Conversion to total hip arthroplasty in posttraumatic arthritis: short-term clinical outcomes

Afshin Taheriazam,1 Amin Saeidinia2,3 1Department of Orthopedics Surgery, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran; 2Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran; 3Medical Faculty, Mashhad University of Medical Sciences, Mashhad, Iran Background: Fractures of the acetabulum are challenging and very difficult to treat, and even after fixation, they can lead to posttraumatic arthritis. Total hip arthroplasty (THA) has been the most common surgery performed for the complications of posttraumatic arthritis in this group of patients. Aim: In this article, it is aimed to assess the functional results and complications of the conversion to THA for posttraumatic arthritis after acetabular fracture. Patients and methods: Forty-nine patients were followed up for a mean of 3.7 years (range 2–5 years). The complications included four cases of sciatic nerve palsy, all of which had injury during the first operation. Two cases underwent two-stage surgery because of infection which was demonstrated by a high level of erythrocyte sedimentation rate/C-reactive protein and according to frozen section samples, which were sent intraoperatively with >10 neutrophil/high-power field; one case was then managed by a one-stage protocol for infection after THA was infected with methicillin-resistant Staphylococcus aureus. In 1 case, we used the Girdlestone operation for severe infections and uncontrolled diabetes; in 2 cases, we used cages; and in 47 cases, we used uncemented cups. Results: The mean of modified Hip Harris Score improved from 47 (31–66) before the conversion to 89 (79–95) at the final follow-up. The pain component of the Western Ontario and McMaster Universities also increased from an average of 15 (7–20) to 4 (0–11) at the final follow-up. No dislocation, deep vein thrombosis or pulmonary thromboembolism, new nerve injury, and heterotopic ossification occurred. Conclusion: The conversion to THA after posttraumatic arthritis in acetabular fracture can lead to reasonable pain relief and functional improvement. Keywords: acetabular fracture, conversion total hip arthroplasty, posttraumatic arthritis, internal fixatio

Total hip arthroplasty and cardiovascular complications: a review

Afshin Taheriazam,1 Amin Saeidinia,2 Faeze Keihanian3,4 1Department of Orthopedics Surgery, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran; 2Mashhad University of Medical Sciences, Mashhad, Iran; 3Cardiology Department, Imam Reza and Ghaem Hospitals, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; 4Pharmaceutical Research Division, Booali Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Abstract: Most adverse events following total hip arthroplasty (THA) are uncommon and preventable or treated easily as expected. Adverse effects related to any major surgical procedure, including anesthesia, performing with other medical problems, drugs, and allergic reactions, might also occur. Potential cardiovascular complications are known to occur during or following THA and will be reviewed here. Complications can be categorized as myocardial infarction, cardiac arrest, thromboembolism, and so on. Special considerations in cardiovascular procedures are also reviewed in this paper. Keywords: myocardial infarction, total hip replacement, post-surgical adverse events, hip fractur

Clinical Study Diastolic Dysfunction and Severity of Cirrhosis in Nonalcoholic Cirrhotic Patients

Background. In this study, we evaluated the association between diastolic dysfunction severity and severity of cirrhosis in nonalcoholic cirrhotic patients. Methods. This cross-sectional study was conducted on all nonalcoholic cirrhotic patients who were admitted in Rasht Razi hospital the Cancer of Guilan Province, north of Iran, from January 2011 to March 2012. Severity of cirrhosis was evaluated by Child-Pugh score. A 12-lead surface ECG and echocardiographic studies were performed. We used a HDI 3000 (Philips ATL, Bothell, WA, USA) equipped with 2 to 4 MHz probes. Diastolic function was determined by an expert cardiac sonographer. Data were analyzed by SPSS for win (version16). A value less than 0.05 was considered significant. Results. Sixty-tree percent of patients were male. The mean age of patients was 52.78 ± 15.2 years. 22%, 38%, and 40% of patients were considered as child class A, B, and C, respectively. There was a significant relation between diastolic dysfunction and disease duration ( = 0.001), female gender ( = 0.004), age > 60 years ( = 0.045), and severity of cirrhosis ( = 0.048). On multivariate analysis, decreased E/A ratio ( = 0.03) and disease duration ( = 0.02) showed an independent significant relation. Conclusion. According to the relation between severity of cirrhosis and diastolic dysfunction, we recommend cardiac assessment in all child B and C cirrhotic patients

Comparison of fluoroscopy time in different catheter-engagement approaches to graft vessels in post-coronary artery-bypass graft angiography

Mostafa Ahmadi,1 Ramin Khameneh Bagheri,1 Faeze Keihanian,2,3 Amin Saeidinia4 1Atherosclerosis Prevention Research Center, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; 2Pharmaceutical Research Division, Booali Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; 3Cardiology Department, Imam Reza and Qaem Hospitals, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; 4Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Background: Although there is ongoing progress in coronary artery-bypass graft (CABG) surgery and percutaneous coronary intervention techniques and supplies, the risk of cardiac complications remains high compared with the normal population. Aim: In this study, our aim was to compare fluoroscopy times in engagement of three different catheters in saphenous vein grafts (SVGs) in post-CABG patients undergoing angiography. Methods: This was a single-center, cross-sectional, comparative study. We evaluated patients with previous CABG referred for invasive coronary diagnostic angiography. Patients having had SVG–obtuse marginal artery, SVG–diagonal, and SVG–posterior descending artery CABG were included. All patients underwent diagnostic angiography by each of a right diagnostic Judkins catheter, right modified Amplatz catheter, and right guiding Judkins catheter. Demographics and clinical history of patients and fluoroscopy time in different groups were evaluated. Results: A total of 61 patients were evaluated. The distribution of baseline characteristics in the three groups of our study was normal. Mean fluoroscopy time in SVG–obtuse marginal artery was 25.70±6.70 seconds in group A, 22.23±6.51 seconds in group B, and 17.35±7.82 seconds in group C. Mean total fluoroscopy time was 86.35±16.28 seconds in group A, 73.80±10.00 seconds in group B, and 51.90±10.22 seconds in group C, which was significant (P<0.001). Conclusion: Our data suggest that when we use the guiding Judkins catheter, fluoroscopy time decreases. However, more evaluations are needed with larger-scale studies and identification of other variables. Keywords: cardiac catheter type, coronary artery-bypass graft surgery, percutaneous coronary intervention, fluoroscopy tim

Diastolic Dysfunction and Severity of Cirrhosis in Nonalcoholic Cirrhotic Patients

Background. In this study, we evaluated the association between diastolic dysfunction severity and severity of cirrhosis in nonalcoholic cirrhotic patients. Methods. This cross-sectional study was conducted on all nonalcoholic cirrhotic patients who were admitted in Rasht Razi hospital the Cancer of Guilan Province, north of Iran, from January 2011 to March 2012. Severity of cirrhosis was evaluated by Child-Pugh score. A 12-lead surface ECG and echocardiographic studies were performed. We used a HDI 3000 (Philips ATL, Bothell, WA, USA) equipped with 2 to 4 MHz probes. Diastolic function was determined by an expert cardiac sonographer. Data were analyzed by SPSS for win (version16). A P value less than 0.05 was considered significant. Results. Sixty-tree percent of patients were male. The mean age of patients was 52.78±15.2 years. 22%, 38%, and 40% of patients were considered as child class A, B, and C, respectively. There was a significant relation between diastolic dysfunction and disease duration (P=0.001), female gender (P=0.004), age > 60 years (P=0.045), and severity of cirrhosis (P=0.048). On multivariate analysis, decreased E/A ratio (P=0.03) and disease duration (P=0.02) showed an independent significant relation. Conclusion. According to the relation between severity of cirrhosis and diastolic dysfunction, we recommend cardiac assessment in all child B and C cirrhotic patients

Antimicrobial effect of Ruta graveolens extract on pathogenic bacteria

Background and Objective: Ruta graveolens is a plant used in traditional medicine with variety of therapeutic effects. This study was done to evaluate the antimicrobial effect of hydro and alcoholic extracts of Ruta graveolens on 8 species of pathogenic bacteria. Methods: In this descriptive study, standard strains of Enterococcus faecalis, Staphilococcus aureus, Staphilococcus epidermis, Strptococcus pneumonia, Escherichia Coli, Klebsiella pneumonia, Salmonella typhi and Enterobacter Cloace were obtained from Iranian institute of scientific and industerial research center. The effect of hydro and hydroalcholic extracts of Ruta graveolens on the growth of bacteria was determined by disc diffusion and serial macro dilution methods. Minimum inhibitory concentration (MIC) for each extract was determined and the findings were compared with 8 common antibiotics including Co-trimoxazole, Oxycycline, Vancomycin, Erythromycin, Furazolidon, Tetracycline, amoxicillin / clavulanic acid and Ampicillin/sulbactam. Results: Hydro and hydroalcoholic extracts of Ruta graveolens did not show any inhibitory effect on growth of the pathogenic bacteria even in the presence of high concentration (3mg/ml). Conclusion: The extracts of arial organs of Ruta graveolens had no inhibitory effect on growth of the common human pathogenic bacteria