Introduction

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Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Computed tomography coronary angiography as initial work-up for unstable angina pectoris : [Unstable anjina pektoris için başlangıç work-up olarak bilgisayarlı tomografi koroner anjiyografi]

Computed Tomography Coronary Angiography (CTCA) is a rapid, non-invasive diagnostic tool for coronary artery disease (CAD). Rapid Access Chest Pain Clinics (RACPC) were introduced in UK in 2000, in order to assess rapidly patients with chest pain. To evaluate the use of CTCA as initial work-up for unstable angina pectoris in a primary care-based RACPC. Eighty-eight (n=88) patients were examined by a consultant cardiologist and referred for CTCA if indicated. CTCA was performed with a 640 slices, 320-row CT scanner. Thirty-five (n=35) patients were discharged without further investigations; 50 (mean age 59.8 years; 24 male) were referred for CTCA and 3 were referred directly for an invasive angiography (IA). Following CTCA, 17 patients were discharged. Seventeen (n=17) patients with no history of CAD, but with positive CTCA findings and eleven (n=11) patients with known CAD but without new lesions on CTCA were discharged after optimisation of medical treatment. Five (n=5) of the 50 patients eventually underwent IA; 2 were referred for CABG; 3 continued with medical treatment. No major adverse cardiac events were recorded in a 6-months' follow up period. The cost for each patient who underwent CTCA was £1,087; 94% of patients rated their experience as good or excellent. The time interval from RACPC visit-to-definitive diagnosis was <3 weeks in 50% of patients, <6 weeks in 90%. Use of CTCA as initial investigation in Primary Care, is both clinically and cost-effective. CTCA should be considered in the initial diagnostic work-up of unstable angina pectoris patients, with or without prior history of CAD.Bilgisayarlı tomografi koroner anjiyografi (BTKA) koroner arter hastalığı (KAH) için non invazif hızlı bir araştırma aracıdır. 2000 yılında Birleşik Krallıkta (UK) göğüs ağrısı olan hastalara hızlı bir şekilde yardımcı olmak için hızlı ulaşılan göğüs ağrısı klinikleri (RACPC) kurulmuştur. Çalışmanın amacı birinci basamak tabanlı RACPC de unstable anjina pektoris için başlangıç work-up olarak BTKA kullanımını araştırmaktı. Seksen sekiz (n=88) hasta bir konsultan kardiyolog tarafından muayene edildi ve eğer endikasyon varsa BTKA çekildi. BTKA bir 640 slices, 320 –row BT skaner ile uygulandı. Otuz beş (n=35) daha ileri araştırma yapılmadan taburcu edildi. 50 (ortalama yaş 59.8 yıl;24 erkek) hastaya BTKA çekildi ve 3 hasta doğrudan invazif anjiyografiye (IA) gönderildi. BTKA sonrası 17 hasta taburcu edildi. KAH öyküsü olmayan, fakat pozitif BTKA ‘si olan 17 hasta ve bilinen KAH öyküsü olan fakat BTKA’sinde yeni lezyon saptanmayan 11 hasta medikal tedavisi düzenlenerek taburcu edildi. Elli hastanın 5’ine IA yapıldı, 2’si CABG’ya yönlendirildi, 3’ünde medikal tedavi ile devam edildi. 6 aylık takip periyodu sonrası herhangi bir majör yan etki kaydedilmedi. BTKA yapılan her hastanın maliyeti £1,087idi; hastaların %94’ü deneyimlerini iyi veya mükemmel olarak derecelendirdiler. RACPC başvurusu ile kesin tanı arasındaki zaman aralığı hastaların %50’sinde <3 hafta, %90’ında <6 hafta idi. Birinci basamakta başlangıç araştırma yöntemi olarak BTKA kullanımı hem maliyet hem de klinik olarak etkindi. BTKA hem KAH olan hem de olmayan unstable anjina pektoris hastalarında başlangıç teşhis work-up olarak değerlendirilmelidir