The impact and deformation of press-fit metal acetabular components

PhDEarly failure of some metal-on-metal (MoM) hip implants are extensively reported but not fully explained. These arthroplasties commonly utilise large-diameter, thin-walled acetabular cups that have the advantage of minimal removal of acetabular bone and a reduced chance of dislocation; however they may deform during insertion which involves impaction. The role of diametrical cup deformation as a factor to unsatisfactory implant performance has not been widely reported. The aim of this thesis was to investigate the extent to which deformations may occur in clinically relevant situations and to assess the significance of a range of variables on the deformation generated. 2D axisymmetric finite element (FE) models established a method of simulating impaction using different momentums. Experimentally validated 3D foam models showed that deformation is clearly influenced by the orientation of the cup, the support of the underlying bone and the geometry of the component itself. CT scans of the pelvis from 8 similarly sized female patients from two discrete age populations were used to develop clinically relevant FE models. Cup deformations were found to occur due to pinching between the iliac and ilial regions and were significant when compared to typical minimum diametrical clearances of 80-120 μm. In young pelvis models deformations of 34–63 μm were found to be significantly greater than in the older pelvis models, p<0.001. Surprisingly, small changes in the cup version increased deformations by up to 40% from the surgeon identified optimal position and were 30% greater when an eccentricity was introduced into the reamed acetabulum. The local deformations estimated in the acetabular cups may cause localised reductions in the fluid-film thickness, resulting in regions where boundary, rather than mixed lubrication takes place. This may help explain why failure and high wear rates are sometimes found in young patients with acetabular components positioned in clinically optimal positions

Paranasal Sinuses Anatomy and Anatomical Variations

Anatomical variations of the sinuses are common and may lead to obstruction to the ventilation and drainage of the sinuses. This may lead to osteomeatal complex disease refractory to medications. A preoperative CT of the paranasal sinuses acts as road map guide to identify vital anatomical variations and its relationship to the orbit, skull base, neurological and vascular structures, to prevent iatrogenic injuries. To control intraoperative bleeding, it is critical to identify the anterior and posterior ethmoidal artery indentations and sphenopalatine artery in the anterior and lateral nasal walls. It is essential for the surgeon to familiarize with the anatomy of the ethmoid region, lateral nasal wall, sphenoid sinus, sella and parasellar region and pterygopalatine/infratemporal fossa before embarking on these approaches. The advent of CT scans and state-of-the-art FESS instrumentation has made surgery of the paranasal sinuses less of a mystery for the surgeon. Therefore, identifying and addressing these anatomical variations during FESS is crucial in restoring ventilation and drainage

Updates on Laryngo-Pharyngeal Reflux (LPR) and Its Management

Laryngo-pharyngeal reflux (LPR); esophageal reflux; pharyngolaryngeal reflux; or reflux laryngitis refers to the backflow of acid from the stomach to the upper aerodigestive tract of the larynx and pharynx. Repetitive reflux of these contents may lead to LPR. It has been estimated that half of the otolaryngology patients with laryngeal and voice disorders have LPR. The pattern of reflux is different in LPR and gastroesophageal reflux. LPR usually occurs during the daytime in the upright position, whereas gastroesophageal reflux disease more often occurs in the supine position at nighttime or during sleep. Laryngeal edema is an important indicator of LPR that is most often neglected. LPR was previously deemed a controversial topic in laryngology but is now clearer with a better understanding of the pathogenesis. Diagnosis is made based on symptoms, and laryngoscopy aided with investigations and confirmed the response to treatment

SUSHRUTA’S GENERAL PRINCIPLES OF FRACTURE CARE TREATMENT & MANAGEMENT

Orthopedic conditions are well explained and documented in the literature of Ayurveda in the name of “Bhagna Chikitsa”. Many of the new techniques are developed for the management as per the condition. Acharya Sushruta described exclusively about fracture, its etiology, classification and various modalities of the management. Bhagna in ancient period were commonly encountered problem occurs in wars and attacks by animals etc but in the present time these are commonly as a result of RTA. Bhagna was explained by Acharaya Sushruta depending upon nature of trauma, shape of fracture, displacement of fracture fragments and fracture with or without wound. If it occurs in the bone it is called as Kand bhagna (bone fracture) and in the joint it is called as Sandhimoksha (dislocation). The principle of fracture management defined by Acharya Sushruta centuries ago are as per condition suggests conservative or surgical treatment. Conservative modalities includes Kushabandha, Alepa, Chakrayoga, Taila Droni, etc are still relevant. The western medicines takes over in the management of complicated fractures with the introduction of many surgical instruments like the intramedullary nails, etc &amp; delays fracture union and healing potential. This paper expounds the wisdom of orthopedic branch in ancient times especially fracture &amp; its management with possible modern correlation and how much knowledge existed and how well organized was it so many centuries ago. It would be worthwhile to explore these unique features for use in present times. The concepts, theories and techniques practiced several thousand years ago hold true even in today’s modern era

A study of urinary incontinence amongst Malaysian women in Selangor: Prevalence, risk factors and quality of life

This study documented “involuntary loss of urine” among Malaysian women. Based on the QUID score criteria, 21.6% complained of moderate to severe urine loss while 34% suffered mild leak. Coffee consumers, fair general health score and postmenopausal women were more likely to report UI. Only 40% sought medical treatment while majority used panty liners or double underwear. They were uncomfortable talking about their urinary symptoms and suffered silently. Albeit, this is a very sensitive issue, but professionals have a duty to reach out and educate women to report early urinary symptoms and receive early medical intervention to improve their QOL

A Study on Effect of Omega 3 Fatty Acids in Hypertriglyceridemia

, was highly significant after 8 weeks of treatment. HDL-cholesterol levels increased highly significantly (37.40±3.96 vs. 39.14±3.40 mg/dl; p&lt;0.001).Total cholesterol also decreased highly significantly (221.71±25.22 vs. 213.97±22.31 mg/dl; p&lt;0.001

An innovative technique for surgical positioning in head and neck surgery

Patient positioning is a vital in ensuring patient comfort, dignity and good access to the operative site. Accurate positioning helps in minimising the risk of injury to the patient. An in-house airbag made from recyclable medical supplies can be used to replace the conventional sandbag for head and neck surgeries. It involves the use of an empty irrigation bottle, a valve and suction tubing. Its shape and volume is readily adjustable by altering the volume of inflated air. Moreover, compressible air moulds the bag to the curvature of the patient’s external surface reducing the risk of pressure sores in prolonged surgery. Ultimately this serves as an innovative technique which is financially savvy with the use of recyclable items

Nodal histiocytic disorder in children: report of three cases and review of literature

Background: Histiocytic system consists of phagocytes and dendritic cells. Both are found in lymph nodes. Usually, this disorder presents with painless cervical lymph node enlargement hence frequently mistaken for lymphoma or tuberculosis. Case presentation: Here, we report three pediatric cases: one of Langerhans cell histiocytosis and two of sinus histiocytosis and massive lymphadenopathy with neck mass as initial presentation. The final diagnosis was made with fine needle aspiration cytology, biopsy, and ancillary tests. Conclusion: Biopsy and immunohistochemistry studies are recommended for determining subtypes of histiocytosis and further management of patient

Comparison of midazolam versus clonazepam as premedication scheduled for elective abdominal hysterectomies

Background and aim: Anxiety is one of the most common problem which affect the patient during surgical procedures. Thus, anxiolytics have a primary role as premedication preoperatively. With this background, we designed this study to compare anxiolytic effects of oral midazolam and oral clonazepam. Methods: Study was carried out in 80 patients scheduled for elective Abdominal hysterectomy and were divided into group of 40 each. Group M 40 patients were given Tab Midazolam 10 mg, 45 min before surgery. Group C of 40 patients were given Tab Clonazepam 2 mg, 45 min before surgery with a sip of water. All hemodynamic parameters, sedation score, satisfactory score, Hamitlon Anxiety Rating Scale were noted. The patient characteristics were analysed using “Chi-square test” and inter group comparison of the parametric data was done using the “unpaired t-test using software IBM SPSS 17.0. Results: Clonazepam is better anxiolytic than midazolam and has longer duration of anxiolytic effects and with minimal side effects and better hemodynamic stability than midazolam. Conclusion: Tab Clonazepam can be used as premedication to allay anxiety in the patients undergoing elective surgeries