Transternal repair of a giant Morgagni hernia causing cardiac tamponade in a patient with coexisting severe aortic valve stenosis

Background  

Foramen of Morgagni hernias have traditionally been repaired by laparotomy, lapascopy or even thoracoscopy. However, the trans-sternal approach should be used when these rare hernias coexist with other cardiac surgical diseases.     

Correlation between backpack weight and way of carrying, sagittal and frontal spinal curvatures, athletic activity, and dorsal and low back pain in schoolchildren and adolescents

This cross-sectional study was carried out to investigate any correlation between backpack carrying, spinal curvatures, and athletic activities on schoolchildren's dorsal (DP) and low back pain (LBP). Three thousand four hundred forty-one students aged from 9 to 15 years who carried backpacks to school were included in this study and asked for DP and LBP experiences in the school period while carrying the backpack. Nonradiating methods (surface back contour analysis) were used to indirectly measure frontal spinal curve (scoliosis) with the scoliometer and lateral curves (thoracic kyphosis and lumbar lordosis) with the kyphometer. All data analyses were undertaken regarding school year level, age, gender, sports participation, backpack weight, and way of carrying (one versus both shoulder) in relation to magnitude of scoliosis, thoracic kyphosis, lumbar lordosis, and DP and LBP while carrying the backpack. DP increased with increasing backpack weight (P < 0.05). The way (one versus both shoulder) of backpack carrying did not correlate either with DP or with LBP. Girls experienced much more LBP and DP than boys (P < 0.001). There was no difference in the prevalence of LBP and DP between adolescents and children. Students' age, height, and body weight as well as magnitude of kyphosis, lordosis, and scoliosis did not correlate with either LBP or DP. At the age of 11 years, girls and boys showed the highest prevalence for DP (72% and 38.5%, respectively), while at the age of 14 years, girls reported significantly (P < 0.05) more DP than boys. Girls showed the highest prevalence of LBP (71%) at the age of 11 years, while for the boys, it was at the age of 15 years (21%). Girls showed at the age of 11 years significantly more LBP (P < 0.05) than boys. Sports exposure seemed to increase LBP in girls (P < 0.001). The results of this study suggest a differential DP and LBP prevalence in schoolchildren and adolescents carrying backpacks with regard to gender and age. The peak in pain prevalence was immediately before puberty as well as immediately after its onset. Girls who participated in sports activities seem to experience more often DP and LBP than boys. Short children who carry backpacks as heavy as do tall children at the same age are more prone to LBP.     

Multiple cervical and intrathoracic plexoid neurofibromas. Case report

A 29-year-old male with known von Recklinghausen's disease is presented. The main symptom of the patient was paroxysmal episodes of pain and numbness in the right upper hand for the last 10 years. Cervical and mediastial magnetic resonance imaging (MRI) revealed 3 large tumors originating from the right vagus nerve and another of the same origin contralaterally. Surgical resection of the masses in the right hemithorax was performed via right posterolateral thoracotomy. The postoperative course was uneventful and symptoms recessed. Plexoid neurofibromas were diagnosed at histological examination. The mass in the left hemithorax is under surveillance according to the patient's preference. The clinical, radiological, surgical, and histopathological features of this rare case are discussed.     

Short-term results with the Zweymueller-SL metal-on-metal total hip arthroplasty

. In a prospective study we followed 266 consecutive patients who received 350 Zweymueller-SL uncemented total hip replacements with metal-on-metal articulation for osteoarthritis. Mean follow-up was 52 (range 37-92) months. Patient age at the time of surgery was 55±9 (25-70) years. Pre-operative Harris score of 45±19 was increased post-operatively to 96±4. Pre-operative invalidity was significantly improved post-operatively (P<0.001), and 97% of the patients were either satisfied or very satisfied with the results. There was no aseptic loosening of either component. Revision was made in six hips (1.8%) because of either septic loosening (five, 1.5%) or technical error (one, 0.3%). At revision, surgical microscopic evidence for metalosis (Mirra grades 1 and 2) was shown in all revised hips. The reasons for early loosening were unrelated to the metal-on-metal bearing but rather were the result of either low-grade deep infection or inadequate surgical technique. Survival rate for Zweymueller screw socket and stem 7.6 years after implantation was 99.4% and 96.8% respectively. There was no evidence that metal-on-metal articulation gives rise to new problems or complications. Résumé. étude prospective d'une cohorte de 266 patients chez lesquels étaient posées 350 prothèses totales de hanche métal-métal Zweymueller-SL pour arthrose primitive (48%) et secondaire à une luxation congénitale (44%). Le recul moyen était de 52 mois, compris entre 37 à 92 mois. L'age des opérés était de 55 + 9 années, compris entre 25 et 70 ans. Le score de Harris était chiffré à 45 + 19 en pré-opératoire et à 96 + 4 en post-opératoire. Le handicap pré-opératoire était significativement amélioré par l'intervention (P<0.001). Quatre-vingt-dix-sept pour cent des patients étaient très satisfaits ou satisfaits du résultat opératoire. Il n'y avait pas de descellement aseptique des implants. La révision opératoire concernait 6 hanches (1.7%), pour 5 descellements septiques (1.4%) et une erreur technique (0.3%). Une métallose microscopique (Mirra Grade) 1 et 2) était observée dans chacune des hanches réopérées. L'origine du descellement précoce n'était pas en rapport avec le frottement métal-métal; il s'agissait soit du résultat d'une infection profonde à bas bruit, soit d'une technique opératoire inadéquate. La durée de survie de la cupule et de la tige était respectivement de 99.4 et de 96.8%, 7.6 années après leur implantation. Dans cette étude, la prothèse de hanche métal-métal de Zweymueller-SL ne paraissait pas donner lieu à l'apparition de problèmes nouveaux; cependant le recul est insuffisant, ce qui ne permet pas d'exclure la survenue de descellement aseptique plus tardif ou de complications générales liées au largage de particules métalliques. Le descellement précoce ne semblait jamais en relation directe avec la friction métal-métal, mais plut?t le résultat d'une infection profonde à bas bruit ou d'un défaut technique.     

CpG Island Methylation Patterns in Relapsing-Remitting Multiple Sclerosis

DNA methylation may predispose to multiple sclerosis (MS), as aberrant methylation in the promoter regions across the genome seems to underlie several processes of MS. We have currently determined the methylation status of eight genes in relapsing-remitting MS patients. Methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA) was used to determine the status of 31 CpG islands, located across eight genes, in 33 healthy individuals and 66 MS patients (33 in relapse and 33 in remission). The methylation levels in the examined sites ranged from 0 to 31%. Methylation positivity for RUNX3 and CDKN2A differed significantly between MS patients and healthy controls. Maximum methylation in RUNX3, CDKN2A, SOCS1, and NEUROG1 genes was significantly different between patients and controls. Roc curves demonstrated that the appropriate cut-offs to distinguish patients from healthy controls were 2% for RUNX3 (OR 3.316, CI 1.207–9.107, p?=?0.024) and 3% for CDKN2A (OR 3.077, CI 1.281–7.39, p?=?0.018). No difference in methylation was observed between patients in relapse and patients in remission, in any of the genes examined. Methylation patterns of RUNX3 and CDKN2A may be able to distinguish between MS patients and healthy controls, but not between MS patients in relapse and in remission.

Open image in new window

Graphical Abstract Methylation patterns of RUNX3 and CDKN2A may be able to discriminate healthy individuals from MS patients.

     

Discrimination indices as screening tests for β-thalassemic trait

The two most frequent microcytic anemias are β-thalassemic trait (β-TT) and iron deficiency anemia (IDA). Several discrimination indices have been proposed to distinguish between these two conditions. These indices are derived from several simple red blood cell indices, like red blood cell (RBC) count, mean cell volume, and RBC distribution width (RDW), as these are provided by electronic cell counters. The purpose of the study is to examine the diagnostic accuracy of six discrimination indices in the differentiation between IDA and β-TT. The six discrimination indices that were examined were as follows: Mentzer Index (MI), Green & King Index (G&K), RDW Index (RDWI), England & Fraser Index (E&F), RDW, and RBC count. We calculated these indices on 373 patients (205 men, 168 women) with β-TT and 120 patients (50 men, 70 women) with IDA, as well as their sensitivity, specificity, positive and negative prognostic value, efficiency, and Youden’s index (YI). G&K shows the highest reliability, followed by E&F, RBC count, MI, and RDWI. On the contrary, RDW completely failed to differentiate between IDA and β-TT. G&K proved to be the most reliable index as it had the highest sensitivity (75.06%), efficiency (80.12%), and YI (70.86%) for the detection of β-TT. These six discrimination indices cannot be relied on for a safe differential diagnosis between β-TT and IDA. They do have high specificity, but their sensitivity for the detection of β-TT is not satisfactory. Consequently, they cannot be used neither as a screening tool for β-TT because they could result in a significant number of false negative results.