Clubfoot is one of the most common congenital limb deformities. Prenatal diagnosis of the condition is essential as it can help treat the malformation as early as possible. We reviewed the recent ...available literature concerning the current methods for prenatal diagnosis of clubfoot.
The following databases were searched from 1966 to 2015: PubMed, OVID, Cochrane, CINAHL, Google scholar and Embase.
Out of a total number of 197 retrieved articles, after abstract or title page evaluation, 158 articles not matching the inclusion criteria were excluded. The full text versions of the remaining 39 articles were obtained, and their reference lists screened, with the addition of another 5 full-text articles.
Currently, ultrasonography is considered the most reliable method of prenatal diagnosis of clubfoot. Ultrasonographic diagnosis of clubfoot appears more likely between the 18th and the 24th week of pregnancy. Alternative imaging is not indicated. There is no agreement whether to propose foetal karyotyping when isolated clubfoot is diagnosed by prenatal ultrasonography. Early detection of clubfoot should prompt a careful surveillance during pregnancy in order to detect any possible additional abnormalities and, if any of these are detected, invasive testing should be offered.
Low back pain is one of the four most common disorders in all regions, and the greatest contributor to disability worldwide, adding 10.7% of total years lost due to this health state. The etiology of ...chronic low back pain is, in most of the cases (up to 85%), unknown or nonspecific, while the specific causes (specific spinal pathology and neuropathic/radicular disorders) are uncommon. Central sensitization has been recently recognized as a potential pathophysiological mechanism underlying a group of chronic pain conditions, and may be a contributory factor for a sub-group of patients with chronic low back pain. The purposes of this narrative review are twofold. First, to describe central sensitization and its symptoms and signs in patients with chronic pain disorders in order to allow its recognition in patients with nonspecific low back pain. Second, to provide general treatment principles of chronic low back pain with particular emphasis on pharmacotherapy targeting central sensitization.
Celotno besedilo
Dostopno za:
DOBA, FSPLJ, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
3.
Physiopathology of Spine Metastasis Maccauro, Giulio; Spinelli, Maria Silvia; Mauro, Sigismondo ...
International Journal of Surgical Oncology,
01/2011, Letnik:
2011
Journal Article
Recenzirano
Odprti dostop
The metastasis is the spread of cancer from one part of the body to another. Two-thirds of patients with cancer will develop bone metastasis. Breast, prostate and lung cancer are responsible for more ...than 80% of cases of metastatic bone disease. The spine is the most common site of bone metastasis. A spinal metastasis may cause pain, instability and neurological injuries. The diffusion through Batson venous system is the principal process of spinal metastasis, but the dissemination is possible also through arterial and lymphatic system or by contiguity. Once cancer cells have invaded the bone, they produce growth factors that stimulate osteoblastic or osteolytic activity resulting in bone remodeling with release of other growth factors that lead to a vicious cycle of bone destruction and growth of local tumour.
Surgical site infection is a common complication after orthopaedic surgery. It can be associated with increased morbidity rate and social cost. The accurate identification of risk factors is ...essential so that strategies to prevent these potentially devastating infections can be developed. We have conducted this study to determine the possible risk factors for the surgical site infections.
We aimed at finding exhaustive evidence concerning the potential risk factors for infections in orthopaedic surgery.
Between October 2009 and December 2011, we identified 84 patients with a superficial and/or deep surgical site infection and compared them with 203 uninfected patients (control group), taken out from a series of 486 patients. We considered the following risk factors: diabetes, BMI >30, ASA Score of 3 or 4, smoking and age.
The most frequently performed operations of the 287 examined patients were the knee and hip arthroplasties (n = 32, 11.14%) and open fracture reductions (n = 178, 62.02%). Staphylococcus Aureus was the most common identified pathogen (n = 63, 75%). The analyses (preoperative and postoperative) of the infected patients showed them to have significantly high serum glucose levels in comparison with the control group (odds ratio = 8.7). We found a significant high rate of infection in patients smoking for more than 20 years (67 patients, 79.7%). The remaining variables (BMI, OR = 2.21; ASA score, OR = 1.3) showed no significant differences between the study group and controls. We also found a correlation between > 65-year-old patients and infections at the surgical site (61 patients, 72.6%).
We found that there was correlation between diabetes, smoking and age as risk factors with the development of infection at the surgical site; other variables such as the ASA score and BMI are not relevant here (contrary to what is reported in literature). We believe that postoperative results can be improved considerably with a properly conducted antibiotic treatment, stringent glycemic control (achievable only with careful multidisciplinary management) and good compliance of patients.
Lactoferrin (Lf) expression was investigated by using a Lf monoclonal antibody in 50 formalin-fixed and paraffin-embedded human bone tumours 10 giant cell tumours (GCTs), 7 osteoid osteomas, 6 ...ossifying fibromas, 19 enchondromas, 2 chondroblastomas, 2 chondrosarcomas, 2 chondroblastic osteosarcomas, 1 myeloma and 1 adamantinoma as well as in 8 samples of adult and foetal human normal bone specimens. In addition, the immunohistochemical expression of the estrogen receptor (ER), progesterone receptor (PR) and Ki-67 antigen was analysed on parallel sections from the same specimens. Quantification of Lf immunoreactivity was performed by using an Intensity Distribution (ID) score. Lf immuno-expression with a variable ID score was encountered in 19/50 tumours and specifically in 10/10 GCTs, in 5/7 osteoid osteomas, in 2/2 chondroblastomas as well as in the adamantinoma and in the myeloma. With reference to normal bone samples, Lf was expressed by the osteoblasts only in the foetal bone. No immunoreactivity for ER and PR was encountered in all neoplastic samples, and no correlation was found between Lf and sex steroid hormone receptor (ER and PR) immuno-expression. Even more, no association was evidenced between Lf immuno-reactivity and the growth fraction of the tumours, reflected by the Ki-67 labelling index. Lf expression in the osteoblastic lineage of bone-forming tumours, together with its presence in the osteoblasts of foetal bone, requires further investigations, although it cannot be ruled out that Lf might be involved in the bone formation in humans, similarly to what has been demonstrated in other species.
Studies on the use of tranexamic acid (TXA) to improve clinical outcomes after joint arthroplasty have reported contrasting results between intravenous (IV) TXA alone and combined IV and ...intraarticular (IA) administration. We compared the effectiveness of the 2 methods in providing higher postoperative hemoglobin (Hb) levels in patients undergoing primary total knee arthroplasty (TKA).
A total of 100 TKA patients were randomly assigned to receive either IV TXA alone (group 1) or combined IV and topical IA TXA (group 2). Hb and hematocrit levels were measured before and after surgery. The amount of drained blood and transfused blood for the 2 groups was compared.
The Hb level was significantly higher at postoperative day 4, together with a positive, albeit not significant, trend toward less postoperative blood loss in the group that received combined IV and IA TXA. No postoperative infections or deep venous thrombosis events occurred.
This study reinforces evidence that, as compared to IV TXA alone, combined IV and IA administration of TXA has a synergic effect, leading to higher postoperative Hb levels without influencing drug safety in TKA patients.
We present a series of cases of type A3.1.2 unstable fractures of the thoracolumbar hinge treated percutaneously with third-generation kyphoplasty and only one next level percutaneous screws. Four ...women aged 75 to 85 years with thoracolumbar vertebral fractures, classified as type A.3.1.2, were treated with Precept® monosegmental percutaneous fixation and the third-generation SpineJack® augmentation system. The traditional treatment of type A3 unstable vertebral wedging fractures is performed with transpedicular fixation of two or more levels adjacent to the fracture causing great rigidity. Recently, the concept of bridge fixation combining one segment intrapedicular fixation with kyphoplasty has emerged as a more stable and less invasive system that allows greater mobility in this type of fractures. The combination of third-generation kyphoplasty and monosegmental bridge fixation may improve results to other fixation systems in type A3 vertebral fractures.
We report a case of clear cell sarcoma in the third metatarsus of the right foot. This type of tumor is very rare and scantily reported in literature. A 42-year-old Caucasian male presented with a ...nodular ulcerated mass on the dorsal side of the left foot. X-rays demonstrated a nodular solid lesion which dislodged the third metatarsus. A biopsy revealed a neoplastic proliferation with a sarcoma clear cell profile; because of the aggressive nature of this type of neoplasm, we performed a trans-tibial amputation according to Bugess to achieve a better functionality for the patient. The present study underlines clinical, morphological, as well as imaging and therapeutic aspects of a rare neoplasm such as clear cell sarcoma. The location site is also quite unusual - the metatarsus of the foot. The histological and immunohistochemical data were suggestive of the diagnosis of clear cell sarcoma of metatarsus. After MRI and a bone scan, the surgical treatment suggested the extension over the forefoot and the ankle and therefore a trans-tibial amputation was made.
Purpose
Unicompartmental knee arthroplasty (UKA) combined with anterior cruciate ligament (ACL) reconstruction has recently been suggested as a feasible treatment option for young and active patients ...with medial compartment osteoarthritis (OA) and ACL deficiency. The aim of this study is to evaluate retrospectively the outcomes of two different implant designs in patients with medial OA secondary to traumatic ACL rupture, who underwent combined ACL reconstruction and unicompartmental knee replacement.
Methods
From January 2007, to December 2013, 24 patients with medial OA secondary to ACL rupture underwent medial unicompartmental knee arthroplasty (UKA) and ACL reconstruction. Nine patients received a mobile bearing UKA (Group 1) and fifteen a fixed-bearing one (Group 2). The mean follow-up was 53 ± 8.3 months for Group 1 and 42 ± 6.7 months for Group 2. Knee Society Score (KSS), Western Ontario and McMaster Index of Osteoarthritis (WOMAC) index and radiological evaluation used to assess the implant loosening alignment of the knee joint and tibial slope were recorded pre-operatively and at the last follow-up.
Results
At the final follow-up, all patients showed statistically significant clinical improvements with respect to the pre-operative values (
p
< 0.05). No significant difference was observed in WOMAC index and KSS both objective and functional between groups at the last follow-up (KSS obj. 73.4 ± 9.3 vs 77.3 ± 10.5; KSS funct. 86.2 ± 6.2 vs 84.7 ± 5.9; WOMAC 79.3 ± 7.3 vs 81.3 ± 7.6 for Group 1 and 2, respectively). No differences in radiolucent lines were found between the groups.
Conclusion
The use of different prosthesis design (fixed- or mobile-bearing) during a combined procedure of ACL reconstruction and medial unicompartmental arthroplasty does not affect the middle-term clinical and radiological outcomes.
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