High Hip Center Reduces the Dynamic Hip Range of Motion and Increases the Hip Load: A Gait Analysis Study in Hip Arthroplasty Patients With Unilateral Developmental Dysplasia

BackgroundLong-term favorable clinical outcomes of anatomical or high hip center techniques in total hip arthroplasty (THA) are reported in patients with developmental dysplasia of the hip (DDH). However, there is little information about the effect of the hip center location on gait characteristics. The purpose of this study was to compare these surgical techniques with gait analysis, analyze the effect of the hip rotation center location on gait parameters, and discuss the possible problems that may arise.MethodsA total of 40 patients who underwent THA due to unilateral coxarthrosis secondary to Crowe type III-IV DDH and completed 5 years of follow-up were included in the study. Group 1 included 20 patients who underwent anatomical hip center reconstruction, while group 2 included 20 patients who underwent high hip center reconstruction. Gait analysis was performed, and the groups were compared according to the gait characteristics.ResultsThe mean temporospatial values were similar between the groups. The extension of the operated side was significantly lower in group 2 (?9.11 ± 8.92) than in group 1 (?1.87 ± 11.51) (P = .04). The mean longitudinal hip joint force was found to be significantly higher in group 2 (8.92 N/kg ± 0.54) than in group 1 (8.16 N/kg ± 0.66) (P = .04). The high hip center technique has been shown to increase the load on the hip and restrict the dynamic range of motion.ConclusionThe high hip center technique can decrease the survival of the implant and increase the fall risk as it increases the load on the hip and reduces the dynamic range of motion. The hip center should be reconstructed anatomically when possible in DDH patients who undergo unilateral THA.     

The effects of local and sustained release of fibroblast growth factor on testicular blood flow and morphology in spermatic artery--and vein-ligated rats

Background/purpose

This study was carried out to evaluate the effects of local and sustained release of fibroblast growth factor (FGF) on testicular blood flow and morphology in spermatic artery— and vein-ligated rats.

Methods

Forty male Wistar albino rats weighting 300 ± 20 g were allocated randomly into 5 groups consisting of 8 in each as follows: G-S (sham); G-C (control); and G-T_0.85, G-T_1.70, G-T_2.55. After the ligation of the left spermatic artery and vein, 1 cm² of unloaded and 0.85 μg, 1.70 μg, and 2.55 μg of FGF-loaded gelatin films were sutured on the left epididymis in G-C, G-T_0.85, G-T_1.70, and G-T_2.55, respectively. After 30 days, bilateral capsular (CBF) and intratesticular (IBF) blood flows were evaluated by colored Doppler ultrasonography (CDUS) and testicular blood flow (TBF) by ¹³³Xe clearance technique. Tunica albuginea and intertubular tissues were studied for the increase of peritesticular and intratesticular vessels. Mean intertubular vascular structure counts, seminiferous tubular diameters, testicular biopsy scores, and Leyding cell scores of each group were recorded and compared.

Results

CBF was present in all animals of G-S, G-T_0.85, G-T_1.70, and G-T_2.55 groups in CDUS, and it was detected in 62% of the G-C rats (P < .05). However, IBF was present in only 25% of the G-C rats, and this percentage was increased from 50% up to 87.5% for treatment groups, and 100% for G-S rats, respectively. ¹³³Xe clearance showed that TBF was significantly decreased in G-C compared with G-S (P < .05). In G-T_2.55, TBF was significantly increased, but still could not reach the level of G-S. Although mean testicular weights were significantly decreased for controls (G-C), G-T_0.85, and G-T_1.70, almost no difference was observed between G-T_2.55 and G-S. Although a slight increase in the vascular structures of tunica albuginea was present in G-C rats, a significant increase was observed in treatment groups. The mean number of intertubular vascular structures was significantly increased in treatment groups when compared with G-S and G-C (P < .05). Mean seminiferous tubular diameters and Leydig cell scores were decreased in G-C but significantly increased in treatment groups (P < .05). Mean testicular biopsy scores were increased in treatment groups compared with G-C but could not reach to sham levels.

Conclusions

Ligation of the spermatic artery and vein has detrimental effects on the ipsilateral testicular blood flow and morphology. These effects may be reversed by local application of FGF.     

A novel NPHS2 gene mutation in Turkish children with familial steroid-resistant nephrotic syndrome

We report in this paper two siblings aged 8 and 17 months who were clinically diagnosed with familial steroid-resistant nephrotic syndrome (SRNS). By mutation screening of the NPHS2 gene, a homozygous missense mutation, P118L, was detected in both children. This study is the first systematic investigation of NPHS2 gene mutations in Turkish children with familial SRNS. If this mutation is a hot spot of mutation in the Turkish population, screening this novel mutation in Turkish children with SRNS may be of great clinical use to prevent unnecessary treatment modalities, provide accurate genetic counselling and predict the prognosis of the disease.     

The superior vena cava syndrome caused by malignant disease. Imaging with multi-detector row CT

OBJECTIVE: The superior vena cava (SVC) obstruction by malignant diseases is either by direct invasion and compression or by tumour thrombus of the SVC. Whatever is its cause, obstruction of the SVC causes elevated pressure in the veins draining into the SVC and increased or reversed blood flow through collateral vessels. Severity of the syndrome depends on the collateral vascular system development. Therefore, imaging of the collateral veins with variable location and connection is important in determining the extension and management of the disease. Our aims are to describe collateral vessels of the superior vena cava syndrome (SVCS) related with the malignant diseases and to assess the ability of multi-detector row CT with multiplanar and 3D volume rendering techniques in determining and describing collateral circulations. MATERIALS AND METHODS: We present CT angiography findings of seven patients with small cell carcinoma of the lung (n = 2), squamous cell carcinoma of the lung (n = 3), Hodgkin disease of the thorax (n = 1), and squamous cell carcinoma of the oesophagus (n = 1). The patients received contrast-enhanced CT scans of the chest and abdomen on a multi-detector row CT during breath holding at suspended inspiration. RESULTS: CT images revealed the cause and level of the SVC obstruction in all patients with axial and multiplanar reconstructed images. The SVC showed total obstruction in five patients and partial obstruction in two patients. The most common experienced collateral vessels were azygos vein (6), intercostal veins (6), mediastinal veins (6), paravertebral veins (5), hemiazygos vein (5), thoracoepigastric vein (5), internal mammary vein (5), thoracoacromioclavicular venous plexus (5), and anterior chest wall veins (5). While one case showed the portal-systemic shunt, V. cordis media and sinus coronarius with phrenic veins were enlarged in two cases, and the left adrenal vein was enlarged in a patient. In one case, the azygos vein with reversed blood flow was drained into both inferior vena cava and hemiazygos vein with the left renal vein. CONCLUSION: Multi-detector row CT with multiplanar and 3D imaging is an effective tool in evaluation of the SVCS and has a greater advantage than the other imaging techniques. 3D volume rendering is a useful technique in determining and describing collateral circulations in addition to the primary disease process.     

Testicular adrenal rests in a patient with congenital adrenal hyperplasia: US and MRI features

We present ultrasonographic and magnetic resonance imaging findings of intratesticular adrenal rests in a 16-year-old patient with congenital adrenal hyperplasia. Scrotal ultrasonography showed bilateral well-delineated homogenous hypoechoic lesions located around the mediastinum testis, which were highly vascularized on power Doppler ultrasonography. Relative to normal testicular parenchyma the lesions were iso- or hyperintense on T1-weighted and hypointense on T2-weighted images. T2-weighted images also showed a target-like appearance caused by a more hypointense peripheral halo around the lesions. The lesions enhanced remarkably on post-contrast images. This case suggests that radiological evaluation of testes, even in the presence of normal physical examination findings, should be included in periodical follow-up of patients with congenital adrenal hyperplasia. Magnetic resonance (MR) imaging is useful in demonstrating the lesions, because the contrast resolution better than with ultrasonography.     

Evaluation of CSF flow patterns of posterior fossa cystic malformations using CSF flow MR imaging

Introduction Differential radiologic diagnosis of cystic malformations of the posterior fossa is often difficult with conventional imaging techniques because of overlapping features of these entities. Posterior fossa cystic malformations occupy the cerebrospinal fluid (CSF) spaces. They may create secondary dynamic effects on the movements of CSF. The aim of this study was to investigate CSF flow alterations in posterior fossa cystic malformations with CSF flow MR imaging.Methods The study included 40 patients with cystic malformations of the posterior fossa. The patients underwent cardiac-gated phase-contrast cine MR imaging. CSF flow was qualitatively evaluated using an in-plane phase-contrast sequence in the midsagittal plane. The MR images were displayed in a closed-loop cine format.Results Twelve of the patients had communicating arachnoid cyst, seven had non-communicating arachnoid cyst, ten had mega cisterna magna, six had Dandy-Walker malformation, two had Dandy-Walker variant, and three had Blake’s pouch cyst. CSF flow MR imaging indicated the regions of no, slow or higher flow, direction of flow, and abnormal cystic fluid motion. Each malformation displayed a distinct CSF flow pattern.Conclusion Phase-contrast cine MR imaging for CSF flow evaluation may be a useful adjunct to routine MR imaging in the evaluation of the cystic malformations of the posterior fossa because it can improve the specificity in differentiating such malformations.Electronic Supplementary Material Supplementary material is available in the online version of this article at Part of this article was presented as a poster exhibition at the ESNR 28th Annual Congress and 12th Advanced Course, 11–14 September 2003, Istanbul.     

Diffusion-weighted and conventional MR imaging in neurotrichinosis

Central nervous system involvement in trichinosis is not rare. Brain lesions in trichinosis have been defined on computed tomography and magnetic resonance imaging (MRI) as multifocal small lesions located in the cerebral cortex and white matter. We present a case of trichinosis with multifocal lesions of the brain detected by MRI and diffusion weighted MRI. Evolutions of these lesions from acute through chronic stages on follow up studies are also presented. This is the first report describing sequential MRI findings and diffusion weighted imaging appearance of brain lesions in trichinosis. Sequential evaluation of conventional and diffusion MR data allowed us to conclude that multifocal lesions in the brain were related to multiple infarctions rather than true inflammatory infiltration of the brain parenchyma.     

Relationship between the superior attachment type of uncinate process and presence of agger nasi cell: A computer-assisted anatomic study

OBJECTIVE: The uncinate process (UP) is an important anatomic landmark in frontal recess surgery. Its superior attachment shows great anatomic variability. The agger nasi (AN) cell is another important structure that affects frontal recess anatomy and there is a close neighborhood between them. The aim of this study was to investigate the relationship between superior attachment type of UP and the presence of AN cell. STUDY DESIGN: A retrospective anatomical study. METHOD: Computed tomography scans were evaluated of 486 sides of 243 patients who had had paranasal sinus. In 125 (26%) sides, the superior attachment of the UP could not be identified. In the remaining 361 (74%) sides, the prevalence of superior attachment of UP types and the presence of AN cell in each side were recorded. The results were evaluated with chi2 test. RESULTS: The AN cell was found in 290 (80.3%) of 361 sides. The prevalence of AN cell according to superior attachment of UP types were 79.6% for type 1/2, 90.1% for type 3, 71.4% for type 4, 86.5% for type 5, and 83.3% for type 6. The presence of AN cell according to superior attachment types of UP was not statistically significant (chi2= 3.54, P = 0.315). CONCLUSIONS: The AN cell was found to be present in 80.3% of the cases. However, the relationship between the presence of the AN cell and the superior attachment types of UP was not statistically significant.     

The role of gastric Helicobacter pylori infection in laryngopharyngeal reflux disease.

OBJECTIVES: To investigate the role of Helicobacter pylori (H pylori) infection in laryngopharyngeal reflux (LPR). STUDY DESIGN: A prospective multidisciplinary clinical study. METHODS: Forty-four adult patients who applied to our ENT clinic with LPR symptoms were evaluated. Then these patients underwent upper gastrointestinal system endoscopy and double probe pH monitoring. In addition, during the endoscopy multiple biopsies from the stomach were obtained to detect H pylori. RESULTS: Results from 32 LPR positive patients were assessed (10 male and 22 female). There were no statistically significant differences between the presence of H pylori and sex, age, degree of gastritis and esophagitis, and also the number of reflux, fractional acid exposure time regarding proximal probe readings. Similarly for both proximal and distal probe readings, the average score of esophageal acid clearance was not statistically significant (P > 0.05). In addition, no statistically significant difference was found between the presence of H pylori and GERD (P > 0.05). CONCLUSIONS: The results of this study demonstrated that there is no relationship between gastric H pylori infection and LPR. EBM rating: B-3b.