Risk factors for prolonged operative time in femoral neck fracture patients undergoing hemiarthroplasty through direct anterior approach

Background

The use of direct anterior approach (DAA) for hemiarthroplasty in femoral neck fracture patients has recently increased worldwide. However, no previous studies have elucidated or validated risk factors for prolonged operative time in hemiarthroplasty through DAA. Accurately predicting operative time would contribute to and the selection of the most appropriate surgical approach for each patient and the effective use of operating room.

The prevalence of scapular malalignment in elementally school aged baseball player and its association to shoulder disorder

Background

Various shoulder disorders have been reported to be associated with scapulothoracic joint dysfunction in adult overhead athletes. However, little is known about the prevalence of scapular malalignment and its relationship to shoulder injuries in skeletally immature baseball players.The purpose of the current study was to investigate the prevalence of scapular malalignment in elementary school-aged baseball players, as well as its association with shoulder disorder.

Prognostic value of serum concentration of heart-type fatty acid-binding protein relative to cardiac troponin T on admission in the early hours of acute coronary syndrome

BACKGROUND: Heart-type fatty acid-binding protein (H-FABP) is proposed as an early biomarker for acute myocardial infarction (AMI), but its prognostic value is unclear in acute coronary syndrome (ACS). We evaluated the prognostic value of the H-FABP concentration relative to cardiac troponin T (cTnT) in the early hours of ACS. METHODS: Serum concentrations of H-FABP and cTnT were measured on admission in 328 consecutive patients hospitalized for ACS within 6 h after the onset of chest pain [AMI, 241 (73.5%) patients; ST-segment elevation myocardial infarction, 154 (47.0%) patients; and emergent coronary angiography within 24 h after admission, 287 (87.5%) patients]. Cardiac events, which were defined as cardiac death or subsequent nonfatal AMI, were monitored for 6 months after admission. RESULTS: During the 6-month follow-up period, there were 25 cardiac events, including 15 cardiac deaths and 10 subsequent nonfatal AMIs. Stepwise multivariate analyses including clinical, electrocardiographic, and biochemical variables revealed that increased H-FABP (above the median of 9.8 microg/L), but not increased cTnT (above the median of 0.02 microg/L), was independently associated with cardiac events in all patients [relative risk (RR) = 8.96; P = 0.0004], the subgroup of patients with ST-segment elevation myocardial infarction (RR = 11.3; P = 0.02), and the subgroup of patients with unstable angina and non-ST-segment elevation myocardial infarction (RR = 8.31; P = 0.007). The area under the ROC curve was higher for H-FABP than for cTnT (0.711 vs 0.578; P = 0.08), suggesting that H-FABP concentrations have a greater predictive capacity for cardiac events than cTnT. CONCLUSION: Serum H-FABP is a potential independent predictor of cardiac events within 6 months of patient admission and may provide prognostic information superior to cTnT in the early hours of ACS.     

Increased serum triglyceride clearance and elevated high-density lipoprotein 2 and 3 cholesterol during treatment of primary hypertriglyceridemia with bezafibrate

Background

Hypertriglyceridemia accompanied by low levels of high-density lipoprotein cholesterol (HDL-C) is a risk factor for coronary artery disease. High-density lipoprotein 2 (HDL₂) and 3 (HDL₃) are believed to suppress the progress of atherosclerosis through reverse cholesterol transport. As a result, peripheral tissues can be protected against excessive accumulation of cholesterol. Although bezafibrate is known to accelerate the increase of HDL-C, results are not standardized regarding increases of HDL₃ and HDL₂ subfractions.

Objective

This study assessed the effects of bezafibrate on serum triglyceride (TG) fractional clearance rate (K₂) and HDL₂ and HDL₃ cholesterol (HDL₂-C and HDL₃-C, respectively) levels in patients with primary hypertriglyceridemia (serum TG ≥150 mg/dL).

Methods

Outpatients with primary hypertriglyceridemia were enrolled in this 8-week study conducted at the Third Department of Internal Medicine, Nagoya City University Hospital (Nagoya, Japan). Oral bezafibrate was administered at a dose of 400 mg/d (200-mg tablet BID, morning and evening) for 8 weeks. After 8 weeks, serum levels of total cholesterol (TC), TG, HDL-C, HDL₂-C, and HDL₃-C were measured. A fat emulsion tolerance test to assess K₂ and measurements of plasma lipoprotein lipase (LPL) mass, LPL activity, and hepatic triglyceride lipase (HTGL) activity in postheparin plasma were performed before bezafibrate administration and after the course of treatment.

Results

Sixteen patients (10 men, 6 women; mean [SD] age, 54 [12] years [range, 30-69 years]; mean [SD] body mass index, 23 [2] kg/m²) entered the study. The following findings were observed in male and female patients after 8 weeks of treatment. A statistically significant reduction was observed in mean serum TG level (P<0.01). Significant increases were seen in HDL-C, HDL₂-C, and HDL₃-C (all P<0.01), K₂ (P<0.01), and in plasma LPL mass (P<0.01) and LPL activity (P<0.05). TC level and HTGL activity did not change significantly. No adverse effects related to the use of bezafibrate were documented.

Conclusions

In this study, bezafibrate treatment resulted in significant decreases in serum TG level and significant increases in HDL₂-C and HDL₃-C levels and plasma LPL mass and activity. We hypothesize that bezafibrate may increase HDL₃-C by promoting TG-rich lipoprotein catabolism and may increase HDL₂-C by promoting the conversion of HDL₃ to HDL₂.     

Superficial Surgical Site Infection in Hepatobiliary-Pancreatic Surgery: Subcuticular Suture Versus Skin Staples

Purpose

Postoperative superficial surgical site infection is a major complication in hepatobiliary-pancreatic surgery. We aimed to compare the efficacy of subcuticular sutures versus staples for skin closure in preventing superficial surgical site infection in hepatobiliary-pancreatic surgery.

Methods

Consecutive patients who underwent hepatobiliary-pancreatic surgery at our hospital from October 2006 to March 2011 and from April 2012 to March 2015 were reviewed retrospectively. Superficial surgical site infection incidence was evaluated in patients who received subcuticular sutures and those who received staples for skin closure. Propensity score matching analysis was used to adjust bias from confounding factors.

Results

A total of 691 patients were included. Patients with skin staple closures (n?=?346) were compared with patients with subcuticular suture closures (n?=?345). After a propensity score matching analysis, a significant difference in superficial surgical site infection incidence was found between the skin stapler group (11.3%) and subcuticular sutures group (2.6%). The same comparison was performed by a subgroup analysis and supported this finding in patients after hepatectomy without biliary reconstruction, pancreatoduodenectomy, or open laparotomy surgeries and in patients with body mass index <?25.

Conclusions

Subcuticular suturing after hepatobiliary-pancreatic surgery was more efficacious in reducing postoperative superficial surgical site infection incidence than staples for skin closure.

     

Breast masses with mixed cystic-solid sonographic appearance

Retrospective analysis was performed for 56 breast masses with mixed cystic and solid sonographic patterns encountered in the last 5 years at Keio University Hospital, with the objective of elucidating their significance. The lesions were classified into two major groups: tumor with cyst (TWC—solid mass with cystic component) and intracystic tumor (ICT—cystic mass with solid component). According to the pathological diagnosis, 57% were benign and 43% were malignant. Fifty eight percent of malignant lesions were shown to have a TWC pattern and 42% an ICT pattern. Among benign lesions, 66% were shown to be TWC and 34% ICT. In malignant tumors, 96% of the cases showed irregular shape and heterogeneous internal content. Even in benign lesions, a high incidence of irregular shape and rough border was found, although the predominant internal echo texture was homogeneous, and threedimensional (3-D) contour was not clear. In conclusion, we observed that in the TWC group, the lack of a defined 3-D contour is the most important criterion, and tumors with multiples cysts tend to be benign. © 1993 John Wiley & Sons, Inc.     

Prognostic value of combination of cardiac troponin T and B-type natriuretic peptide after initiation of treatment in patients with chronic heart failure

BACKGROUND: Recent studies have suggested that cardiac troponin T (cTnT) and troponin I may detect ongoing myocardial damage involved in the progression of chronic heart failure (CHF). This study was prospectively designed to examine whether the combination of cTnT, a marker for ongoing myocardial damage, and B-type natriuretic peptide (BNP), a marker for left ventricular overload, would effectively stratify patients with CHF after initiation of treatment. METHODS: We measured serum cTnT, plasma BNP, and left ventricular ejection fraction (LVEF) on admission for worsening CHF [New York Heart Association (NYHA) functional class III to IV] and 2 months after initiation of treatment to stabilize CHF (n = 100; mean age, 68 years). RESULTS: Mean (SD) concentrations of cTnT [0.023 (0.066) vs 0.063 (0.20) micro g/L] and BNP [249 (276) vs 753 (598) ng/L], percentage increased cTnT (>0.01 micro g/L; 35% vs 60%), NYHA functional class [2.5 (0.6) vs 3.5 (5)], and LVEF [43 (13)% vs 36 (12)%] were significantly (P <0.01) improved 2 months after treatment compared with admission. During a mean follow-up of 391 days, there were 44 cardiac events, including 12 cardiac deaths and 32 readmissions for worsening CHF. On a stepwise Cox regression analysis, increased cTnT and BNP were independent predictors of cardiac events (P <0.001). cTnT >0.01 micro g/L and/or BNP >160 ng/L 2 months after initiation of treatment were associated with increased cardiac mortality and morbidity rates. CONCLUSION: The combination of cTnT and BNP measurements after initiation of treatment may be highly effective for risk stratification in patients with CHF.     

First clinical experiences of concurrent bleeding control and intracranial pressure monitoring using a hybrid emergency room system in patients with multiple injuries

Background

The outcomes of multiple injury patients with concomitant torso hemorrhage and traumatic brain injury (TBI) are very poor. The hybrid emergency room system (HERS) is a trauma management system designed to complete resuscitation, computed tomography (CT), surgery, angioembolization, and intracranial pressure (ICP) monitoring all in one trauma resuscitation room without patient transfer. We aimed to review the outcomes of polytrauma patients who underwent concurrent bleeding control and ICP monitoring using the HERS.

Methods

In this retrospective observational study, we enrolled patients who underwent concurrent bleeding control and ICP monitoring using the HERS between August 2011 and June 2018. Initial data on vital signs, Injury Severity Score (ISS), probability of survival (Ps) calculated by the Trauma and Injury Severity Score (TRISS), intervention type, 28-day mortality, and Extended Glasgow Outcome Scale at 6?months after injury were collected. Continuous variables were expressed as the median (25th and 75th percentiles) and categorical variables as numbers (%).

Results

Ten patients were included in the analysis. The injury severity of the patients was as high as an ISS of 58 (50–64) and TRISS Ps of 0.15 (0.02–0.36). Seven of the 10 (70%) patients had hemodynamic instability within 30?min from arrival. The recorded durations from arrival to events were CT examination 9 (6–16) min, bleeding control procedure 29 (22–42) min, and neurosurgical intervention 39 (31–53) min. Four of the 10 patients (40%) survived to discharge, and two of them (20%) were able to live independently at 6?months after injury.

Conclusions

The concurrent performance of bleeding control procedure and ICP monitoring would be feasible in HERS settings among polytrauma patients with exsanguinating hemorrhage and TBI.