Posterior bone block for footdrop - A report of two cases

A posterior bone-block operation is one of the few treatment options in cases of paralytic footdrop. A case with a flail ankle and no bony deformity is ideal for this approach. Two cases of acquired flail ankle with equinus deformity were treated using a new modification of the bone-block technique that does not interfere with subtalar joint motion. A bone block harvested from the iliac crest was fixed at the posterior talus after partial resection of the posterior tubercle. The graft was in contact with the posterior malleolus of the tibia. Satisfactory correction was achieved, and both patients could walk without the use of external splints

Midterm results of the cylindrical fully porous-coated uncemented femoral stem in revision patients with Paprosky I-IIIA femoral defects

Introduction: The aim of this study was to analyze the survival of the Echelon (R) femoral stems in revision hip surgeries in patients with Paprosky I-IIIA femoral defects. Patients and methods: Sixty-six patients (70 hips) who underwent revision hip surgery with at least 3 years of follow-up data were included in the study between 2000 and 2013. The mean patient age was 64.5 (32-83) years, and the mean follow-up period was 93 (45-206) months. The reasons for revision were aseptic loosening in 55 (78.6%) patients, periprosthetic joint infection in 9 (12.9%) patients, periprosthetic fracture in 4 (5.7%) patients, and stem fracture in 2 (2.9%) patients. The preoperative and postoperative follow-up X-rays and functional scores were evaluated. Results: Five patients died in an average of 70 (45-86) months after surgery due to non-related diseases. We encountered sciatic nerve palsy in two patients and early hip dislocation in two patients, whereas 54 patients were able to walk without any assistive device. The remaining 12 patients required an assistive device to walk. The mean Harris hip score significantly increased from 34 (7-63) preoperatively to 72 (43-96) postoperatively. Aseptic loosening was observed in one patient. The survival of the porous-coated anatomical uncemented femoral stem was 98.4% over 10 years. Conclusion: This study showed that good clinical outcomes and survival can be obtained when using porous-coated anatomical uncemented femoral stems

The results of monoblock stem with step-cut femoral shortening osteotomy for developmentally dislocated hips

Introduction: The main objective of this study was to evaluate the midterm results of cementless THA with the use of monoblock stems combined with step-cut femoral shortening derotational osteotomy for DDH

The relationship between hypertensive retinopathy and angiotensin converting enzyme gene polymorphism

Objective: Hypertensive retinopathy is an important complication and a major site of target organ damage from hypertension. Angiotensin converting enzyme (ACE) has a main role in cardiovascular physiology. It was shown that ACE gene polymorphism is related to plasma concentrations of ACE. We aimed to investigate the relationship between ACE gene polymorphism and hypertensive retinopathy. Methods: One-hundred and eight patients (62 female, mean age; 52.8 ± 7.0 years) with essential hypertension and 30 healthy volunteers were enrolled in this study. Hypertensive retinopathy was diagnosed in a dark room with direct ophthalmoscopy by a single ophthalmologist who was blinded to clinical data. Polymerase chain reaction analysis was used to detect the insertion/deletion (I/D) polymorphism of the ACE gene. Patients were assigned to Group DD, Group ID and Group II. Three genotypic subgroups were compared for hypertensive retinopathy. Results: There were 42 patients (27 female, mean age: 52.4 ± 7.8) in DD group; 51 patients (28 female, mean age: 53.6 ± 6.9) in ID group and 15 patients (7 female, mean age: 51.2 ± 5.6) in II group. Basal characteristics of the patients were similar in the three groups. The genotypic distributions of patients and healthy controls were comparable. Hypertensive retinopathy was determined in 15 (35.7%) patients in DD group, 8 (15.6%) patients in ID group and 2 (13.3%) patients in II group (p<0.05). Conclusion: We found a significant relationship between ACE gene I/D polymorphism and hypertensive retinopathy. Identification of ACE genotype in hypertensive patients might be useful to discriminate the patients who are more susceptible to hypertensive retinopathy. © 2006 Bentham Science Publishers Ltd

Decreased ovarian reserve in female Sprague–Dawley rats induced by isotretinoin (retinoic acid) exposure

Isotretinoin is a retinoid widely used for the treatment of severe nodulocystic acne. Although it has broad side effects, there is no well-designed study about its effects on the ovary. This study investigated possible toxic effects of isotretinoin on female gonads. A total of 30 female rats were randomly divided into three equal groups according to the dose of isotretinoin they were administered: 0 mg/kg/day (group 1), 7.5 mg/kg/day (group 2) or 15 mg/kg/day (group 3). Thirty days after the treatment, the effects of isotretinoin on the ovaries were evaluated with serum anti-Mullerian hormone (AMH) concentrations, apoptosis by TUNEL assay and immunohistochemical observations by proliferating cell nuclear antigen (PCNA). The percentage of atretic follicles was calculated for each stage of folliculogenesis. The serum AMH concentrations were found to be lower in both isotretinoin groups. The percentage of atretic follicles in both isotretinoin groups was higher than the control. The number of PCNA-positive granulosa cells was decreased in the isotretinoin groups. The number of ovarian follicles with apoptotic granulosa cells was increased in the experimental groups. These data are the first to identify that exposure of isotretinoin may be responsible for decreased ovarian reserve and toxic effects on rat ovaries. RBMOnline Crown Copyright (C) 2013. Published by Elsevier Ltd. All rights reserved

Venous Thromboembolism Prophylaxis In Major Orthopaedic Surgery: A Multicenter, Prospective, Observational Study

Objectives: We investigated risk factors for venous thromboembolism (VTE), prophylaxis measures employed, and incidence of symptomatic deep venous thrombosis (DVT) and pulmonary embolism (PE) in patients undergoing major orthopaedic surgery (MOS). Methods: An open, multicenter, prospective, observational study was conducted in 21 medical centers, comprising 899 patients. Of these. 316 patients (35.2%) underwent total hip arthroplasty (THA), 328 patients (36.5%) underwent total knee arthroplasty (TKA), and 255 patients (28.4%) underwent surgery for hip fractures (HF). Pharmacologic prophylaxis was employed in all the patients. Results: Risk factors for VTE were seen in 73.2% of the patents. the most common being obesity (72%) and prolonged immobilization (36.3%). Low-molecular-weight heparin (91.1%) and fondaparinux (8.9%) were used for prophylaxis, which was short-term in 273 patients (30.4%) and long-term in 626 patients (69.6%). Mechanical prophylaxis was performed with compression stockings in 610 patients (67.9%) and by intermittent pneumatic compression in 67 patients (7.5%). During three-months of follow-up, symptomatic DVT and PE were seen in eight (0.9%) and four patients (0.4%), respectively. Mortality occurred in 10 patients (1.1%). Complications of major and minor bleeding were seen in eight (0.9%) and 40 (4.5%) patients, respectively. Conclusion: Effective VTE prophylaxis is associated with low risk of clinically apparent DVT and PE in MOS.WoSScopu

Does previous open nephrolithotomy affect the outcomes and complications of percutaneous nephrolithotomy in children?

Objective: To analyze the success and complication rates of percutaneous nephrolithotomy (PCNL) performed in pediatric patients and to compare outcomes of the patients undergoing primary PCNL with those of patients who had undergone previous open nephrolithotomy