Nontraumatic osteonecrosis of the humeral head

The humeral head is the second most common site for nontraumatic osteonecrosis after the femoral head, yet it has attracted relatively little attention. Osteonecrosis is associated with many conditions, such as corticosteroid use, sickle-cell disease, alcoholism, dysbarism (or caisson disease), Gaucher's disease, and other systemic conditions. The diagnosis is a clinical and radiographic one, the latter forming the basis for its staging. Treatment depends on the chronicity and severity of symptoms, as well as the degree of clinical and radiographic progression. Surgical treatment includes arthroscopic debridement and core decompression for early osteonecrosis and hemiarthroplasty or total shoulder arthroplasty for more advanced disease. This report reviews osteonecrosis of the humeral head, with an emphasis on current treatment options.     

Midterm outcomes of outfracture of the inferior turbinate

Objective

A variety of medical and surgical treatment alternatives exists for the management of inferior turbinate hypertrophy, indicating a lack of consensus on the optimal technique. The purpose of the present study was to evaluate the inferior turbinate objectively by means of radiologic methodology during the early and late periods in patients treated with inferior turbinate outfracture.

Study Design

Case series with planned data collection.

Setting

Tertiary referral center.

Subjects and Methods

Eighty inferior turbinates of 40 patients (28 males, 12 females) who underwent surgery because of septum deviation and inferior turbinate hypertrophy were included in this prospective clinical study. All patients were evaluated by paranasal sinus computed tomography preoperatively and at one and six months postsurgery. The angle and the distance between the inferior turbinate and the lateral wall of the nasal fossa and the area lateral to the inferior turbinate bone were measured on the coronal plane anterior posteriorly at five different anatomic levels.

Results

Statistically significant reductions were noted in the angle and distances in all sections one and six months postoperatively when compared with the preoperative measurements (P < 0.005).

Conclusion

Compared with the preoperative status, those patients who underwent turbinate outfracture procedures displayed a reduction in the angle and the distance between the inferior turbinate bone and the lateral wall of the nasal fossa and the area lateral to the inferior turbinate bone one month following surgery. Ongoing outcomes of this treatment method have been objectively shown.     

Neuroprotective effects of alpha-lipoic acid in experimental spinal cord injury in rats

Background:

Oxidative stress is a mediator of secondary injury to the spinal cord following trauma.

Objective:

To investigate the putative neuroprotective effect of α-lipoic acid (LA), a powerful antioxidant, in a rat model of spinal cord injury (SCI).

Methods:

Wistar albino rats were divided as control, vehicle-treated SCI, and LA-treated SCI groups. To induce SCI, a standard weight-drop method that induced a moderately severe injury (100 g/cm force) at T10 was used. Injured animals were given either 50 mg/kg LA or saline at 30 minutes postinjury by intraperitoneal injection. At 7 days postinjury, neurologic examination was performed, and rats were decapitated. Spinal cord samples were taken for histologic examination or determination of malondialdehyde (MDA) and glutathione (GSH) levels, myeloperoxidase (MPO) activity, and DNA fragmentation. Formation of reactive oxygen species in spinal cord tissue samples was monitored by using a chemiluminescence (CL) technique.

Results:

SCI caused a significant decrease in spinal cord GSH content, which was accompanied with significant increases in luminol CL and MDA levels, MPO activity, and DNA damage. Furthermore, LA treatment reversed all these biochemical parameters as well as SCI-induced histopathologic alterations. Conversely, impairment of the neurologic function caused by SCI remained unchanged.

Conclusion:

The present study suggests that LA reduces SCI-induced oxidative stress and exerts neuroprotection by inhibiting lipid peroxidation, glutathione depletion, and DNA fragmentation.     

Percutaneous nephrolithotomy in children: does age matter?

Purpose  

To compare the outcomes of percutaneous nephrolithotomy (PCNL) in 2 age groups.     

Primary renal leiomyosarcoma

Primary renal sarcomas are very rare. We report a case of renal leiomyosarcoma with 36 months follow-up. Neither ultrasonography, computed tomography nor magnetic resonance imaging are able to differentiate between leiomyosarcoma and renal cell carcinoma. Radical nephrectomy and adrenalectomy was curative. Diagnosis was established on histology and immunohistochemistry. There were no metastases. Histology and later on immunohistochemistry is the only mean by which these tumours can be diagnosed. After a period of 36 months, patient is alive and well.     

Peroneal artery-only runoff following endovascular revascularizations is effective for limb salvage in patients with tissue loss

OBJECTIVE: Peroneal artery bypass is effective for limb salvage (LS), however, the efficacy of peroneal artery-only runoff (PAOR) following endovascular (EV) interventions is unknown. The goal of our article was to compare the efficacy of EV interventions with PAOR to those with other runoff vessels for LS in patients presenting with tissue loss. METHODS: A retrospective review of 111 consecutive patients who underwent infrainguinal EV revascularizations for nonhealing ulcers/gangrene between June 2001 and December 2006 was performed. Patients with PAOR (n = 33) were compared with those with other vessel runoff (OTHER, n = 78). Fisher exact test and chi2 test were used for comparing variables, Kaplan-Meier analyses for patency, LS, and Cox regression multivariate analysis was used for identifying factors associated with limb loss. RESULTS: The patients in PAOR were older, but other morbidities were similar between groups. The most distal level of intervention was infrapopliteal (tibioperoneal or peroneal artery) in 42% in PAOR group whereas this was 24% in OTHER group (P = .071). Preoperative ankle-brachial index (ABI) was similar (0.49 +/- 0.23 vs 0.50 +/- 0.23), however, postprocedure ABI was significantly less for patients with PAOR (0.76 +/- 0.21 vs 0.92 +/- 0.13, P = .001). The primary patency, assisted primary patency, secondary patency and LS were not significantly different between groups. There was also no difference in time-to healing between groups (PAOR vs OTHER, 2.9 +/- 2.1 mo vs 3.7 +/- 3.6 mo, P = .319). We found the presence of gangrene (odds ratio [OR]: 3.5, 95% confidence interval [CI], 1.1-10.8, P = .028) and dialysis-dependence (OR: 2.9, 95% CI, 1.0-8.2, P = .046) to be associated with limb loss, when adjusted for diabetes, hypertension, hyperlipidemia, smoking, location of wound, and PAOR. CONCLUSION: Endovascular revascularization with PAOR results in acceptable patency and limb salvage rates in patients presenting with tissue loss, and is equivalent to other vessel runoff for patency, limb salvage and wound healing rates.