Detection of severe acute pancreatitis by contrast-enhanced magnetic resonance imaging

The aim of the study was to assess the ability of MRI to differentiate between the two forms of severity of acute pancreatitis (AP), which is important for the detection of patients who require intensive monitoring and therapy. The second objective was to evaluate whether the distinction would be possible regardless of the MRI equipment. Magnetic resonance imaging was performed before and after intravenous administration of a gadolinium (Gd) chelate at 1.0 T using the breath-hold multislice rapid gradient-echo turbo fast low-angle shot (FLASH) sequence in 14 patients, and at 1.5 T with the 2D FLASH(50) sequence with fat saturation in 18 patients with acute pancreatitis early in the course of the disease. The patients were classified according to the Atlanta classification system as having the mild (MAP) or severe (SAP) form of the disease. At 1.0 T with use of a body coil, contrast-enhanced MRI failed to distinguish mild from severe pancreatitis. At 1.5 T with a phased-array body coil, the signal intensities of the patients with SAP were statistically significantly lower than those of the MAP group. Our initial clinical experience suggests that MRI with a sufficient magnetic field gradient strength may be useful for separating the two forms of acute pancreatitis in their early phases. Received: 19 January 1999; Revised: 28 May 1999; Accepted: 22 July 1999     

Medial unicompartmental knee arthroplasty with Miller-Galante II prosthesis: mid-term clinical and radiographic results

Aim  The purpose of our study was to evaluate retrospectively the mid-term results of the Miller-Galante II (Zimmer, Warsaw, USA) unicondylar knee arthoplasty (UKA). Method  The study included 46 patients with medial UKAs. Mean follow-up time was 7.0 years (range 2.7–13.1 years). Results  Survival rate of the prosthesis was 86.6% (95% CI 73.7–99.6) at 7 years. The mean clinical and functional Knee Society Scores had increased from 51 and 62 points preoperatively to 76 and 93 points (P < 0.001) postoperatively. Five of the 46 knees were revised because of excessive wear of the polyethylene liner, and three due to progression of the osteoarthritis in the lateral compartment of the knee. Conclusion  Survival of this fixed-bearing UKA was not as good as previously reported and polyethylene wear seems to be a more common problem than previously assumed.     

Comparison of the bioabsorbable and metal screw fixation after ACL reconstruction with a hamstring autograft in MRI and clinical outcome: a prospective randomized study

There has never been an MRI study of tunnel widening comparing bioabsorbable to metal screw fixation in autologous hamstring anterior cruciate ligament (ACL) reconstruction. We randomized 62 patients to hamstring ACL reconstruction with either a bioabsorbable (n = 31) or metal screw (n = 31) fixation. The evaluation methods were clinical examination, KT-1000 arthrometric measurement, the International Knee Documentation Committee and Lysholm scores, and MRI. There were no differences between the groups preoperatively. Fifty-five patients (89%) were available at a minimum of 2-year follow-up (range 24–36 months). There was tunnel widening in both groups, but the increase was significantly greater in the AP dimension of the femoral tunnel in the bioabsorbable screw group compared to metal group (P = 0.01). The tibial tunnels showed no intergroup difference. Ninety-four percent of the knees were normal or nearly normal according to the IKDC scores and the average Lysholm score was 91 with no intergroup difference. The follow-up AP tibial tunnel diameter was smaller with normal knee laxity compared to abnormal knee laxity. The graft failure rate in the bioabsorbable screw group was 23% (7/31 patients) and 6% (2/31 patients) in the metal screw group. The use of bioabsorbable screws resulted in more femoral tunnel widening, and more graft failures compared to metal screws. The tunnel widening in the tibia was associated with the knee laxity (P = 0.02).     

Arthrography for the diagnosis of abductor avulsion after total hip arthroplasty: a comparison of arthrographic and surgical findings in 33 patients

Background Weakness of the abductor muscles—or even their avulsion—is a potential risk when total hip arthroplasty (THA) is performed using the anterolateral approach. Avulsion of the re-attached gluteus medius leads to a limp, but can also provide an open canal for joint fluid to escape to the trochanteric region. Thus, our hypothesis was that arthrography can be used to diagnose such detachment.

Methods We compared THA arthrographies with peroperative findings retrospectively in 33 patients who had undergone surgical exploration for a muscle reattachment because of a strong suspicion of abductor avulsion at physical examination.

Results After a mean follow-up time of 22 (2-57) months after THA, 14/33 patients had a positive (pathological) arthrogram whereas 19 had a negative (normal) result. All 14 patients with a positive arthrogram were verified to have an avulsion of the abductor muscle at the operation. 10 of the 19 patients with a negative arthrogram had an intact abductor insertion, but 9 had an avulsion. All of these 9 patients with the peroperatively disclosed avulsion had a fibrous capsule, which obstructed the fistula leading from the joint cavity to the trochanteric bursa region.

Interpretation Arthrography is a valuable diagnostic aid in the evaluation of patients with abductor weakness and with Trendelenburg's gait appearing after a THA performed using the anterolateral approach. A positive finding helps in the operative decision making, but a negative arthrogram is not a reliable predictor.     

Two-ring hybrid external fixation of distal tibial fractures: a review of 47 cases

BACKGROUND: The healing of a metaphyseal fracture line is a major problem in cases of distal tibial fracture treated with external fixation. METHODS: Forty-seven distal tibial fractures treated with two-ring Ilizarov hybrid external fixation (16 AO/OTA type A and 31 type C, 10 open) were followed up. Fracture reduction and union time was evaluated and IOWA and RAND 36-Item Health Survey scores were used to assess functional outcome. RESULTS: Thirty-five fractures united uneventfully in a median time of 20 weeks, but 12 fractures needed additional procedures because of delayed union. According to univariate analysis, the risk factors for a longer time needed for fracture union were translational displacement and current smoking, and the risk factors for reoperation because of delayed union translational displacement fibular fracture fixation, and the number of cigarettes smoked per day. In multivariate analysis, translational displacement was a risk factor for both longer time to fracture union and reoperation and fibular fracture fixation was a risk factor for reoperation. If the translational displacement was less than 3 mm, the reoperation rate was 6%, whereas if the displacement was more than 3 mm, it was 83%. Reoperation was performed on 50% of the patients who underwent fibular fixation and on 15% of the patients who did not undergo fibular fixation. There were only marginal decreases in the range of motion and arthritis scores in the AO/OTA fracture types other than type C3. There were no significant differences in RAND 36 scores between the general Finnish population aged 18 to 64 years and our patients. CONCLUSIONS: Hybrid external fixation of distal tibial fractures is associated with delayed union, which is closely related to the degree of residual translational displacement after reduction. Fixation of an associated fibular fracture does not help to achieve better contact in the tibial fracture and increases the risk of delayed union.     

Healing of subcapital femoral osteotomies fixed with self-reinforced poly-L-lactide screws: an experimental long-term study in sheep

Subcapital femoral osteotomies of ten young adult sheep were fixed with two bioabsorbable, self-reinforced, poly- L-lactide (SR-PLLA) lag screws of 4.5 mm in diameter. At 3 weeks radiographs were taken to check the reduction and fixation achieved. After follow-up periods of 12 weeks, 1 year and 3 years with three sheep in each group, and of 7 years and 4 months with one sheep, the sheep were killed, and the healing of the osteotomies, degradation and tissue response of the implants were examined radiographically, histologically and microradiographically. All osteotomies healed with a firm bony union. There was no dislocation or wound infection. Histologically, there was no marked tissue response in the bone tissue. At 12 weeks the implants were grossly intact, at 1 year granulation tissue and new bone formation had started to penetrate into the implant, and at 3 years the implant area was mostly replaced by connective tissue and new bone, but implant material was still seen as little islands surrounded by some lymphocytes. At 7 years and 4 months, the implant material had been degraded and replaced by tight bone. Self-reinforced poly- L-lactide lag screws seem to possess adequate mechanical properties and good biocompatibility for this demanding fixation.     

A sideways fall and hip fracture

A sideways fall onto the hip is known to be a clear risk factor for hip fracture of elderly people, but it has remained unclear how severe injury such a fall can be. This retrospective patient file survey of young adults aged 15 to 49 years suggested that a fall onto the hip is indeed a serious high-impact injury possessing energy to fracture the proximal femur even in young healthy men. This being the case, it is evident that sideways falls can be very dangerous and thus a natural target for fracture prevention.     

Antiendomysial and antihuman recombinant tissue transglutaminase antibodies in the diagnosis of coeliac disease: a biopsy-proven European multicentre study

OBJECTIVE: To investigate the value of serum antitissue transglutaminase IgA antibodies (IgA-TTG) and IgA antiendomysial antibodies (IgA-EMA) in the diagnosis of coeliac disease in cohorts from different geographical areas in Europe. The setting allowed a further comparison between the antibody results and the conventional small-intestinal histology. METHODS: A total of 144 cases with coeliac disease [median age 19.5 years (range 0.9-81.4)], and 127 disease controls [median age 29.2 years (range 0.5-79.0)], were recruited, on the basis of biopsy, from 13 centres in nine countries. All biopsy specimens were re-evaluated and classified blindly a second time by two investigators. IgA-TTG were determined by ELISA with human recombinant antigen and IgA-EMA by an immunofluorescence test with human umbilical cord as antigen. RESULTS: The quality of the biopsy specimens was not acceptable in 29 (10.7%) of 271 cases and a reliable judgement could not be made, mainly due to poor orientation of the samples. The primary clinical diagnosis and the second classification of the biopsy specimens were divergent in nine cases, and one patient was initially enrolled in the wrong group. Thus, 126 coeliac patients and 106 controls, verified by biopsy, remained for final analysis. The sensitivity of IgA-TTG was 94% and IgA-EMA 89%, the specificity was 99% and 98%, respectively. CONCLUSIONS: Serum IgA-TTG measurement is effective and at least as good as IgA-EMA in the identification of coeliac disease. Due to a high percentage of poor histological specimens, the diagnosis of coeliac disease should not depend only on biopsy, but in addition the clinical picture and serology should be considered.