Results of total elbow arthroplasty as a salvage procedure for failed elbow reconstructive operations

Total elbow arthroplasty (TEA) was used as a salvage procedure following failed open reduction and internation fixation, failed triaxial arthroplasties, and septic and aseptic loosening of implant arthroplasty. A minimally constrained bicondylar implant with a block to disarticulation was substituted for the reconstruction of 20 revision TEAs. Custom-designed implant TEA was substituted in cases with substantial bony or soft tissue loss. Revision of the polyethylene-bearing component, coupled with the addition of a yolk-type locking mechanism, was implanted when only the bearing system of a well-fixed implant had failed. TEA can be performed successfully with satisfactory durability as a revision procedure. Revision of failed open reduction internal fixation or a failed bearing system was highly successful. Revision of previously infected elbows in a single-stage procedure was unsuccessful in two of three cases and has been abandoned in favor of a staged procedure. A revision of loose TEA was successful in only three of five cases. Further investigations are necessary to improve the function durability of TEA.     

Complications of heparin therapy after total joint arthroplasty

The cases of 112 patients who were treated intravenously with heparin for thromboembolic disease after total joint arthroplasty were reviewed. The over-all frequency of bleeding complications that were associated with therapy with heparin was approximately 30 per cent. In patients who were treated within six days after total joint replacement, the frequency of bleeding complications was 45 per cent. The prevalence of bleeding problems declined to 15 per cent in patients who were treated more than one week after arthroplasty. In roughly 35 per cent of the patients, therapy with heparin had to be discontinued because of complications. Thrombocytopenia developed in fewer than 5 per cent of the patients. It was concluded that anticoagulation therapy with heparin for clinically unimportant thromboembolic problems in the immediate postoperative period is not justified.     

Nutritional and Sensory Properties of Vegetable Oil Filled Milk Beverage Prepared with Pulp of <Emphasis Type="Italic">Mangifera indica</Emphasis> L

Value addition of a beverage was carried out by blending mango juice at three concentrations (5, 10 and 15 %) with skimmed milk and three concentrations (3, 3.5 and 4.0 %) of vegetable oil with 80 % rice bran oil and 20 % Carthamus tinctorius L. oil (Saffola Gold Open image in new window). Sensory evaluation showed significant differences in flavour and taste, consistency and overall acceptability amongst the various treatment combinations. It showed maximum overall acceptability (7.55/9) among all tested combinations. Beverage prepared from 3.5 % vegetable oil and 15 % pulp was observed superior in terms of nutritional quality showing fats (2.9 %), proteins (2.83 %), carbohydrate (12.16 %) and total solids (18.73 %). Total sugar, ascorbic acid and acidity decreased while total solids and pH increased as the storage period of beverage was increased from 0–30 days, however the changes were observed lesser at low temperature than at room temperature. Addition of vegetable oil ≥3.5 % produced minimum total plate count (≤1.8 cfu/mL) and negative test for coliform. The beverage products were found microbiologically safe during one month of storage at low temperature (around 4 °C). The value added filled milk beverage prepared with 80 % rice bran oil, 20 % safflower seed oil and 15 % mango pulp was prescribed for the best use for a week.     

Glans resurfacing for the treatment of carcinoma in situ of the penis: surgical technique and outcomes

Background

The management of carcinoma in situ (CIS) of the penis is controversial, with relatively high local recurrence rates after minimally invasive therapies.

Objective

Report the surgical technique and outcome of partial glans resurfacing (PGR) and total glans resurfacing (TGR) as primary treatment modalities for CIS of the glans penis.

Design, setting, and participants

Between 2001 to 2010, 25 patients with biopsy-proven CIS underwent TGR (n = 10) or PGR (n = 15), defined as <50% of the glans requiring resurfacing. All patients were surveyed clinically every 3 mo for 2 yr and every 6 mo thereafter.

Surgical procedure

Excision of the glans epithelium and subepithelium of either the entire glans or the locally affected area, with a macroscopic clear margin. The penis was then reconstructed using a split skin graft.

Measurements

Positive surgical margin (PSM) rates and rates of recurrence and progression were collated. Complications, cosmesis, and patient satisfaction were evaluated.

Results and limitations

Mean follow-up was 29 mo (range: 2–120 mo). There were no postoperative complications, and 24 of 25 patients (96%) had complete graft take with excellent cosmesis. Overall, 12 of 25 patients (48%) had PSMs. Only 7 of 25 (28%) required further surgery, 2 of 25 (8%) for extensive CIS at the margin and 5 of 25 (20%) for unexpected invasive disease. Additional surgery consisted of further resurfacing in 4 of 25 cases (16%) or glansectomy in 3 of 25 cases (12%). Those undergoing further surgery had no further compromise to their oncologic outcome. The overall local recurrence rate was 4%. There were no cases of progression.

Conclusions

Glans resurfacing is a safe and effective primary treatment for CIS. The procedure maintains a functional penis without compromising oncologic control, while ensuring that definitive histopathlogy is obtained. Glans resurfacing has a low risk of recurrence and progression. Patients need to be warned that approximately 28% will require further surgery for PSM or understaging of their primary disease, although the need for further surgery does not compromise oncologic control.     

Effects of tibial slope changes in the stability of fixed bearing medial unicompartmental arthroplasty in anterior cruciate ligament deficient knees

Patients with anterior cruciate ligament (ACL) deficiency may have increased failure rates with UKA as a result of abnormal contact stresses and altered knee kinematics. Variations in the slope of the tibial component in UKA may alter tibiofemoral translation, and affect outcomes. This cadaveric study evaluated tibiofemoral translation during the Lachman and pivot shift tests after changing the slope of a fixed bearing unicondylar tibial component. Sectioning the ACL increased tibiofemoral translation in both the Lachman and pivot shift tests (P<0.05). Tibial slope leveling (decreasing the posterior slope) of the polyethylene insert in a UKA decreases anteroposterior tibiofemoral translation in the sagittal plane to a magnitude similar to that of the intact knee. With 8° of tibial slope leveling, anterior tibial translation during the Lachman test decreased by approximately 5mm. However, no variation in slope altered the pivot shift kinematics in the ACL deficient knees.     

Cadmium and Lead Bioaccumulation During Growth Stages Alters Sugar and Vitamin C Content in Dietary Vegetables

A field experiment was designed to investigate the effects of cadmium and lead on biomass production, sugar and vitamin C content of dietary vegetables. At seedling stage the reduction magnitudes in biomass production with added cadmium up to 50?mg?kg^?1 soils were 49?C51?% in fenugreek root and 32.2?C39.6?% in spinach leaf; while at 40?days after sowing (vegetative growth stage); they were observed as 36.1?C47.2?% in spinach root and 17.8?C20?% in coriander leaf. Cadmium caused maximum reduction in sugar content (62?%) in radish leaf and vitamin C content (56.4?%) in coriander leaf at seedling stage; whereas, maximum reduction in sugar content (66.7?%) and vitamin C content (59.4?%) was observed in spinach leaf and coriander leaf, respectively, under the combined treatment (Cd 50?mg?kg^?1?+?Pb 500?mg?kg^?1) at vegetative growth stage. The dietary vegetables enhance their antioxidant activity against metal stress when applied below the critical level, however, dosage of Cd higher than critical level (??25?mg?kg^?1 soil in treatments II, III and IX) drastically alters plant growth (stunted), reduced yield as well as dietary contents (sugar and vitamin C) of these important vegetables especially it??s antioxidant content; and the hazardous effect was more visible at higher bioaccumulation of heavy metals during vegetative growth stage. It is concluded that dietary vegetables should be utilized for human consumption before the vegetative growth stage especially in the soils polluted with cadmium and lead in order to minimize the intake of pollutants.     

Sciatic hernia causing sciatica: MRI and MR neurography showing entrapment of sciatic nerve

Sciatic hernia is a rare condition with diverse clinical manifestations. We report a case of sciatic hernia causing sciatica, in which the diagnosis made on CT was subsequently confirmed on MRI including magnetic resonance neurography. The salient clinical and imaging features and a brief review are presented.Sciatic hernia is a rare condition that can lead to bowel obstruction, sciatica, pelvic pain, back pain or ureteric obstruction [1, 2]. Clinical diagnosis of this condition is difficult. Ultrasonography and CT are the imaging modalities commonly used to diagnose sciatic hernia, although MRI can be used in cases in which entrapment of the sciatic nerve is suspected. Magnetic resonance neurography (MRN) provides high-resolution images to demonstrate entrapment of the nerve and morphological changes in the nerve [3]. Colour Doppler can be useful in surgical planning, as it can provide information regarding bowel viability.     

How Should We Define Clinically Significant Outcome Improvement on the iHOT-12?

Background

There is increased emphasis on efficiently administering patient-reported outcome measures (PROMs). The International Hip Outcome Tool-12 (iHOT-12) is a short-form version of the iHOT-33, and relatively little is known about clinically significant outcomes using the iHOT-12.

Questions/Purposes

The purpose of this study was to define minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) for the iHOT-12 and to identify predictors for achieving these psychometric end points in patients undergoing arthroscopic treatment of femoroacetabular impingement (FAI).

Methods

Data was prospectively collected and retrospectively analyzed as part of an institutional hip preservation repository. One hundred and twenty patients were included; mean age and body mass index (BMI) were 38.7 years and 25.9, respectively. A majority of patients were female (67.5%) and white (81.7%) and participated in recreational sports (79.2%). The iHOT-12 was administered pre-operatively and at 1-year follow-up to patients undergoing primary hip arthroscopy for FAI. The following anchor question was also asked at 1-year follow-up: “Taking into account all the activities you have during your daily life, your level of pain, and also your functional impairment, do you consider that your current state is satisfactory?” MCID was calculated using a distribution-based method. Receiver-operating characteristic analysis with area under the curve was used to confirm the significance of the PASS threshold.

Results

Mean iHOT-12 scores improved from 35.6 at pre-operative assessment to 70.7 at 1-year follow-up. Patients indicating satisfaction with their outcome improved from 37.5 pre-operatively to 79.0 at 1-year follow-up. MCID value for the iHOT-12 was 13.0. The PASS threshold was 63.0, indicating an excellent predictive value that patients scoring above this threshold were likely to have met an acceptable symptom state. Worker’s compensation patients and those with increased BMI were less likely to achieve PASS; lower pre-operative iHOT-12 score was predictive for achieving MCID, and achieving MCID was predictive for achieving PASS.

Conclusion

This is the first study to define PASS and MCID for the iHOT-12, which measures clinically significant outcome improvement comparably to that of other commonly used hip PROMs. As its use becomes more widespread, the iHOT-12 data-points presented in this study can be used to determine clinically significant improvement of patient-reported outcomes.