The Effect of Type of Femoral Component Fixation on Mortality and Morbidity after Hip Hemiarthroplasty: A Systematic Review and Meta-Analysis

HSS Journal ® - Hip hemiarthroplasty is a well-established treatment of displaced femoral neck fracture, although debate exists over whether cemented or uncemented fixation is superior....     

Bilocular unicystic ameloblastoma of the mandible in a 9 yr old child – A diagnostic and management dilemma

Unicystic ameloblastoma is a less encountered variant of the ameloblastoma that usually presented as unicystic lesions of jaw occurring in 3rd and 4th decades of life. It shows a typical ameloblastomatous epithelium lining the cyst cavity, with or without variable tumor proliferations. The case presented here is of a 9?yr old boy who was referred to our center for the management of a large diffuse swelling on the right side of the face. Clinical and radiologic evaluation showed two interconnected cystic lesions in the right body and the symphyseal regions of the mandible associated with impacted canines bilaterally. The initial histopathology of both cystic spaces showed the lesion to be dentigerous cysts and the results were reconfirmed in two other centers. A complete surgical enucleation of this bilocular cyst was done sparing the impacted teeth. The histopathologic examination of the post-operative specimen showed features of Unicystic Ameloblastoma. The patient was followed up on a regular basis for more than 3?years. There is no signs of recurrence and his latest radiographic examinations shows good bone formation. The impacted teeth are erupting into position. This case reports the difficulty in clinical diagnosis and the peculiar bilocular presentation of unicystic ameloblastoma which was conservatively managed by surgical enucleation of the complete lesion, sparing the dentition.     

Awareness and knowledge of breast cancer and mammography among a group of Malaysian women in Shah Alam

Objectives: The aim of this study was to assess awareness and knowledge of breast cancer and mammography among Malaysian women in Shah Alam. Methods: This cross sectional study was conducted among 250 Malaysian women. Data were collected using a self administrated questionnaire which included questions on socio-demographic data, knowledge of breast cancer and awareness of mammography. Results: Mean age of respondents was 28 ± 9.2 with 69.2% aged 18 to 29 years. The majority had heard about breast cancer (81.2%) and indicated books, magazines and brochures as their source of information (55.2%). However, most did not know about signs and symptoms of breast cancer and many of its risk factors. On multivariate analysis, significant predictors of breast cancer knowledge were age, race, marital status, level of education, occupation, family size and family history of other cancers (p<0.05). Fifty percent of women were aware of mammography, significant predictors being age, occupation, marital status and knowledge of breast cancer (p<0.05). Conclusion: Most women were aware of breast cancer. However, the knowledge about signs and symptoms of breast cancer and awareness of mammography were inadequate. It is recommended that the level of knowledge should be raised among Malaysian women, particularly in the young and less educated women.     

Transvaginal cystocele repair using tension-free polypropylene mesh at the time of sacrospinous colpopexy for advanced uterovaginal prolapse: a prospective randomised study

The management of an advanced multi-compartment prolapse requires a combination of techniques. The objective of this study was to report the anatomical outcomes of a prospective randomised trial comparing tension-free polypropylene mesh-reinforced anterior vaginal prolapse with anterior colporrhaphy at the time sacrospinous colpopexy and posterior fascial plication for the management of massive uterovaginal prolapse. A total of 116 patients with a stage III or IV (Pelvic Organ Prolapse Quantification System/International Continence Society) uterovaginal prolapse were randomised into two groups. The mesh group includes transvaginal cystocele repair using a tension-free polypropylene mesh, while the non-mesh group includes anterior colporrhaphy. All patients in the two groups underwent a sacrospinous colpopexy and posterior fascial plication. The primary outcome was objective success < stage 2 prolapse. The secondary outcomes were reoperation for recurrent prolapse, subjective success rates, patient satisfaction with the surgery and complications. The overall objective success rates (in all compartments) were 79 % (42/53) in the mesh group and 62 % (39/63) in the non-mesh group (p?=?0.043). The objective success rates in the anterior compartment were 85 % (45/53) in the mesh group and 62 % (39/63) in the non-mesh group (p?=?0.006). Three (6 %) patients in the mesh group and 12 (19 %) in the non-mesh group underwent repeat surgery for recurrent pelvic organ prolapse (p?=?0.03). The subjective success rates were 89 % (47/53) in the mesh group and 76 % (48/63) in the non-mesh group (p value?=?0.08). The mean patient satisfaction rates with the surgery were 84 % in the mesh group and 76 % in the non-mesh group (p?=?0.08). The development of a urinary tract infection, right-sided buttock pain (temporary sciatic neuralgia) and new-onset stress urinary incontinence were not significantly different between the two groups. The mesh exposure rate was 8 %. Transvaginal cystocele repair using tension-free polypropylene mesh at the time of sacrospinous colpopexy and posterior fascial plication offers lower anatomic recurrence and less need for further prolapse surgery to correct recurrent pelvic floor defects than anterior colporrhaphy, sacrospinous colpopexy and posterior fascial plication.     

Half of the Emirati Population Has Abnormal Red Cell Parameters: Challenges for Standards and Screening Guidelines

In populations with high prevalences of iron deficiency and thalassemia trait, many apparently healthy individuals have abnormal erythroid parameters, which may cause diagnostic problems in clinical practice. We studied the prevalence and causes of red cell parameter values outside their reference ranges in 394 healthy individuals of Bedouin Arab origin, who had complete blood counts (CBCs), hemoglobin (Hb) analyses and serum ferritin tests done. Their mean age?±?standard deviation (SD) was 24.8?±?4.9 years and 51.8% were females. Overall, 53.0% (209/394) had low Hb, MCV or MCH or high RDW. Anemia was present in 27.0% (55/204) of the women and 3.0% (6/190) of the men. Overall prevalence of MCV <80.0?fL was 45.0% (176/394) and MCH <27.0?pg was 48.0% (190/394); RDW >14.0% was found in 21.0% (43/204) of women and 7.0% (14/190) of men. Of the women, 16.0% had iron deficiency anemia (33/204) and 65.0% had ferritin values of <30.0?μg/L (133/204). The estimated prevalence of α-thalassemia (α-thal) trait in men was 32.0% (60/190) and that of β-thalassemia (β-thal) trait in both sexes was 3.0% (12/394). In conclusion, half of the healthy Emirati population have abnormal CBC values. For clinical purposes, they require reference standards for red cells that are derived from their own population. Screening of women for iron deficiency is justified due to a high prevalence of iron deficiency.     

Outcome of adolescent pregnancy at a university hospital in Jordan

Objective: To determine whether adolescent pregnancies are associated with increased risk of adverse obstetrical outcome. Materials and methods: This is a retrospective study comparing the obstetric outcome of 267 adolescent pregnancies to 500 adult women pregnancies during the same period at a university hospital. Results: Medical and obstetric complications including pregnancy-induced hypertension, diabetes mellitus, anemia, placenta praevia, abruptio placenta and multiple pregnancy were not different in both groups, where there was a significant increase of preterm labor in adolescent pregnancies compared to adult pregnancies (14.6 and 8%, respectively). Moreover, adolescent pregnancies when compared to adult pregnancies, were associated with a significantly higher incidence of forceps delivery (4.5 and 1.4%, respectively), neonatal intensive care unit admission (22.7 and 13.5%, respectively) and a lower incidence of caesarean section (7.1 and 16.8%, respectively). Conclusion: Adolescent pregnancies are associated with a favorable obstetric outcome apart from the higher incidence of preterm labor.