Periprosthetic joint infection of a total hip arthroplasty with Candida parapsilosis

INTRODUCTION: Fungal periprosthetic joint infection (PJI) is a disruptive and complex complication of joint arthroplasty. We present a case of a fungal PJI with Candida parapsilosis after a total hip arthroplasty (THA). PRESENTATION OF CASE: A 73-year-old woman with a history of ovarian cancer with peritoneal metastases, was treated with a THA, due to symptomatic arthritis of the right hip. One month after surgery, she had difficulties walking. Inflammatory parameters were mildly increased. Aspiration of a subcutaneous abscess diagnosed Candida parapsilosis. A two-stage revision arthroplasty without spacer was performed. During a six-week prosthesis-free interval, intravenous fluconazole 400 mg was given. After reimplantation, fluconazole was continued for two weeks intravenously and life-long perorally. Follow-up of the patient after six months showed no recurrence of infection. DISCUSSION: This case revealed that when PJI is suspected, a low treshold for joint aspiration is important. Two-stage revision with systematic antifungal therapy is the preferred treatment of fungal PJI. Our case demonstrated a good result with a prosthesis-free interval. Fluconazole is the preferred antifungal treatment and it should be applied for at least six months or longer. CONCLUSION: To our knowledge, this is the first case of a fungal PJI with Candida parapsilosis after a THA treated with a two-stage revision arthroplasty without spacer and a life-long fluconazole treatment. (C) 2020 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd

A new method for fine-scale assessments of the average urban Heat island over large areas and the effectiveness of nature-based solutions

People living in cities experience extra heat stress due to the so-called Urban Heat Island (UHI) effect. To gain an insight into the spatial variability of the UHI for the Netherlands, a detailed map (10 m horizontal resolution) has been calculated that shows the summer-averaged daily maximal UHI situation. The map is based on a relationship between the UHI, mean wind speed at 10 m height and the number of people living within a distance of 10 km, derived from simulations of over 100 European cities with the extensively validated urban climate model UrbClim. The cooling effect of green and blue infrastructure is also taken into account in the map, based on these simulation results. The presented map will help local authorities in defining target areas for climate adaptation measures and estimate the impact of nature-based solutions

Angulated greenstick fractures of the distal forearm in children: closed reduction by pronation or supination

The purpose of this study was to evaluate a reduction method that is based on the theory of Evans to reduce angulated greenstick fractures of the distal forearm with a rotation manoeuvre, to evaluate an immobilisation technique and to evaluate a brief survey on surgeon practice for treatment of these fractures. A retrospective study was performed on 21 patients. Fractures were reduced with a pronation or supination manoeuvre depending on the angulation of the fracture and were immobilised in pronation or supination. A good reduction was achieved in all patients. Six weeks after manipulation a loss of reduction was seen in 6 out of 21 patients, but with a re-angulation of less than 15 degrees. There was no significant difference between fractures immobilized in pronation or in supination. There was no need for re-manipulation. At the 2008 Osteosynthesis and Trauma Care Foundation (OTC) meeting, a brief informal survey was performed concerning the reduction method and the use of K-wires after reduction. No surgeons indicated they would perform only a rotation manoeuvre

Variations in serum electrolyte concentrations and renal function after therapeutic hip arthroscopy: a pilot study

Purpose: The purpose of this study was to analyze changes in serum electrolyte concentration and renal function after hip arthroscopy. Methods: We studied 10 consecutive patients (4 men and 6 women; median age, 30.5 years [range, 20 to 50 years]) undergoing hip arthroscopy. Operating time, traction time, and perfusion volume of lactated Ringer solution (in milliliters) were recorded. Preoperative and postoperative levels of sodium (Na+), potassium (K+), cloride (Cl-), calcium (Ca2+) magnesium (Mg2+), phosphorous (P), creatinine, and blood urea nitrogen (BUN) were compared. Results: The median operating time was 80 minutes (range, 60 to 150 minutes). The median perfusion volume of lactated Ringer solution was 15,000 mL (range, 6,000 to 30,000 mL). The median traction time was 37.5 minutes (range, 30 to 105 minutes). None of the patients had postoperative complications develop. With a mean decrease of 0.84 +/- 0.68 mg/dL, only serum calcium levels were found to decrease significantly (P=.01). There was a mean decrease of 1.50 +/- 2.07 mEq/L in sodium concentrations (P=.06). Hip arthroscopy was associated with a mean postoperative decrease in creatinine and BUN concentrations of 0.05 +/- 0.06 mg/dL (P=.19) and 9.84 +/- 10.36 mg/dL (P=.13), respectively. Although the mean decrease in BUN concentration was important, this was not shown to be significant. No correlations were found between operating time, perfusion volume, and postoperative changes. Conclusions: Lengthy therapeutic hip arthroscopy under high intra-articular pressure has only a minimal effect on electrolyte balance and renal function. We therefore conclude that performing routine preoperative and postoperative blood analysis of electrolyte concentrations and renal function is unnecessary

Regioselective monoalkylation of 17β-estradiol for the synthesis of cytotoxic estrogens

The regioselective synthesis of estrogens and their derivatives continues to be of interest. Most reported syntheses require multistep protocols associated with poor overall yield and lack of regioselectivity. New preparative protocols are still desired. Herein, 11 2-alkylated 17β-estradiol analogs were synthesized in a highly regioselective manner. The products were obtained using a convenient, one pot and high-yielding protocol. The anti-proliferative activity of the compounds was tested in human T-cell leukemia (CEM), human cervix carcinoma (HeLa) and human dermal microvascular endothelial (HMEC-1) cells.status: publishe

Regioselective monoalkylation of 17β-estradiol for the synthesis of cytotoxic estrogens

The regioselective synthesis of estrogens and their derivatives continues to be of interest. Most reported syntheses require multistep protocols associated with poor overall yield and lack of regioselectivity. New preparative protocols are still desired. Herein, 11 2-alkylated 17β-estradiol analogs were synthesized in a highly regioselective manner. The products were obtained using a convenient, one pot and high-yielding protocol. The anti-proliferative activity of the compounds was tested in human T-cell leukemia (CEM), human cervix carcinoma (HeLa) and human dermal microvascular endothelial (HMEC-1) cells

A pilot study of the use of an osteochondral scaffold plug for cartilage repair in the knee and how to deal with early clinical failures

Purpose: To present our short-term experience with an osteochondral scaffold plug (TruFit plug; Smith & Nephew, Andover, MA) for cartilage repair in the knee and, more importantly, to discuss our approach to treat early clinical failures. Methods: Twenty patients were consecutively treated for their cartilage lesions with the plug technique. These patients were prospectively clinically evaluated at 6 and 12 months of follow-up. Magnetic resonance imaging (MRI) was used for morphologic analysis of the cartilage repair. Biopsy samples were taken from 3 cases during revision surgery, allowing histologic assessment of the repair tissue. Results: The short-term clinical and MRI outcome of this pilot study are modest. No signs of deterioration of the repair tissue were observed. Of the 15 patients followed up during 1 year, 3 (20.0%) showed persistent clinical symptoms or even more clinical symptoms after insertion of the plug. These patients were considered as failures and therefore eligible for revision surgery. During revision surgery, the repair tissue was carefully removed. The remaining osteochondral defect was filled with autologous bone grafts. Immediate and persistent relief of symptoms was observed in all 3 patients. Histologic assessment of biopsy specimens taken during revision surgery showed fibrous vascularized repair tissue with the presence of foreign-body giant cells. Conclusions: The overall short-term clinical and MRI outcome of the osteochondral scaffold plug for cartilage repair in the knee is modest. In this pilot study a modest clinical improvement became apparent at 12 months of follow-up. MRI data showed no deterioration of the repair tissue. Of the 15 patients, 3 (20%) had persistent clinical symptoms after surgery. These patients were successfully treated with removal of the osteochondral plug remnants and the application of autologous bone grafts. Level of Evidence: Level IV, therapeutic case series