Analysis of factors among 30-day and 1-year mortality rates in patients with borderline stable-unstable intertrochanteric hip fracture

ObjectiveThis study aimed to evaluate the possible effects of surgical procedures on mortality and to identify the possible risk factors for mortality in the management of geriatric hip fractures.MethodsA total of 191 patients (105 women and 86 men; mean age 82.26±9.681 [60–108] years) with AO/OTA 31A2.2 intertrochanteric fractures and treated with sliding hip screw, proximal femoral nail, or hemiarthroplasty were included in this retrospective cohort study. The treatment type was decided by the responsible surgeon according to the patients’ pre-injury activity level, bone quality, and features of the fracture. Age, sex, type of fracture, type of surgery performed, American society of anesthesiology (ASA) grade, type of anesthesia, time to surgery, type of physical therapy, length of hospital stay, and number of comorbidities were documented. We evaluated the 30-day and 1-year mortality of patients treated with sliding hip screw (SHS), proximal femoral nail antirotation (PFN-A), or hemiarthroplasty and identified the possible risk factors for mortality.ResultsA total of 49 patients underwent SHS, 58 underwent PFN-A, and 84 underwent hemiarthroplasty. Of these, 2 patients with SHS, 2 with PFN-A, and 11 with hemiarthroplasty died within 30 days after surgery, whereas 7 patients with SHS, 15 with PFN-A, and 23 with hemiarthroplasty died 1 year after surgery. The 30-day and 1-year overall mortality rates were 7.9% and 23.6%, respectively. Both the 30-day and 1-year mortality risks were higher in patients undergoing hemiarthroplasty than in patients undergoing SHS (p=0.068 versus 0.058). The 30-day mortality was higher in patients receiving general anesthesia than in those receiving combined spinal and epidural anesthesia (p=0.009). The 1-year mortality risk was higher in patients with ASA grade 4 than in those with grade 1 and 2 (p=0.045). Advanced age (p=0.022) and male sex (p=0.007) were also found to be the risk factors for 1-year mortality.ConclusionWe demonstrated that higher ASA grade, male sex, general anesthesia, and hemiarthroplasty procedures are associated with higher mortality rates in elderly patients with hip fractures. Thus, we highly recommend orthopedic surgeons to consider all these factors in the management of intertrochanteric hip fractures in the geriatric population.Level of EvidenceLevel IV, Prognostic Study     

Delay‐dependent feedforward control of time‐delay systems with parametric uncertainties via dynamic IQCs

This paper studies the design problem of a robust delay‐dependent H _∞ feedforward controller design for a class of linear uncertain time‐delay system having state and control delays when the system is subject to ‐type disturbances. The proposed controller scheme involves two main controllers, which are static state‐feedback and dynamic feedforward controllers. The state‐feedback controller is used for stabilizing the delay and uncertainty‐free system, whereas the feedforward controller performs disturbance attenuation. Dynamic type integral quadratic constraints (IQCs), which consist of frequency‐dependent multipliers, have been introduced to represent the delays and parametric uncertainties in the system where the degree of the multiplier used in IQC representation is in an adjustable nature. This scheme allows the designer to obtain less conservative controllers with increasing precision. Sufficient delay‐dependent criteria in terms of linear matrix inequalities are obtained such that the uncertain linear time‐delay system is guaranteed to be globally, uniformly, asymptotically stable with a minimum disturbance attenuation level. Several numerical examples together with the simulation studies provided at the end illustrate the usefulness of the proposed design. Copyright © 2012 John Wiley & Sons, Ltd.     

Unusual localization and aggressive progression of large infantile fibrosarcoma

Infantile fibrosarcoma is a very rare soft tissue tumor in infants and children most commonly located in extremities. It constitutes less then 1 percent of all childhood cancers. Prognosis and clinical course of it is relatively good compared to adult forms. Local recurrence is common but metastasis is infrequent.In this case report we present infantile fibrosarcoma with relapse and lung metastasis despite neoadjuvant chemotherapy, pelvic reconstruction surgery with wide surgical excision and adjuvant chemotherapy protocol. The patient was a 2-year-old girl at the time of diagnosis, and there was a huge mass in pelvic region. After neoadjuvant chemotherapy, type 1 pelvic resection and pelvic reconstruction with bone cement performed. The patient presented with relapse and lung metastasis 6 months after the surgery.This is the first report of pelvic infantile fibrosarcoma with pelvic resection surgery. This case suggests that these tumors may exhibit unpredictable clinical behavior.     

Supplementation of quercetin for advanced DNA integrity in bull semen cryopreservation

The aim of this study was to identify the effects of adding quercetin (Q) to Tris extender in order to identify levels of oxidative stress in bull sperm after freeze thawing. Ejaculates were collected via artificial vagina from Holstein bulls. Semen was divided into five tools and diluted to a final concentration of 15 × 10⁶ spermatozoa/ml with the Tris extender containing Q (25, 50, 100 and 200 μg/ml) and no additive (control; C). All examples were equilibrated at 4°C during 4 hr then were loaded into 0.25‐ml straws and frozen using a controlled rate. Sperm motility and motility characteristics were determined using the computer‐assisted semen analyser. Sperm membrane integrity was assessed using the hypoosmotic swelling test. Sperm chromatin integrity was investigated using the single cell gel electrophoresis. Total antioxidant capacities were performed colorimetrically. Q supplementation used as an antioxidant did not produce better results in the proportion of sperm progressive and total motility, plasma membrane integrity and sperm abnormalities. Q supplementation exhibited the favourable tail length, tail DNA and tail moment. In conclusion, when whole parameters are considered, Q25 can be added to the Tris extender due to its positive effect on sperm DNA integrity and no adverse effect on the progressive and total motilities of sperm.     

The effect of using different embolic agents on survival in transarterial chemoembolization of hepatocellular carcinoma: gelfoam versus polyvinyl alcohol

PURPOSE

We aimed to compare the effect of using different embolic agents such as gelfoam and polyvinyl alcohol (PVA) on survival, tumor response, and complications in transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC) patients.

MATERIALS AND METHODS

We retrospectively reviewed the medical records of 38 inoperable HCC patients who underwent TACE between August 1998 and April 2007. A total of 50 TACE sessions were performed using PVA (n=18) or gelfoam particles (n=20), following the application of 60 mg doxorubicin with 10–20 mL lipiodol emulsion. The PVA and gelfoam groups were compared based on clinical, laboratory, and demographic variables. Survival rates were calculated starting from the first TACE session using the Kaplan-Meier analysis.

RESULTS

There was no significant difference between the survival rates of PVA and gelfoam groups (P = 0.235). Overall survival rates at 12, 24, 36, 48, and 60 months were 55%, 36%, 15%, 7%, and 5%, respectively. Tumor response, age, lipiodol accumulation type, number of HCC foci, complications, and serum alpha-fetoprotein level were significant factors for survival in all patients.

CONCLUSION

Use of gelfoam or PVA as the embolic agent did not have a significant impact on survival. Complete tumor response, intensive lipiodol accumulation in tumor, older age (>60 years), fewer (≤3) HCC foci, and low serum alpha-fetoprotein level (≤400 ng/mL) were found to improve cumulative survival significantly.Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the liver and the third leading cause of cancer death worldwide. More than 90% of HCC occurs following liver cirrhosis (1). Transplantation, ablative treatments, and surgical resection are considered as curative treatments (2). Unfortunately, only 30% of HCC cases are eligible for these curative treatments at the time of diagnosis, while the majority is diagnosed in advanced stage, beyond the criteria for surgical therapy (3, 4). Transarterial chemoembolization (TACE) remains the most widely used and established palliative treatment in the management of patients with advanced HCC, with proven survival benefits over the best supportive care (5–8). Despite the worldwide acceptance of TACE in the treatment of surgically unresectable HCC, there is still no standard protocol for its use (9). Various TACE techniques which comprise selective or superselective catheterization, different chemotherapeutic regimens (doxorubicin, 5-fluorouracil, cisplatin, mytomycin-c, epirubicin, neocarzinostatin), and different embolization agents can influence the patient outcome (10, 11). Furthermore a previous review stated that polyvinyl alcohol (PVA) particles may be better than gelatin sponge in TACE treatment (12). Thus, the primary aim of our study was to compare the effect of different embolic agents such as PVA and gelfoam on survival and patient outcome in the treatment of surgically unresectable HCC. The secondary aim was to investigate the effect of TACE on survival.     

Duane's retraction syndrome: its sensory features

Purpose: To investigate binocularity in Duane’s retraction syndrome (DRS) and to evaluate whether or not there is a relationship between the sensory and clinical features of the syndrome. Methods: Clinical and sensory findings of 29 patients with DRS were recorded. Binocularity was tested with the Bagolini glasses (BG), Worth four‐dot (W4D), TNO and the stereo‐fly plate of the Titmus test. Results: Twenty‐four (83%) patients showed fusion with the BG at near and 23 (79%) had fusion at distance. With the W4D, 23 (79%) patients had fusion at near and 19 (65%) had fusion at distance. Seven (24%) patients demonstrated normal stereoacuity, 15 (52%) had reduced stereoacuity and the remaining seven (24%) patients had no measurable stereoacuity. In patients without stereoacuity, amblyopia (p < 0.001), type 2 and 3 DRS (p = 0.031) and exotropia (p = 0.003) in primary position were more common than in those with reduced or with normal stereoacuity. Restriction of ocular ductions was also more severe in patients without stereoacuity than in those with reduced or normal stereoacuity (p = 0.019, p = 0.016). Patients with type 2 and 3 DRS were significantly more likely to have amblyopia (p = 0.037), large‐angle heterotropia (p = 0.005) in primary position, upshoot or downshoot (p = 0.010) than those with type 1 DRS. Conclusions: Although approximately 75% of DRS patients had fusion and measurable stereoacuity, only 25% demonstrated normal binocularity. This report provides new data on the relationship of sensory features to most of the clinical findings of this syndrome. Sensory features, as well as most clinical features of the syndrome, are better in patients with type 1 DRS.     

Reconstruction of the middle cerebral artery after excision of a giant fusiform aneurysm

A patient with a giant fusiform aneurysm of the left inferior trunkus of the middle cerebral artery (MCA) is presented. The size of the aneurysm was 5 cm at its largest diameter. Retrograde flow was well developed. After the application of temporary clips the aneurysm was excised and microsurgical reconstructions were undertaken. Adequate flow in the reconstructed MCA trunkus was maintained. This rare case is discussed in the light of the literature.     

Influence of age of onset on clinical features in obsessive-compulsive disorder

We compared early-onset and late-onset obsessive-compulsive disorder (OCD) patients in terms of demographic and clinical features. One hundred sixteen outpatients whose primary diagnosis was OCD according to DSM-IV diagnostic criteria were recruited. Early-onset (n=50) and late-onset (n=66) OCD groups were compared with respect to demographic variables and scores obtained on various scales. A male gender predominance was found in early-onset OCD group. Symmetry/exactness obsessions, religious obsessions, hoarding/saving obsessions, and hoarding/collecting compulsions also were significantly more frequent in the early-onset group than in the late-onset group. The results may suggest a phenotypic difference between the two groups. Further studies are needed to investigate the differences between early-onset and late-onset OCD groups to examine the hypothesis that early-onset OCD is a distinct subtype of the disorder.