Letter to the Editor: Increased Risk of Revision,Reoperation, and Implant Constraint in TKA After Multiligament Knee Surgery

Clinical Orthopaedics and Related Research® -     

Diagnosis, pathophysiology and surgical treatment of duodenogastric reflux in peptic ulcer

Results of the examination of 142 patients with ulcer disease were studied. The incidence of DGR was found to be 48% in gastric ulcer and 44% in duodenal ulcer. The unfavorable influence on the gastric mucosa was greater under conditions of the acidic intragastric medium. Special attention to causes of DGR in the surgical treatment of the ulcer disease and the use of areflux anastomoses can improve results of the surgical treatment of such patients.     

Association between race and oncologic outcome following radical prostatectomy for clinically organ-confined prostate cancer: a long-term follow-up study

Purpose

Few studies have evaluated prostate cancer oncologic outcomes in different ethnic groups following radical prostatectomy for clinically organ-confined disease. Existing studies lack long-term outcome data. We conducted this study to assess the impact of racial differences on risk profile and oncologic outcomes in a large cohort of patients with prostate cancer who underwent radical prostatectomy.

Methods

Using our institutional review board-approved prostate cancer database, we retrospectively reviewed the records of 3437 patients who underwent radical prostatectomy with curative intent in our institution between 1987 and 2009. Based on ethnicity, patients were divided into Asian Americans (n?=?133), African Americans (n?=?155) and Caucasians (n?=?3149). Baseline characteristics and oncologic outcomes including biochemical recurrence free, clinical recurrence free and overall survival were compared between the study groups.

Results

A total of 3437 patients with a mean age of 63?±?9.8 years and median follow-up period of 8.7 (range 0.1–24.1) years were included in the analysis. Pathologic stage and the frequency of poorly differentiated cancer were higher in Asian Americans; however, margin status did not differ significantly. Moreover, oncologic outcomes were comparable between different ethnic groups. In multivariate analysis, both pathologic stage and grade were independent predictors of oncologic outcomes, but race was not.

Conclusions

In this large, ethnically diverse long-term follow-up study, we noted that Asian Americans compared to African Americans and Caucasians are more likely to have high risk prostate cancer; however, race was not an independent predictor of oncologic outcome following radical prostatectomy with curative intent.

     

呼吸衰竭的营养支持

许多重症疾病都合并有呼吸功能不全,而呼吸衰竭患者常伴有营养不良。营养不良可影响呼吸肌的功能,引起肺组织结构改变及降低呼吸道的抗感染防御机能,故营养支持对呼吸衰竭的病程发展及转归影响很大。过多地给予碳水化合物可使氧的消耗及二氧化碳的生成增加。合理地摄取糖、脂肪和蛋白质是治疗呼吸衰竭所必需的。     

Die Behandlung der Condylus-radialis-humeri-Fraktur im Kindesalter

Objective

Surgical treatment of lateral humeral condyle fractures with reduction and retention in order to prevent lasting malalignment, pseudarthrosis, and joint instability.

Indications

Absolute: fractures with a complete dislocation or those in which plaster-free control X-ray on day 4 shows a gap of > 2 mm. Relative: complete fractures of the lateral humeral condyle which demonstrate a dislocation ≤ 2 mm on follow-up.

Contraindications

Incomplete, so-called hanging fractures of the lateral humeral condyle without notable secondary dislocation on follow-up.

Surgical Technique

Open reduction of the lateral humeral condyle via a lateral approach to the elbow joint. In smaller children (< 5 years of age) fixation with Kirschner wires. In older children (≥ 5 years of age) or in cases requiring compression radial screw fixation is recommended. In all cases, suture repair of the periosteum is advisable.

Postoperative Management

Long upper-arm plaster cast until wound healing is achieved. Subsequently, upper-arm plaster cast for 3–4 weeks postoperatively. Implants are removed following consolidation (confirmed by X-ray) after approximately 2–3 months. Routine physiotherapy is normally not required.

Results

From January 1, 1999 to December 31, 2006, 85 children with a median age of 6.1 years had lateral condyle fracture of the humerus treated. 47 patients underwent surgery. Of these, 31 were treated with a combination of screw and Kirschner wire fixation, 13 with a single screw, and in three cases, the fracture was fixed with Kirschner wires only. After a median of 8.6 weeks (range, 5.0–17.1 weeks), implants were removed. Median follow-up time was 6 months (range, 2–50 months). There were no late complications in this series (e.g., lack of consolidation, pseudarthrosis). In five cases, hyposensitivity of the skin above the proximal aspect of the radial bone was noted postoperatively. This problem was solved in all instances within the following 6 months. A telephone survey with a response rate of 87% (74 patients) was undertaken in September 2007. Three children noted a minimal deficiency in strength of the injured arm in comparison to the contralateral extremity. One of these children additionally stated a minor flexion deficit of the elbow already present at the last follow-up in the outpatient clinic, which showed no progress. None of the patients had to be referred back to the outpatient clinic because of persistent problems and/or unacceptable results.