Valgus osteotomy for nonunion and neglected neck of femur fractures

Nonunion neck of femur can be a difficult problem to treat, particularly in the young, and is associated with high complication rates of avascular necrosis due to the precarious blood supply and poor biomechanics.The various treatment options that have been described can be broadly divided according to the aim of improving either biology or biomechanics. Surgeries aimed at improving the biology, such as vascularized fibula grafting, have good success rates but require high levels of expertise and substantial resources. A popular surgical treatment aimed at improving the biomechanics-valgus intertrochanteric osteotomyoptimizes conditions for fracture healing by converting shear forces across the fracture site into compressive forces. Numerous variations of this surgical procedure have been developed and successfully applied in clinical practice. As a result, the proximal femoral orientation for obtaining a good functional outcome has evolved over the years, and the present concept of altering the proximal femoral anatomy as little as possible has arisen. This technical objective supports attaining union as well as a good functional outcome, since excessive valgus can lead to increased joint reaction forces. This review summarizes the historical and current literature on valgus intertrochanteric osteotomy treatment of nonunion neck of femur, with a focus on factors predictive of good functional outcome and potential pitfalls to be avoided as well as controversies surrounding this procedure.     

Surgical repair of left ventricular aneurysms: a comparative evaluation of linear versus Dor's repair

BACKGROUND: Resection and linear repair of aneurysms of the left ventricle alter its geometry and thereby reduce its performance over the long term. Hence, Dor's circular patch repair was advocated to maintain the geometry of the left ventricle. However, the superiority of this procedure over linear repair is debatable. METHODS AND RESULTS: We retrospectively analyzed 95 cases of left ventricular aneurysm repair--28 cases by Dor's procedure and 67 by linear repair. The age group, symptoms, risk-factor profile and severity of coronary artery disease were comparable in both the groups, but the cardiopulmonary bypass and mean aortic cross-clamp time were longer in those treated with Dor's procedure. The left internal mammary artery could be grafted to the left anterior descending artery or diagonal branch in 13 cases in the group undergoing Dor's procedure (group I) versus 14 cases in the group undergoing linear repair (group II). There was no mortality in group I while there were 7 deaths in group II. Patients in group I were followed up for up to 2 years and those in group II for up to 13 years. During follow-up, 16/2 8 remained in NYHA functional class I or II in group I versus 24/67 in group II. The mean preoperative left ventricular ejection fraction was 34.9% in group I which improved to 39.7% during follow-up. In group II, the mean preoperative left ventricular ejection fraction was 37.2% which improved to 41.5% during follow-up. This difference was not statistically significant. CONCLUSIONS: In our retrospective study, we did not observe any superiority of Dor's repair over linear repair for left ventricular aneurysm as regards NYHA functional class and left ventricular ejection fraction. However, follow-up with Dor's repair was short (up to 2 years). Hence, no definite conclusions can be drawn.     

Bone mass of overweight affluent Indian youth and its sex-specific association with body composition

Summary

The study assessed whether overweight is associated with better bone densities in healthy youth. It was observed that overweight individuals had better BMDs at the hip but not at other sites after controlling for the bone area. Lean body mass was an important determinant of BMDs in men, but both lean and fat mass were important for BMDs in women.

Introduction

The study assessed the relationship of overweight and obesity to the bone mass in young men and women consuming adequate calcium.

Methods

Bone and body composition parameters were measured using dual energy X-ray absorptiometry in overweight men (n?=?74) and women (n?=?77) in the age group of 20–35 years and compared with controls having normal body mass index (BMI). Biochemical parameters of bone metabolism were also assessed.

Results

After adjustment for whole body bone area, bone mineral densities (BMDs) at femoral neck and hip were significantly higher in overweight individuals when compared with controls. However, BMD at lumbar spine, forearm, and whole body were not significantly different in the two BMI groups. Overweight women had lower vitamin D and higher parathormone levels than controls. Regression analyses indicated that height was an important determinant of BMD at most of the skeletal sites in both men and women. Lean body mass was an important determinant of BMDs in men, but both lean and fat mass were important for BMDs in women.

Conclusion

Overweight may be associated with better BMDs at the hip but not at other sites after controlling for the bone area. Body composition parameters may have sex-specific associations with BMD.     

Common infections in diabetes: pathogenesis, management and relationship to glycaemic control

Specific defects in innate and adaptive immune function have been identified in diabetic patients in a range of in vitro studies. However, the relevance of these findings to the integrated response to infection in vivo remains unclear, especially in patients with good glycaemic control. Vaccine efficacy seems adequate in most diabetic patients, but those with type 1 diabetes and high glycosylated haemoglobin levels are most likely to exhibit hypo-responsiveness. While particular infections are closely associated with diabetes, this is usually in the context of extreme metabolic disturbances such as ketoacidosis. The link between glycaemic control and the risk of common community-acquired infections is less well established but could be clarified if infection data from large community-based observational or intervention studies were available. The relationship between hospital-acquired infections and diabetes is well recognized, particularly among post-operative cardiac and critically ill surgical patients in whom intensive insulin therapy improves clinical outcome independent of glycaemia. Nevertheless, further research is needed to improve our understanding of the role of diabetes and glycaemic control in the pathogenesis and management of community- and hospital-acquired infections.     

A prospective study of the natural history of hematuria associated with benign prostatic hyperplasia and the effect of finasteride

PURPOSE: We prospectively studied the effect of finasteride on chronic hematuria associated with benign prostatic hyperplasia. MATERIALS AND METHODS: We prospectively evaluated 57 patients with chronic intermittent hematuria who were randomized to a finasteride treated or a control arm. RESULTS: In the untreated control group hematuria recurred in 17 patients (63%) within a year but in only 4 (14%) in the finasteride group, which was a statistically significant difference (p <0.05). Surgery was required for bleeding in 7 controls (26%), while no patient on finasteride required surgery. CONCLUSIONS: Hematuria secondary to prostatic bleeding may be significant if not treated. Finasteride appears to be effective for suppressing hematuria caused by benign prostatic hyperplasia and should be considered as treatment.     

Clinical pharmacology of liposomal anthracyclines: focus on pegylated liposomal Doxorubicin

Pegylated liposomal doxorubicin (PLD) is a liposomal formulation with a distinct pharmacokinetic profile characterized by an extended circulation time and a reduced volume of distribution. Biodistribution animal studies indicate preferential accumulation of PLD into various implanted mouse-human tumors, with an enhancement of liposomal drug tumor levels compared with free drugs. The extended circulation time of pegylated liposomes and their ability to extravasate through the leaky vasculature of tumors results in the enhanced delivery of liposomal drug and/or radiotracers to the tumor site in patients with cancer. In malignant effusions, Kaposi sarcoma skin lesions, and a variety of solid tumors there is evidence of selective tumor uptake detected by various methods. Pegylated liposomal doxorubicin has been approved for clinical use in a variety of neoplastic conditions because of its antitumor efficacy and unique safety profile with an impressive reduction of cardiac toxicity in comparison with conventional doxorubicin.     

Community-acquired infections in type 2 diabetic patients and their nondiabetic partners. The Fremantle Diabetes Study

AIMS: The aim of this study was to investigate the association between Type 2 diabetes and community-acquired infections. METHODS: We recruited 68 patients (mean+/-S.D. age=64.9+/-9.1 years; 57.4% males) from a community-based cohort and their nondiabetic partners (age=63.8+/-9.9 years; mean relationship duration=37.3+/-11.5 years) to a prospective observational matched-pair cohort study. Participants were assessed for infection risk factors and were required to complete an infection diary over the following year. RESULTS: Sixty patient-partner pairs returned completed diaries. A greater proportion of patients than partners had received influenza vaccination in the past year (73.3% vs. 60.0%; P=.057), but pneumococcal vaccination coverage in the previous 5 years was similar (11.7% vs. 10.0%; P=1.0). The proportions of patients and partners reporting no infections were similar (51.7% vs. 58.3%; P=.52), but the diabetic patients were more likely to have experienced more than one infection (33.3% vs. 18.3%: P=.022). Baseline glycosylated hemoglobin levels in patients with and without at least one infection were similar, and there was no association between multiple infections and glycosylated hemoglobin (P>.2 in each case). After adjusting for age and gender, the probability of at least one infection during follow-up was not associated with diabetes (P=.33), but the number of infections was positively associated with diabetes (P=.005). CONCLUSION/INTERPRETATION: Although similar proportions of Type 2 diabetic patients and their nondiabetic partners remained infection-free over a 12-month period, the diabetic patients who developed infections had a greater number of episodes. Glycemic control did not predict the risk or frequency of community-acquired infections in the diabetic group.     

Functional outcome of biological condylar blade plating of subtrochanteric fractures

BackgroundThe aim of this study was to review high-energy subtrochanteric fractures treated biologically with the 95° angled blade plate, to assess the time to union and return to work, and to perform a functional evaluation using the traumatic hip rating scale.Patients and methodsThis study is a retrospective review of 22 patients with 23 fractures. Twenty-one patients (96 %) with 22 fractures were available for analysis. The average age was 33 years (range 18–47). There were seventeen males and four females. The right side was involved in fifteen patients, the left in five patients, and one patient had bilateral fractures. Motor vehicle accident was the predominant mode of injury in eleven patients. Seven patients had other associated injuries. 32B2.1 (40 %) was the commonest fracture pattern according to the OTA classification.ResultsThe average follow-up period was 29 months (range 12–49). The mean time to fracture healing was 16 weeks (range 12–32). All patients returned to their pre-fracture occupation (100 %). Eighteen patients (86 %) healed without any additional surgery. The outcome according to the hip rating scale was excellent in ten patients and good in eleven patients. Two patients (9 %) required additional surgery.ConclusionsBiological fixation of subtrochanteric fractures using 95° CBP results in a high union rate with low morbidity and good functional outcome.