The role of computed tomography in the diagnosis and management of femoral neck fractures in the geriatric patient

Femoral neck fractures are common in the elderly; however, agreement on classification and treatment varies. It was hypothesized that computed tomography (CT) would increase agreement for Garden Classification and treatment plan over plain radiographs alone. This article presents results of an online survey completed by 32 respondents at a single institution. The survey was comprised of 5 elderly patients with femoral neck fractures using plain radiographs and CT images. Cases were randomly presented in 3 formats: (1) plain radiograph, (2) CT, and (3) plain radiograph and CT together. Patients were described as low-energy trauma, 65 years or older, and cleared for surgery. Garden Classification and treatment plans were queried. A single case was repeated for intraobserver reliability. Kappa was calculated for inter- and intraobserver reliability. The addition of CT and modification of the Garden Classification (nondisplaced vs displaced) improved interobserver agreement in all cases. Participants were 1.7× more likely (P=.042) to change their Modified Garden Classification when CT was added to plain radiograph compared to plain radiograph added to CT. Treatment agreement was slight to fair. Intraobserver agreement varied from slight to moderate. The rate of arthoplasty recommendations was similar across attending subspecialties; however, arthroplasty-trained surgeons were 20 to 60 times more likely to recommend total hip arthroplasty (P=.009) over hemiarthroplasty compared to nonarthroplasty-trained surgeons. The addition of CT to plain radiograph after femoral neck fracture improves Garden Classification agreement. However, treatment agreement was not impacted by CT. Factors other than improved classification agreement appeared to direct surgeons' treatment recommendations.     

Shelhigh no-react pulmonic valve conduit for pulmonary valve endocarditis

Pulmonary valve endocarditis is uncommon, so experience of surgical treatment is limited. A case of pulmonary valve endocarditis in a 26-year-old man, with associated extension into the pulmonary valve annulus and vegetations in the main pulmonary artery, is described. This necessitated surgical excision of the main pulmonary artery and pulmonary valve including the root, annulus, and part of the right ventricular outflow tract. The defect was reconstructed with a Shelhigh No-React porcine pulmonic valve conduit.     

Das präformierte LCP®-Plattenfixateursystem bei distalen Humerusfrakturen AO-Typ 13C3

In distal intraarticular humerus fractures primary stable osteosynthesis is essential for early mobilization of the elbow joint. Double-plate osteosynthesis techniques using different configurations are the gold standard. In the literature plate position is sometimes discussed controversially. In cases of distal humerus fractures (type AO 13C3) with metaphyseal comminution, as well as in elderly patients with poor bone quality, utilizing locking plates with angular stability was found to have increased structural properties with regard to primary fixation stability. The dorsal approach with osteotomy of the olecranon seems to be very effective in open reduction and internal fixation of this type of fracture.One new development is the anatomically preformed plate-fixation systems such as the LCP-System for distal humerus (Synthes). This study presents our first experience with this system in 11 cases of open reduction and internal fixation of type AO 13C3 distal humerus fractures. The system-specific features and intraoperative options were analyzed.     

The underlying mechanisms of verbal fluency deficit in frontotemporal dementia and semantic dementia

Verbal fluency tasks are commonly used to explore semantic memory and executive functions. The aim of this study was to gain a better understanding of the cognitive and neural mechanisms underlying verbal fluency impairment in the frontal variant of frontotemporal dementia (fv-FTD) and in semantic dementia (SD). Semantic and phonemic fluency tasks were performed by 36 fv-FTD and SD patients and 18 elderly controls. We also carried out a neuropsychological investigation of semantic memory, working memory and shifting and updating processes. We performed correlative and regression analyses of fluency scores and neuropsychological data. In addition, patients underwent a resting positron emission tomography examination, and statistical parametric mapping was used to establish correlations between resting-state FDG uptake in the whole brain and fluency scores for each patient group. Both patient groups displayed impaired performances on both fluency tasks compared with controls, but with different patterns. While fv-FTD patients scored higher than SD patients on semantic fluency, their performances on the phonemic task did not differ. Correlation and regression analyses clearly demonstrated that the fv-FTD patients’ performances on both fluency tasks depended on their executive abilities, while those of the SD patients were hampered by the impairment of their semantic memory store. Correlations with resting FDG uptake were consistent with the results of the cognitive study. In fv-FTD, both fluency performances were related to the metabolism of the frontal lobes, while we observed significant correlations between performances on both fluency tasks and the left temporal lobe metabolism in SD.     

Radio-frequency ablation: new technology for palliative treatment of hematuria in disseminated renal cell carcinoma

Hematuria is often a significant symptom in patients with disseminated renal cell carcinoma. We present a case in which the minimally invasive procedure of radio-frequency ablation was used in a patient with serious hematuria. The procedure was completely successful and there were no complications. In our opinion it may be recommended in such a situation.     

Reliving lifelong episodic autobiographical memories via the hippocampus: a correlative resting PET study in healthy middle-aged subjects

We aimed at identifying the cerebral structures whose synaptic function subserves the recollection of lifetime's episodic autobiographical memory (AM) via autonoetic consciousness. Twelve healthy middle-aged subjects (mean age: 59 years +/- 2.5) underwent a specially designed cognitive test to assess the ability to relive richly detailed episodic autobiographical memories from five time periods using the Remember/Know procedure. We computed an index of episodicity (number of Remember responses justified by the recall of specific events and details) and an index of retrieval spontaneity, and additionally an index of semanticized memories (number of Know responses). The regional cerebral blood flow (rCBF) was measured in the resting state, with H(2)O(15) as part of an activation PET study. The indexes were correlated with blood flow using volumes of interest in frontotemporal regions, including hippocampus and voxel-wise analyses in SPM. With both analyses, significant correlations were mainly found between the index of episodicity and rCBF in the medial temporal lobe, including hippocampus, across the five time periods (unlike the index of semanticized memories) and between the spontaneity index and rCBF in the prefrontal areas. These results highlight, in healthy subjects, the distinct role of these two structures in AM retrieval and support the view that the hippocampus is needed for reexperiencing detailed episodic memories no matter how old they are.     

The use of osteochondral allograft with bone marrow-derived mesenchymal cells and hinge joint distraction in the treatment of post-collapse stage of osteonecrosis of the femoral head

Osteonecrosis of the femoral head is an entity which occurs mainly in young and active patients aged between 20 and 50. The success of hip joint preserving treatments ranges from 15% to 50% depending on the stage and amount of osteonecrotic lesion. Total hip replacement is indicated in late post-collapse hips but it has unsatisfactory survival because of the wear and osteolysis in young and active patients. Osteochondral allografts have been reported in the treatment of large articular lesions with defects in underlying bone in knee, talus and shoulder. By combining osteoconductive properties of osteochondral allograft with osteogenic abilities of bone marrow-derived mesenchymal cells it has a potential to be an alternative to an autologous graft. The adjunct of hinged joint distraction should minimize stresses in subchondral bone to promote creeping substitution and prevent femoral head collapse. Unlike current treatment modalities, it would provide both structural support and allow bony and articular substitution.     

Florid-reactive periostitis of the phalanges: a 2-case report

Florid-reactive periostitis, also known as fibroosseous pseudotumor, is a benign bone lesion. It occurs rarely among pediatric patients. Usually, it affects the phalanges of the hands and feet, where most lesions concern the proximal phalanx. Girls are more commonly affected than boys. The lesion appears benign radiographically but on histologic examination could be mistaken for a variety of malignant lesions, especially osteosarcoma. Therefore, histologic evaluation is a must for distinguishing this benign lesion from malignant and infectious etiologies. We present 2 patients with florid periactive periostitis of the phalanges who were treated in our clinic. After physical and microscopy examination of the soft and bone tissues, we found no evidence of malignant process. Because of a definitive diagnosis and the benign nature of the histologic findings, a conservative treatment, that is, no surgical intervention, with a close supervision of our patients was used. During follow-up observations in both patients, we did not notice any limitations of finger movements or an enlargement of the tumor. These findings confirmed that for cases with no aggressive growth, a conservative treatment may be effective and beneficial for a patient.