Orthopedic surgery in Estonia

We did a survey on the development of orthopedic surgery in Estonia, especially during the past 10 years, including education, hospital-based orthopedic surgery and orthopedic research. The main types of orthopedic operations were analyzed, on the basis of data from the Estonian Social Ministry, Bureau of Medical Statistics and several departments of orthopedic. On the average, 11,831 orthopedic operations were performed yearly during the years 1996-1998 in hospital departments.     

Treatment of renal angiomyolipoma: pooled analysis of individual patient data

Epididymal anomalies and patent processus vaginalis are frequently found in boys with cryptorchidism or hydrocele. We conducted this study to evaluate the association between epididymal anomalies and testicular location or patent processus vaginalis in boys with undescended testis or hydrocele. Children undergoing surgery with undescended testis (group A, 136 boys and 162 testes) or communicating hydrocele (group B, 93 boys and 96 testes) were included. Testicular locations and epididymal anomalies were investigated prospectively. An anomalous epididymis was defined as anomalies of epididymal fusion that consisted of loss of continuity between the testis, the epididymis, and the long looping epididymis. The epididymis was considered normal when a normal, firm attachment between the testis, the caput, and the cauda epididymis was present. The mean ages of groups A and B were 24.6 ± 19.7 (range, 8–52 months) and 31.4 ± 20.6 months (range, 10–59 months). The incidence of epididymal anomalies was significantly higher in group A than that in group B (65.4 % vs. 13.5 %, P < 0.001). The incidence of epididymal anomalies in boys with undescended testis was significantly different according to testis location. Epididymal anomalies were observed in 100 %, 91.4 %, and 39.3 % of cases when the testis was located in the abdomen, inguinal canal, and distal to the external inguinal ring, respectively (P < 0.001). We conclude that epididymal anomalies were more frequent in boys with undescended testis than in boys with hydrocele, and that these anomalies were more frequent when undescended testis was at a higher level. These results suggest that testicular location is associated with epididymal anomalies rather than patent processus vaginalis.     

Mechanisms of pain in chronic pelvic pain syndrome: influence of prostatic inflammation

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), is of considerable interest in clinical urology. During the past decade, several new approaches have been made to discover its aetiology and pathophysiological mechanisms and to develop treatment modalities. The aetiology of CPPS has remained unresolved. Bacterial, chemical, urodynamic and immunological aetiologies have been suggested, but none of these has been conclusively proven. The histopathological changes in CP and CPPS are relatively well known, but the pathophysiological changes that lead to chronic inflammation and prolonged symptoms are still poorly understood. This review proposes an additional approach to the pathophysiology of CPPS. The concept of prostate tissue pressure is introduced as an objectively measurable parameter in evaluating the inflammatory process in CPPS. Chronic pain due to neurogenic inflammation and altered mast cell function is also discussed.     

Injuries from motorcycle- and moped crashes in Sweden from 1987 to 1999

The objective of this paper is to study injuries from motorcycle and moped crashes in Sweden from 1987 to 1999. Databases at the National Board for Health and Welfare and codes from both ICD9 and ICD10 systems were used, including patterns of age, gender, E-code and type of injury. Length of hospital stay, type of injuries and trends over time was evaluated. To get a more detailed picture of the age distribution, type of vehicle used and number of killed, data from the Swedish National Road Administration were also used. In Sweden, 27,122 individuals received in-patient care due to motorcycle and moped injuries between 1987 and 1999. The motorcycle and moped injury rate was reduced in the second half of the studied period and so were the total days of treatment per year. Males had eight times the incidence of injuries compared to females. Riders under the age of 26 and in particular those at an age of 15 had the highest incidence rate. Head injuries were the most frequent diagnosis, followed by fractures to the lower limbs. Concussion was the most frequent head injury. Focal and diffuse brain injuries combined showed the same frequency as concussion. It is concluded that more preventative strategies must be presented before the injury rate can be reduced.     

Quadriceps femoris muscle function prior and after total knee arthroplasty in women with knee osteoarthritis

Purpose

The aim of the present study was to evaluate an isometric voluntary force generation and relaxation capacity of the quadriceps femoris (QF) muscle prior and after total knee arthroplasty (TKA).

Methods

Isometric maximal voluntary contraction force, rate of force development, voluntary activation, half-relaxation time, and latency of contraction of the QF muscle were recorded in 12 female patients (aged 49–68 years) with knee osteoarthritis one day before, 3 and 6?months following TKA in the operated and nonoperated leg. Knee pain intensity was assessed by visual analog scale, and Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire was used to assess knee problems during daily living.

Results

A significant decrease in knee pain and significant increase in KOOS were established after TKA. Maximal voluntary isometric force in the operated leg was lower (P?P?Conclusions The present study indicated reduced maximal and explosive strength of quadriceps femoris muscle in the operated leg 3 and 6?months after TKA with no significant changes in voluntary activation, and capacity for rapid contraction and relaxation.

Level of evidence

Prospective comparative study, Level II.     

Metabolic factors and oxidative stress in osteoarthritis: a case–control study

Previous studies suggest that metabolic disturbances might be involved in the development of osteoarthritis (OA). Associations have been found between the individual components of metabolic syndrome (MetS) and OA. MetS has been associated with increased oxidative stress (OxS). The study aimed to clarify the role of MetS components in OA and to evaluate the levels of OxS in OA patients and in age-matched controls. Fifty-five patients with end-stage OA (age 63?±?7 years) prior to hip or knee joint replacement surgery and 55 age-, gender- and body mass index matched controls (61?±?8 years) were enrolled in the study. Serum levels of glucose, insulin, c-peptide, cholesterols and OxS markers were recorded. Homeostasis model assessment for insulin resistance was used as the proxy measure of insulin resistance. Radiographic severity was assessed using the Kellgren–Lawrence score. The OA patients had higher total peroxide concentration and oxidative stress index [488 (250–612) μmol/L vs. 326 (168–442) μmol/L, p?=?.011 and 34 (17–51) vs. 20 (11–28), p?=?.002, respectively] and decreased total antioxidant capacity (1.49?±?0.27 vs. 1.66?±?0.27?mmol trolox equivalent/L, p=?.008) compared with the controls. In addition, OA group had significantly higher level of C-peptide compared with the controls [1.8 (0.94–2.47) vs. 1.3 (0.46–1.42) ng/mL, p?<?.001, respectively]. Furthermore, OA radiographic severity was independently associated with LDL-cholesterol (p?=?.007) and oxidized LDL (p?=?.022). This study demonstrates that end-stage OA patients have increased levels of OxS and decreased antioxidant capacity. OA is associated with impaired lipid metabolism and dysglycemia. Our results underline the importance OxS and metabolic disturbances in the pathogenesis of OA.     

The chronic prostatitis-chronic pelvic pain syndrome can be characterized by prostatic tissue pressure measurements.

PURPOSE: We performed a prospective study to confirm early results implying that intraprostatic tissue pressure is elevated in men with the chronic prostatitis-chronic pelvic pain syndrome. We planned to determine further whether this technique would detect a significant difference in inflammatory and noninflammatory categories IIIA and IIIB. MATERIALS AND METHODS: A total of 48 patients with the chronic prostatitis-chronic pelvic pain syndrome, including 18 with inflammatory category IIIA and 30 with noninflammatory category IIIB disease, and 12 asymptomatic controls completed a Finnish version of the National Institutes of Health-Chronic Prostatitis Symptom Index. In addition, culture and microscopy of lower urinary tract segmented specimens, serum prostate specific antigen determination, transrectal ultrasound, uroflowmetry and ultrasound post-void residual urine measurement were done. All patients and controls also underwent independent intraprostatic right and left lobe tissue pressure measurement using a standard intracompartmental tissue pressure monitor system. Pressure was measured via an intraprostatic needle placed percutaneously in the perineum at baseline, and 10, 60 and 120 seconds after standard saline injection. RESULTS: All patients with the chronic prostatitis-chronic pelvic pain syndrome had significantly higher pressure at all measurement points compared with controls (p <0.001). Mean intraprostatic tissue pressure was significantly higher (p <0.01) in category IIIA with greater than 10 leukocytes per high power field in prostate specific specimens compared with category IIIB with less than 10. CONCLUSIONS: Our study supports the suggestion that patients with the chronic prostatitis-chronic pelvic pain syndrome have significantly higher prostate tissue pressure than controls. Findings also validated the previous clinical assumption that there is a rationale for differentiating chronic prostatitis-chronic pelvic pain syndrome cases into inflammatory and noninflammatory categories.     

Anterior knee pain following total knee replacement correlates with the OARSI score of the cartilage of the patella

Background

Attempts to relate patellar cartilage involvement to anterior knee pain (AKP) have yielded conflicting results. We determined whether the condition of the cartilage of the patella at the time of knee replacement, as assessed by the OARSI score, correlates with postsurgical AKP.

Patients and methods

We prospectively studied 100 patients undergoing knee arthroplasty. At surgery, we photographed and biopsied the articular surface of the patella, leaving the patella unresurfaced. Following determination of the microscopic grade of the patellar cartilage lesion and the stage by analyzing the intraoperative photographs, we calculated the OARSI score. We interviewed the patients 1 year after knee arthroplasty using the HSS patella score for diagnosis of AKP.

Results

57 of 95 patients examined had AKP. The average OARSI score of painless patients was 13 (6–20) and that of patients with AKP was 15 (6–20) (p = 0.04). Patients with OARSI scores of 13–24 had 50% higher risk of AKP (prevalence ratio = 1.5, 95% CI: 1.0–2.3) than patients with OARSI scores of 0–12.

Interpretation

The depth and extent of the cartilage lesion of the knee-cap should be considered when deciding between the various options for treatment of the patella during knee replacement.Patellar cartilage degeneration may be one cause of anterior knee pain (AKP) following total knee replacement. However, so far, attempts to relate intraoperatively assessed patellar cartilage involvement to postsurgical AKP have yielded conflicting results (van Jonbergen et al. 2012). There have been studies both affirming (Picetti 3rd et al. 1990, Rodríguez-Merchán and Gómez-Cardero 2010) and refuting (Barrac et al. 1997, 2001, Wood et al. 2002, Burnett et al. 2004, Campbell et al. 2006, Pilling et al. 2012) a relationship between the state of the patellar cartilage at the time of arthroplasty and postoperative AKP. The original Outerbridge classification (Outerbridge 1961) and its modification by Beguin and Locker (1983) have been used in most studies for grading of cartilage degeneration.Previous research of AKP has focused on the macroscopic cartilage changes. However, the disease process may be quite advanced at the histological level before any macroscopic changes become visible (Agha and Webb 2006, Bentley and Hill 2007).To our knowledge, the relationship between histological changes in the cartilage of the patella at the time of arthroplasty and postsurgical AKP has not been investigated. The Osteoarthritis Research Society International (OARSI) has developed a system for grading of the cartilage pathology, which is based on combined assessment of the depth of the lesion and the extent of the arthritic changes over the joint surface (Pritzker et al. 2006). We hypothesized that there is a correlation between OARSI score and AKP following total knee replacement with unresurfaced patella.The aims of the study were (1) to estimate the prevalence of AKP following total knee replacement with unresurfaced patella, and (2) to determine whether there is a correlation between the condition of the cartilage of the unresurfaced patella at the time of knee replacement, as assessed by the OARSI score, and postsurgical AKP.     

Myonuclear domain size and myosin isoform expression in muscle fibres from mammals representing a 100,000-fold difference in body size

This comparative study of myonuclear domain (MND) size in mammalian species representing a 100 000-fold difference in body mass, ranging from 25 g to 2500 kg, was undertaken to improve our understanding of myonuclear organization in skeletal muscle fibres. Myonuclear domain size was calculated from three-dimensional reconstructions in a total of 235 single muscle fibre segments at a fixed sarcomere length. Irrespective of species, the largest MND size was observed in muscle fibres expressing fast myosin heavy chain (MyHC) isoforms, but in the two smallest mammalian species studied (mouse and rat), MND size was not larger in the fast-twitch fibres expressing the IIA MyHC isofom than in the slow-twitch type I fibres. In the larger mammals, the type I fibres always had the smallest average MND size, but contrary to mouse and rat muscles, type IIA fibres had lower mitochondrial enzyme activities than type I fibres. Myonuclear domain size was highly dependent on body mass in the two muscle fibre types expressed in all species, i.e. types I and IIA. Myonuclear domain size increased in muscle fibres expressing both the β/slow (type I; r = 0.84, P < 0.001) and the fast IIA MyHC isoform ( r = 0.90; P < 0.001). Thus, MND size scales with body size and is highly dependent on muscle fibre type, independent of species. However, myosin isoform expression is not the sole protein determining MND size, and other protein systems, such as mitochondrial proteins, may be equally or more important determinants of MND size.