four because of periprosthetic fracture; one stem was well fixed, but presented a large osteolytic lesion in the metaphyseal area and the last stem was revised because of aseptic loosening. Stem survival taking aseptic loosening as the end-point was 98%. Bone atrophy in the proximal femur caused by stress shielding was observed in 39 stems (75%), but there was no case of subtrochanteric stress shielding. Moreover, atrophy appeared within two years postoperatively, with no extension thereafter.

Conclusions:

We achieved good clinical and radiographic results by uncemented metaphyseal fit femoral stem regardless of patient''s age and femoral canal type.     

Can Denosumab cure giant cell tumors of the spine? A case report and literature review

European Journal of Orthopaedic Surgery & Traumatology - Bone giant cell tumors, although benign, may be locally aggressive and cause severe morbidity; in some cases, they can also disseminate...     

The impact of the prevention strategies on the indirect effects of CMV infection in solid organ transplant recipients

Transplant recipients receiving immunosuppressive therapy are at increased risk of active cytomegalovirus (CMV) infection and disease. Without appropriate prophylaxis, as many as 80% of solid organ transplant recipients may experience CMV infection. In addition to the direct effects of CMV, infection may be associated with a range of indirect effects, including an increase in risk of other infections, as well as a higher incidence of rejection, graft loss and death. The indirect effects of CMV infection can vary depending on the transplanted organ. For example, CMV-infected kidney transplant recipients may be at increased risk of cardiovascular disease and diabetes, while CMV infection in liver transplant recipients may potentiate hepatitis C infection and increase the risk of post-transplant lymphoproliferative disease. Indirect effects result from a number of pathological processes, including immune modulation and immunosuppression, generation of cytotoxic, pro-inflammatory responses, and smooth muscle proliferation. Prophylactic treatment with antiviral medication can reduce the risk of CMV disease, thereby improving graft survival and overall outcomes, particularly in kidney and heart transplant recipients. Antiviral prophylaxis should be considered for all patients at risk of CMV infection after solid organ transplantation. In this paper we review the main indirect effects of CMV infection in solid organ transplant recipients, and the impact of CMV prophylaxis on these effects.     

Results of a comparative study analyzing octogenarians with renal cell carcinoma in a competing risk analysis with patients in the seventh decade of life

ObjectivesTo analyze clinicopathological features and survival of surgically treated patients with renal cell carcinoma (RCC)≥80 years of age in comparison with patients between the ages of 60 and 70 years.Materials and methodsThe data for 2,516 patients with a median follow-up of 57 months were retrieved from a multinational database (Collaborative Research on Renal Neoplasms Association [CORONA]), including data for 6,234 consecutive patients with RCC after radical or partial nephrectomy. Comparative analysis of clinicopathological features of 241 octogenarians (3.9% of the database) and 2,275 reference patients between the ages of 60 and 70 years (36.5%) was performed. Multivariable regression analysis adjusted for competing risks was applied to identify the effect of advanced age on cancer-specific mortality (CSM) and other-cause mortality (OCM). Furthermore, instrumental variable analysis was employed to reduce residual confounding by unmeasured parameters.ResultsSignificantly more women were present (50% vs. 40%, P = 0.004), and significantly less often nephron-sparing surgery was performed in octogenarians compared with the reference group (11% vs. 20%, P<0.001). Although median tumor size and stages did not significantly defer, older patients less often had advanced or metastatic disease (N+/M1) (4.6% vs. 9.6%, P = 0.009). On multivariable analysis, higher CSM (hazard ratio = 1.48, P = 0.042) and OCM rates (hazard ratio = 4.32, P<0.001) were detectable in octogenarians (c-indices = 0.85 and 0.72, respectively). Integration of the variable age group in multivariable models significantly increased the predictive accuracy regarding OCM (6%, P<0.001), but not for CSM. Limitations are based on the retrospective study design.ConclusionsOctogenarian patients with RCC significantly differ in clinical features and display significantly higher CSM and OCM rates in comparison with their younger counterparts.     

Solving Two-Mode Shallow Water Equations Using Finite Volume Methods

In this paper, we develop and study numerical methods for the two-mode shallow water equations recently proposed in [S. STECHMANN, A. MAJDA, and B. KHOUIDER, Theor. Comput. Fluid Dynamics, 22 (2008), pp. 407–432]. Designing a reliable numerical method for this system is a challenging task due to its conditional hyperbolicity and the presence of nonconservative terms. We present several numerical approaches–two operator splitting methods (based on either Roe-type upwind or central-upwind scheme), a central-upwind scheme and a path-conservative central-upwind scheme– and test their performance in a number of numerical experiments. The obtained results demonstrate that a careful numerical treatment of nonconservative terms is crucial for designing a robust and highly accurate numerical method.     

Implementation of a mobile team to provide normothermic regional perfusion in controlled donation after circulatory death: Pilot study and first results

Normothermic regional perfusion (NRP) in controlled donation after circulatory death is becoming a popular method due to the favorable results of the grafts procured under this technique. This procedure requires experience, and, sometimes, the availability of extracorporeal membrane oxygenation (ECMO) machines to implement NRP is limited to tertiary hospitals. In order to provide support with NRP in controlled donation after circulatory death across the different hospitals of the Autonomous Community of Madrid, a mobile NRP team was created. In the first 18 months since its creation, the mobile NRP team participated in 33 procurements across nine different hospitals, representing 72% of all controlled donations after circulatory death in the Autonomous Community of Madrid. NRP was successfully performed in 29 (88%) cases, with a mean duration of 69 ± 27 minutes. A total of 39 kidneys, 12 livers, and 5 bilateral lungs were recovered and transplanted. None of the livers were discarded due to an elevation in transaminases during NRP. A mobile NRP team is a feasible option and, in our series, aided in the optimization and recovery of organs from donors after controlled circulatory death in centers where ECMO technology was not available.     

Robotic transanal endoscopic microsurgery in benign rectal tumour

Aim

To present a case of resection of a rectal tumour by a transanal robotic approach.

Patient

A 58-year-old woman with a 3-cm tumour located 6 cm proximal to anal verge (uT1N0).

Results

We describe the details of the surgical technique. A complete resection with adequate margins was accomplished. The defect was closed with a running suture. Operation time was 180 min. There were no complications and the patient was discharged 24 h after surgery.

Conclusion

A complete resection of a rectal tumour by a robotic approach is feasible and safe. More studies are needed to clearly define the indications where this new approach can show clear advantages over other transanal resection approaches.     

Breast reduction surgery—an easy formula to estimate the resection weight to be removed

Background

The preoperative prediction of therapeutic breast reduction weights which achieve both relief of symptoms and excellent shape and size breasts remains a challenge and, in addition, in the selection of patients with symptomatic macromatia for being treated by reduction mammaplasty the estimation of the amount of tissue to be removed plays an important role because this criterion is required almost universally. The objective of this study is to calculate a formula for the preoperative prediction of the amount of breast tissue which has to be removed in the treatment of symptomatic macromastia based on data obtained from a series of patients with symptomatic breast hypertrophy treated with reduction mammaplasty characterized by the fact that successful outcome (functional and cosmetic) had previously been achieved and assessed objectively.

Methods

A prospective study was performed on 39 patients undergoing reduction mammaplasty for breast hypertrophy. The Short Form (SF)-36 quality of life questionnaire (Spanish version 1.4, June 1999) and the Breast Reduction Assessed Severity Scale Questionnaire, which was double-blind translated, were both answered preoperatively, a week before, and postoperatively, 6 months after surgery, for testing the effectiveness of the treatment. The patients were asked to score cosmetic results (1 to 10, very bad to excellent) and how satisfied with the new breast size they were. Data were collected from these patients to calculate a formula for preoperative prediction of breast resection weight. Regression analysis was performed separately on each of 78 breasts of these patients with breast weight as dependent variable and sternal notch-to-nipple distance (SNN), inframammary fold-to-nipple distance (IMFN), age, body mass index (BMI) and ascent of the nipple areola complex (ANAC) as independent variables.

Results

A simple model combining two variables (IMFN, ANAC) is strongly correlated with actual resection weight with adjusted r ² coefficient of 0.701. The formula breast weight (g)?=?(60(ANAC) (cm)?+?50(IMFN) (cm))???648 can predict resection weight which obtains satisfactory cosmetic results and a relief of symptoms improving quality of life.

Conclusions

A new easy formula to estimate preoperatively the amount of breast tissue to be removed is offered to surgeons who are planning a breast reduction mammaplasty. Level of evidence: level IV, risk/prognostic study     

Estudio de coste-beneficio comparando la reparación de la hernia ventral abierta y laparoscópica

Objective

Laparoscopic surgery is a successful treatment option offering significant advantages to patients compared with open ventral hernia repair. A cost-benefit analysis was performed to compare the clinical results and economic costs of the open and laparoscopic techniques for anterior abdominal wall hernia repair, in order to determine the more efficient procedure.

Material and methods

We performed a prospective study of 140 patients with primary and incisional hernia, and analyzed clinical data, morbidity, costs of surgery and hospital stay costs.

Results

The cost of disposable surgical supplies was higher with laparoscopic repair but reduced the average length of stay (P < .001) and patient morbidity (P < .001). The total cost of the laparoscopic procedure was, therefore, less than initially estimated, yielding a savings of 1,260 € per patient (2,865 € vs. 4,125 €).

Conclusions

Laparoscopic ventral hernia repair is associated with a reduced complication rate, a lower average length of stay and with lower total costs. Laparoscopic repair can save 1.260 € for each patient, and so this procedure should be considered a cost-effective approach.