Influence of the treatment of developmental dysplasia of the hip by the abduction brace on locomotor development in children

Purpose  

To assess the influence of treating developmental dysplasia of the hip (DDH) with the abduction brace on locomotor development in children.     

The influence of non‐HLA antibodies directed against angiotensin II type 1 receptor (AT1R) on early renal transplant outcomes

Non‐HLA antibodies (Abs) targeting vascular receptors are thought to have an impact on renal transplant injury. Anti‐angiotensin II type 1‐receptor‐activating antibodies (anti‐AT1R) have been mentioned to stimulate a severe vascular rejection, but the pretransplant screening has not been introduced yet. The aim of our study was to assess the incidence and importance of anti‐AT1R antibodies and their influence on renal transplant in the 1st year of observation. We prospectively evaluated the presence of anti‐AT1R antibodies in 117 consecutive renal transplant recipients in pre‐ and post‐transplant screening. Anti‐AT1R antibodies were observed in 27/117 (23%) of the analyzed recipients already before transplantation. The function of renal transplant was considerably worse in anti‐AT1R(+) group. The patients with anti‐AT1R Abs >9 U/ml lost their graft more often. Biopsy‐proven AR was described in 4/27 (15%) pts in the anti‐AT1R(+) group and 13/90 (14.4%) in the anti‐AT1R(?) group, but more severe cases of Banff IIB or antibody‐mediated rejection (AMR) were more often observed in anti‐AT1R (+) 4/27 (15%) vs. 1/90 (1.1%) in anti‐AT1R(+) (P = 0.009). Patients with anti‐AT1R Abs level >9 U/ml run a higher risk of graft failure independently of classical immunological risk factors. The recipients with anti‐AT1R Abs developed more severe acute rejections described as IIB or AMR in Banff classification. More recipients among the anti‐AT1R‐positive ones lost the graft. Our study suggests monitoring of anti‐AT1R Abs before renal transplantation for assessment of immunologic risk profiles and the identification of patients highly susceptible to immunologic events, graft failure, and graft loss.     

Complications following hip arthroscopy: a retrospective review of the McMaster experience (2009–2012)

Background

The use of hip arthroscopy has been steadily rising as technology, experience and surgical education continue to advance. Previous reports of the complication rate associated with hip arthroscopy have varied. The purpose of this study was to report our experience with hip arthroscopy complications at a single Canadian institution (McMaster University).

Methods

We performed a retrospective chart review of 2 hip arthroscopists at the same institution to identify patients who had undergone the index surgery and had been followed for a minimum of 6 months postoperatively. We used a standard data entry form to collect information on patient demographic and clinical characteristics, including age, sex, surgical indication and type of complication if any.

Results

A total of 211 patients underwent 236 hip arthroscopies. The mean age at time of surgery was 37 ± 13 years and mean follow-up was 394 ± 216.5 days. The overall complication rate associated with hip arthroscopy was 4.2% (95% confidence interval 2.3%–7.6%). We identified 4 major and 6 minor complications.

Conclusion

Overall, hip arthroscopy appears to be safe, with minor complications occurring more frequently than major ones. However, surgeons should recognize the possibility of serious complications associated with this procedure. Future research should focus on prospective designs looking for potential prognostic factors associated with hip arthroscopy complications.     

Laparoscopy as a treatment for intraperitoneal bladder injury

OBJECTIVE: To present our experience of laparoscopic repair of iatrogenic bladder perforation. MATERIAL AND METHODS: Four cases of intraperitoneal bladder perforation occurred as a complication of transurethral tumor resection. The mean age of the patients was 66 years. Details of the surgical technique are presented. RESULTS: The operation time ranged from 25 to 60 min. There were no intra- or postoperative complications. The average duration of hospitalization was 4 days and the recovery time was < or =12 days. CONCLUSION: Laparoscopic repair of iatrogenic bladder perforation is a valuable alternative to open surgery.     

Injections of botulinum A toxin for the treatment of anal fissures.

OBJECTIVE: To find out how injections of botulinum A toxin influence the healing of anal fissures. DESIGN: Retrospective study. SETTING: Medical University of Lodz, Poland. SUBJECTS: 13 patients (6 women, 7 men), mean age 49 (range 31-78), treated with injections of botulinum A toxin 50 units on either side of the anal fissure into the internal anal sphincter from May to December 1999. MAIN OUTCOME MEASURES: Complications and relapse. RESULTS: Seven fissures had healed by one month and four by two months. Two remained unhealed but asymptomatic. There was no incontinence of flatus or faeces after three months of treatment. Resting anal pressure was significantly lower in 10 of 13 patients compared with before treatment (p < 0.05). One fissure relapsed after 4 months and this patient had a successful anal stretch. CONCLUSION: Injection of botulinum A toxin gives good results in the treatment of anal fissures.     

ESTS guidelines for intraoperative lymph node staging in non-small cell lung cancer.

The European Society of Thoracic Surgeons (ESTS) organized a workshop dealing with lymph node staging in non-small cell lung cancer. The objective of this workshop was to develop guidelines for definitions and the surgical procedures of intraoperative lymph node staging, and the pathologic evaluation of resected lymph nodes in patients with non-small cell lung cancer (NSCLC). Relevant peer-reviewed publications on the subjects, the experience of the participants, and the opinion of the ESTS members contributing on line, were used to reach a consensus. Systematic nodal dissection is recommended in all cases to ensure complete resection. Lobe-specific systematic nodal dissection is acceptable for peripheral squamous T1 tumors, if hilar and interlobar nodes are negative on frozen section studies; it implies removal of, at least, three hilar and interlobar nodes and three mediastinal nodes from three stations in which the subcarinal is always included. Selected lymph node biopsies and sampling are justified to prove nodal involvement when resection is not possible. Pathologic evaluation includes all lymph nodes resected separately and those remaining in the lung specimen. Sections are done at the site of gross abnormalities. If macroscopic inspection does not detect any abnormal site, 2-mm slices of the nodes in the longitudinal plane are recommended. Routine search for micrometastases or isolated tumor cells in hematoxylin-eosin negative nodes would be desirable. Randomized controlled trials to evaluate adjuvant therapies for patients with these conditions are recommended. The adherence to these guidelines will standardize the intraoperative lymph node staging and pathologic evaluation, and improve pathologic staging, which will help decide on the best adjuvant therapy.     

Intracardiac bone cement embolism as a complication of vertebroplasty: management strategy

Background

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Vertebroplasty carries multiple complications due to the leakage of polymethylmethacrylate (PMMA) into the venous system through the iliolumbar or epidural veins. The rate of venous cement complications may vary from 1 to 10 %, with cement extravasation into the venous system in 24 % of patients. Emboli may further migrate into the right heart chambers and pulmonary arteries. Patients may vary in presentation from asymptomatic or symptoms such as syncope to life-threatening complications.

Case report

We present a case of a 57-year-old lady diagnosed with osteoporosis who underwent a staged antero–posterior fixation with PMMA vertebroplasty of progressive thoraco–lumbar kyphosis caused by osteoporotic fractures to T12, L1 and L2 vertebral bodies. Four weeks after the operation, the patient developed symptoms of left-sided chest pain, tachycardia and tachypnea. CT pulmonary angiogram (CTPA) found a high-density material within the right atrium, whilst ECHO demonstrated normal systolic function. The patient was commenced on enoxaparin at therapeutic dose of 1.5 mg/kg for 3 months and remained asymptomatic. Follow-up ECHO found no change to the heart function and no blood clot on the PMMA embolus.

Conclusions

Factors influencing the decision about conservative treatment included symptoms, localisation of the embolus, as well as time lapse between vertebroplasty and clinical manifestation. Patients that are commonly asymptomatic can be treated conservatively. The management of choice is anticoagulation with low-molecular-weight heparin or warfarin until the foreign body epithelialises and ceases in becoming potentially thrombogenic. Symptomatic patients with thrombi in the right atrium are commonly managed via percutaneous retrieval, whilst those with RV involvement or perforation are commonly managed with surgical retrieval. Management of individual patients should be based on individual clinical circumstances. Patients presenting with intracardiac bone cement embolism related to spinal procedures require thorough clinical assessment, cardiology input, and if required, surgical intervention.

     

<Emphasis Type="Italic">LRP5</Emphasis> Polymorphisms and Response to Risedronate Treatment in Osteoporotic Men

Genetic factors are important in the pathogenesis of osteoporosis, but little is known about the genetic determinants of treatment response. Previous studies have shown that polymorphisms of the LRP5 gene are associated with bone mineral density (BMD), but the relationship between LRP5 polymorphisms and response to bisphosphonate treatment in osteoporosis has not been studied. In this study we investigated LRP5 polymorphisms in relation to treatment response in a group of 249 osteoporotic or osteopenic men who participated in a 24-month randomized double blind placebo-controlled trial of risedronate treatment. BMD and biochemical markers of bone turnover were measured at baseline and after 6, 12, and 24 months of follow-up. We analyzed two coding polymorphisms of LRP5, which have previously been associated with BMD, V667M (rs4988321) and A1330V (rs3736228), and found a significant association between the A1330V polymorphism and hip BMD at baseline. Subjects with the 1330 Val/Val genotype had 8.4% higher total-hip BMD compared with the other genotype groups (P = 0.009), and similar associations were observed at the femoral neck (P = 0.01) and trochanter (P = 0.002). There was no association between A1330V and spine BMD, however, or between the V667M polymorphism and BMD at any site. The difference in hip BMD between A1330V genotype groups remained significant throughout the study, but there was no evidence of a genotype–treatment interaction in either risedronate- or placebo-treated patients. In conclusion, the LRP5 A1330V polymorphism is associated with hip BMD in osteoporotic men, but allelic variations in LRP5 do not appear to be associated with response to bisphosphonate treatment.     

Responses of trigeminal ganglion neurons to the radial distance of contact during active vibrissal touch

Rats explore their environment by actively moving their whiskers. Recently, we described how object location in the horizontal (front-back) axis is encoded by first-order neurons in the trigeminal ganglion (TG) by spike timing. Here we show how TG neurons encode object location along the radial coordinate, i.e., from the snout outward. Using extracellular recordings from urethane-anesthetized rats and electrically induced whisking, we found that TG neurons encode radial distance primarily by the number of spikes fired. When an object was positioned closer to the whisker root, all touch-selective neurons recorded fired more spikes. Some of these cells responded exclusively to objects located near the base of whiskers, signaling proximal touch by an identity (labeled-line) code. A number of tonic touch-selective neurons also decreased delays from touch to the first spike and decreased interspike intervals for closer object positions. Information theory analysis revealed that near-certainty discrimination between two objects separated by 30% of the length of whiskers was possible for some single cells. However, encoding reliability was usually lower as a result of large trial-by-trial response variability. Our current findings, together with the identity coding suggested by anatomy for the vertical dimension and the temporal coding of the horizontal dimension, suggest that object location is encoded by separate neuronal variables along the three spatial dimensions: temporal for the horizontal, spatial for the vertical, and spike rate for the radial dimension.     

Higher order aberrations in physiological optical system--own experience

PURPOSE: To assess higher order aberrations in the physiological optical system in relation to pupil diameter and age of people studied. MATERIAL AND METHODS: The study comprised 235 eyes of 122 subjects (67 women and 55 men) (mean age 43.8 +/- 15.5 years). Aberrations of the optical system were assessed using a LADARWave aberrometer (Alcon Laboratories). Aberration finding analysis included age, the pupil diameter, and their interrelations. ANOVA, Kruskal-Wallistest, multiple comparison and Ch2 tests were used to establish the statistical significance, and the correlation coefficient was calculated according to Spearman test. RESULTS: Basing on the studies performed, we found that the older subjects were the more statistically significant was the increase in the prevalence of higher order aberrations, including coma and spherical aberrations, at the same pupil diameter of 5-6.5 mm. When the relationship between aberrations and the pupil diameter was analyzed in a group of subjects aged 20-40 yrs, it turned out that the bigger the pupil diameter was the more statistically significant was the increase of higher order aberrations, including coma. While assessing the whole group studied we found a statistically significant reverse correlation between the pupil diameter and the subjects' age. Aberrations parameters between age groups 20-40, 40-60 and over 60 y. did not differ significantly. CONCLUSIONS: In the optical system an age-related increase of higher order aberrations is compensated by miosis, which reduces disadvantages of these aberrations and maintains the best optical quality of retinal image.