Supraacetabular insufficiency fractures

Insufficiency fractures in the supraacetabular region were identified in five women, aged 55-83 years. Factors contributing to the diminished resistance of their bones included postmenopausal osteoporosis, steroid therapy, radiation therapy, and rheumatoid arthritis. The supraacetabular fractures were seen on routine radiographs as hazy bands of sclerosis located immediately above and parallel to the acetabular roof. All five patients had additional fractures in the spine or pelvis. Supraacetabular insufficiency fractures may be an unsuspected cause of hip pain, especially in older women.     

Colon perforation following percutaneous nephrostomy and renal calculus removal

Two patients had colonic perforation as a result of percutaneous nephrostomy placement followed by track dilatation and renal calculus removal. We present the technical aspects of nephrostomy placement and stone removal, as well as the clinical diagnosis and management of these cases. Both patients recovered well with conservative therapy and required no surgical intervention. This report reviews the anatomic considerations for percutaneous nephrostomy in patients undergoing renal stone removal.     

Hypertension: pathophysiology and treatment

Arterial hypertension is a major cause of morbidity and mortalitybecause of its association with coronary heart disease, cerebrovasculardisease and renal disease. The extent of target organ involvement(i.e. heart, brain and kidneys) determines outcome. North Americanstudies have shown that hypertension is a major contributorto 500 000 strokes (250 000 deaths) and 1 000 000 myocardialinfarctions (500 000 deaths) per annum.     

The surgical hypertensive patient

We reviewed the pathophysiology and treatment of hypertensionin a recent edition of this journal (see key references). Inthis article, we discuss the management of the hypertensivepatient presenting for surgery and anaesthesia.     

Talent LPS AAA stent graft: results of a pivotal clinical trial

PURPOSE: We report results of a pivotal prospective clinical trial that compared standard surgical repair with endovascular exclusion of abdominal aortic aneurysm (AAA) with the Talent LPS stent graft system. METHODS: Between March 24, 1999, and September 19, 2000, 240 patients with AAA who underwent stent graft placement and 126 patients who concurrently underwent surgery to treat AAA were enrolled at 17 centers in the United States. All patients were considered to be at low risk from aortic surgery. Patients who underwent endovascular repair received a bifurcated Talent LPS stent graft; surgical control subjects underwent standard operative techniques. Inclusion criteria were AAA larger than 4.0 cm in diameter, with proximal neck > 5 mm long and 14 to 32 mm in diameter, and a 15 mm landing zone in at least one common iliac artery. Access requirements included one external iliac artery of 7 mm caliber or larger. Preoperative anatomic evaluation included computed tomography and angiography. After stent-graft placement, evaluation involved plain radiography and computed tomography performed before discharge and at 1, 6, and 12 months and yearly thereafter. RESULTS: There was no significant difference in early (<30 days) or late mortality between the two groups. Complications were slightly higher in the surgical cohort. The stent graft group did better in terms of procedure duration, requirement for general anesthesia and blood transfusion, and intensive care unit and hospital stay. There were three access or deployment failures. Immediate surgical conversion was necessary in only 1 patient, and late conversion in 5 additional patients. There were no aneurysm ruptures. Endoleak rate detected at CT (core laboratory validated) was 14% at 1 month, 12% at 6 months, and 10% at 12 months. CONCLUSIONS: Compared with surgical control subjects, patients with AAA treated with the Talent LPS stent graft had fewer complications and the same low operative mortality. Likewise, endovascular repair performed better than surgery in the perioperative period, as measured with several key procedural indicators. Long-term follow-up of patients with the stent graft will be essential to assess durability of these early results.