Acquired immunodeficiency syndrome-associated non-Hodgkin's lymphomas and other malignancies in patients with hemophilia

Non-Hodgkin's lymphoma (NHL) is the most common human immunodeficiency virus (HIV)-associated malignancy in hemophiliacs. We studied the incidence and clinicopathologic features of NHL in 3,041 hemophiliacs followed at 18 US Hemophilia Centers between 1978 and 1989. Of the 1,295 (56.6%) who were HIV(+), 253 (19.5%) developed acquired immunodeficiency syndrome (AIDS), of whom 14 (5.5%) developed NHL. Three NHL occurred in HIV(-) hemophiliacs, for a 36.5-fold greater risk in HIV(+) than HIV(-) hemophiliacs (P < .001). The NHL incidence rate was 29-fold greater than in the US population by Surveillance, Epidemiology, and End Results (SEER) estimates (P < .001). Between 0 and 4 lymphomas have been observed per year between 1978 and 1989. At presentation 13 (92.9%) of the HIV(+) NHL were extranodal. Ten were stage IV, 1 stage II, and 3 stage IE. Ten (71.4%) were high-grade, 3 (21.4%) intermediate-grade, and 1 (7.1%) was a low-grade B-cell lymphoma. Epstein-Barr virus (EBV) DNA was detected in 36% by in situ hybridization, including one central nervous system (CNS) lymphoma. The mean CD4 cell count at NHL diagnosis was 64/mm3, the mean latency from initial HIV infection was estimated to be 59 months, and the median survival was 7 months. The incidence of basal cell carcinoma in HIV(+) hemophiliacs was 18.3-fold greater than in HIV(-) hemophiliacs (P < .001) and 11.4-fold greater than in the US population (P < .001). In conclusion, incidence rates of NHL and basal cell carcinoma in HIV(+) hemophiliacs are significantly increased over rates in HIV(-) hemophiliacs and over rates in the US population. Clinicopathologic presentation of NHL in HIV(+) hemophiliacs is similar to that in HIV(+) homosexual men.     

Early functional results after Hemiarthroplasty for femoral neck fracture: a randomized comparison between a minimal invasive and a conventional approach

ABSTRACT: BACKGROUND: It was our hypothesis that geriatric patients with a fractured neck of femur, when surgically treated via a direct anterior approach to the hip, would regain their mobility faster. METHODS: Sixty patients who sustained a fractured neck of femur were randomly assigned into two groups. In the minimal invasive arm, a so called "direct anterior approach" (DAA) was chosen, in the conventional arm Watson-Jones-Approach was used for implantation of a bipolar hemi-arthroplasty. Evaluated were the mobility as measured by the four-item-Barthel index, pain, haemoglobin-levels, complications, duration of surgery, administration of blood transfusion and external length of incision. RESULTS: A statistically significant difference (p=0,009) regarding the mobility as measured with the four-item Barthel index was found already at the 5th postoperative day, favouring the DAA. Evaluation of the intensity of pain with a visual analogue scale (VAS) showed a statistically significant difference (p=0,035) at day 16. CONCLUSIONS: Comparing different approaches to the hip joint for the implantation of a bipolar hemi-arthroplasty after fractured neck of femur, it can be stated that mobilization is faster for the DAA compared to the WJA when measured by the four-item Barthel index, there is less pain as measured using the VAS. Level of Evidence: Level II therapeutic study German clinical trials register (DRKS Number: DRKS00003332).     

Primary small bowel malignancies: single-center results of three decades

We highlight one medical center's experiences with primary malignancies of the small bowel. During a 27-year period, 79 patients were treated for small bowel tumors. Of these, 15 (20%) were lost to follow-up; thus, 64 patients were reviewed retrospectively with emphasis on histological distribution and their topography, perioperative complications, overall survival, and prognostic factors. In our 64-patient series, 33 (51.6%) presented with adenocarcinoma; 10 (15.5%), lymphoma; 8 (12.1%), leiomyosarcoma; 5 (7.6%), neurogenic tumor; 2 (3%), unclassified carcinoma; 5 (7.6%), other types of sarcoma; and 1 patient presented with synchronous adenocarcinoma and lymphoma. Of all patients, 30 (46.9%) were curatively treated, whereas 34 (53.1%) underwent palliative procedures. Hospital lethality was 9.4% and mainly occurred in patients operated on under emergency circumstances. Reoperation rate was 29.7%. The observation period lasted at least five years or until death; three patients were alive less than five years postoperatively. Cumulative five-year survival rate was 22.5% in the adenocarcinoma group, 33.3% in the lymphoma group, 33.3% in the leiomyosarcoma group, and 22.2% in patients with other tumors. The uncharacteristic symptoms presented by patients suffering from small intestinal malignancies make early diagnosis difficult. Therefore, especially in patients with long-standing bowel diseases, malignancy should be considered. Early diagnosis and surgical treatment lead to a good prognosis as shown by our study.     

Standardized AP radiographs do not provide reliable diagnostic measures for the assessment of acetabular retroversion

Diagnosis of acetabular retroversion is essential in femoroacetabular impingement (FAI), but its assessment from radiographs is complicated by pelvic tilt and the two‐dimensional nature of plain films. We performed a study to validate the diagnostic accuracy of the cross‐over sign (COS) and the posterior wall sign (PWS) in identifying acetabular retroversion. COS and PWS were evaluated from radiographs and computed tomography (CT) scans as the standard of reference in 50 hips of subjects with symptoms of FAI. A CT‐based method using three‐dimensional (3D) models was developed to measure the COS, PWS, true acetabular version, and pelvic tilt relative to the anterior pelvic plane. The new CT‐based method aimed to eliminate errors resulting from variations in the position and orientation of the pelvis during imaging. A low level of agreement for COS and PWS was found between radiographs and CT scans. A positive COS strongly correlated with pelvic tilt. These results suggest that COS and PWS determined from anteroposterior radiographs are considerably limited by pelvic tilt and inherent limitations of radiographs. Their use as the sole basis for deciding whether or not surgical intervention is indicated seems questionable. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 30:1369–1376, 2012     

Recruitment and screening policies and procedures used to establish a paid donor oocyte registry

We have reviewed the demographic characteristics of, and report abnormalities noted in, the de-novo growth and development of a paid oocyte donation programme. The personal profiles of all prospective oocyte donors were reviewed. Acceptance or rejection of candidates was based upon screening the results of medical, genetic and psychological testing. A total of 603 candidates initially responded to our advertisement. From this pool, 313 individuals were considered suitable and contacted by telephone. Following further conversation, 176 women were scheduled an entry interview. On completion of the formal screening process, 17.6% (n = 31) of those actually interviewed were denied entry. Thus, from the initial interested parties, only 23% of women wishing to participate in oocyte donation were considered suitable candidates. Given the high attrition rate, we concluded that the need for rigorous and thorough medical, psychological and genetic testing is mandatory for the establishment of a donor registry. Furthermore, professional counselling of prospective donors with respect to the results of tests and the implications of test results with respect to their future medical and reproductive health, are important parts of providing comprehensive care.