Study Type – Therapy (case series) Level of Evidence 4
What’s known on the subject? and What does the study add?
Emphysematous pyelonephritis (EPN) is a severe necrotizing infection of the renal ...parenchyma. The clinical course of EPN can be severe and life‐threatening if not recognized and treated promptly. Most of the information has been from case reports, a few large series have also been reported. Using an evidence‐based approach, this review describes the pathogenesis, classification, complications, and management of EPN.
Emphysematous pyelonephritis (EPN) is an acute severe necrotizing infection of the renal parenchyma and its surrounding tissues that results in the presence of gas in the renal parenchyma, collecting system, or perinephric tissue. The cause for mortality in EPN is primarily due to septic complications. Up to 95% of the cases with EPN have underlying uncontrolled diabetes mellitus. The risk of developing EPN secondary to a urinary tract obstruction is about 25–40%. There are three classifications of EPN based on radiological findings. Acute renal failure, microscopic or macroscopic haematuria, severe proteinuria are other positive findings in EPN. Escherichia coli is the most common causative pathogen with the organism isolated on urine or pus cultures in nearly 70% of the reported cases.
A plain radiograph shows an abnormal gas shadow in the renal bed raising the suspicion whereas an ultrasound scan or computed tomography (CT) will confirm the presence of intra‐renal gas thus supporting the diagnosis of EPN. Gas may extend beyond the site of inflammation to the sub capsular, perinephric and pararenal spaces. In some cases, gas was found to be extending into the scrotal sac and spermatic cord.
Subsequent case studies have shown patients being successfully treated with PCD when used in addition to medical management, with significant reduction in the morality rates. PCD should be performed on patients who have localized areas of gas and functioning renal tissue is present. The treatment strategies include MM alone, PCD plus MM, MM plus emergency nephrectomy, and PCD plus MM plus emergency nephrectomy. In small proportion of patients managed with MM and PCD, subsequent nephrectomy will be required and in these patients the reported mortality is 6.6% Nephrectomy in patients with EPN can be simple, radical or laparoscopic.
Background:
Increased external tibial torsion and tibial tuberosity–trochlear groove distance (TTTG) affect patellofemoral instability and can be corrected by tibial rotational osteotomy and tibial ...tuberosity transfer. Thus far, less attention has been paid to the combined correction of tibial torsion and TTTG by supratuberositary osteotomy.
Purpose:
To quantify the effect of a supratuberositary torsional osteotomy on TTTG.
Study Design:
Descriptive laboratory study.
Methods:
Seven patients who underwent supratuberositary osteotomy to treat patellofemoral instability and an additional 13 patients with increased TTTG were included (N = 20). With 3-dimensional (3D) surface models, supratuberositary rotational osteotomies were simulated with predefined degrees of rotation. Concomitant 3D TTTG was measured by a novel and validated measurement method. In addition, all operated patients underwent 2-dimensional (2D) radiographic evaluation with pre- and postoperative computed tomography data. Absolute differences among simulated, predicted, and achieved postoperative corrections were compared.
Results:
A total of 500 supratuberositary osteotomies were simulated. The linear regression estimate yielded a change of −0.68 mm (95% CI, −0.72 to −0.63; P < .0001) in 3D TTTG per degree of tibial rotation, and 2D and 3D TTTG measurements in the operated patients were comparable in pre- and postoperative measurements (preoperative, 19.8 ± 2.5 mm and 20.0 ± 2.4 mm; postoperative, 13.6 ± 3.8 mm and 14.6 ± 3.4 mm, respectively). Postoperative 2D TTTG deviated in absolute terms from predicted (regression) and simulated TTTG by 1.4 ± 1.0 mm and 1.5 ± 0.6 mm. Inter- and intrarater reliability (intraclass correlation coefficient) for radiological and simulated measurements ranged between 0.883 and 0.996 and were almost perfect.
Conclusion:
In supratuberositary osteotomy, TTTG changes by −0.68 mm per degree of internal tibial rotation. The absolute mean difference between postoperative predicted TTTG and 2D TTTG was only 1.4 mm. Thus, TTTG correction can be successfully predicted by the degree of tibial rotation.
Clinical Relevance:
TTTG correction can be successfully predicted by the degree of tibial rotation. Therefore, in selected cases, tibial torsional deformity and TTTG can be corrected by 1 osteotomy. However, isolated rotations have been performed, and unintended translational movements during tibial rotation may alter the postoperative results.
•The low stability of red cabbage anthocyanins limits its application as a natural colorant.•The encapsulated anthocyanins were studied for stability and shelf life against oxygen, sunlight, ...temperatures 80–160 °C, and storage (at 25 °C & 4 °C).•In-vitro gastrointestinal studies showed that encapsulated anthocyanins are bioavailable.
The study insights into the effect of temperature (80–160 °C), oxygen (O2), sunlight (SL), and storage on color attributes, shelf-life, and anthocyanins content on red cabbage (RC) anthocyanins (ANS) and their in-vitro bioaccessibility. The previously well-established encapsulating agent i.e. maltodextrin in combination with RC waste derived-pectin was used to stabilize the anthocyanins. The stability of encapsulated and non-encapsulated anthocyanins was accomplished in terms of total anthocyanin content under temperature, oxygen, sunlight, and storage. The individual content of 3,5-O-diglucoside and 3-O-glucoside of cyanidin exhibited 1.76% (SL), 1.56% (O2) & 1.8% (4 °C), 1.62% (25 °C) and 0.17% (SL), 0.15% (O2) & 0.259% (4 °C), 0.258% (25 °C) retention in maltodextrin/ pectin (MPC)-ANS, respectively. The encapsulated anthocyanins showed significantly improved stability against oxygen, sunlight, high temperature, and storage, with the highest anthocyanin retention, color, and hue angle, inducing very few color differences (ΔE). Besides, the MPC-ANS appeared to be a suitable encapsulating agent to delay anthocyanin release throughout the simulated gastrointestinal digestion.
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Abstract Background Ascorbic acid (AA) is an established antioxidant and has been used for treatment of various disorders. Recent reports suggest that administration of AA increases the level of ...steroids such as progesterone in the body. The present study investigated the protective role of progesterone against ischemia-reperfusion–induced acute kidney injury (AKI) and possible involvement of progesterone receptors in AA-mediated renoprotection in rats. Materials and methods The male rats were subjected to bilateral renal ischemia for 40 min followed by reperfusion for 24 h to induce AKI. The rats were treated with progesterone (5 and 10 mg/kg, intraperitoneally) and AA (500 mg/kg, intraperitoneally for 1, 2, and 5 d) before AKI. In separate groups, mifepristone, the progesterone receptor antagonist was administered to rats before progesterone (10 mg/kg) and AA treatment (5 d). Various parameters including creatinine clearance, serum urea, uric acid, potassium level, fractional excretion of sodium, lactate dehydrogenase, and microproteinuria were used to assess kidney injury. Moreover, renal tissues were subjected to quantification of oxidative stress and evaluation of histopathologic changes. Results The exogenous administration of progesterone afforded protection against AKI in a dose-dependent manner that was abolished by mifepristone. The administration of AA for 1, 2, and 5 d induced significant increase in serum progesterone levels and afforded protection against AKI. The antioxidant and renoprotective effect of AA was abolished by prior treatment with mifepristone. Conclusions It is concluded that exogenous administration of progesterone exerts significant antioxidant and renoprotective effect. Moreover, the progesterone receptors find their explicit involvement in AA-mediated renoprotection against ischemia-reperfusion–induced AKI in rats.
The aim was assessment of blood flow to uterus in cattle suffering from uterine torsion as a tool for predicting the fetal survivability after detorsion. Dairy cattle (14) with uterine torsion were ...detorted and fetal delivery was completed within 30 min after detorsion. Doppler sonography of middle uterine artery ipsilateral (IpsiUA) and contralateral (ContUA) to the side of torsion was carried out before uterine detorsion and 30 min after fetal delivery for Doppler indices, viz. blood flow volume (BFV), time-averaged peak velocity (TAP), resistance index (RI) and pulsatility index (PI). Before uterine detorsion, RI-IpsiUA and PI-IpsiUA were high in comparison to their values in ContUA. Although RI-IpsiUA and PI-IpsiUA had difference between their values before uterine detorsion and 30 min after fetal delivery, but in contrast, at the same time point, there was no difference in RI-ContUA and PIContUA. In comparison to RI-IpsiUA and PI-IpsiUA before detorsion, their respective values decreased after fetal delivery subsequent to successful detorsion, and were almost similar to their respective post-fetal delivery RIContUA and PI-ContUA. In cases where fetus after detorsion of uterus was delivered dead, in the middle uterine artery ipsilateral to the side of uterine torsion, BFV-IpsiUA and TAP-IpsiUA were low, whereas PI-IpsiUA were high. In conclusion, depicting the blood flow within middle uterine artery using Doppler sonography could be helpful in predicting the viability of fetus in uterine torsion affected cattle and may confirm the resumption of blood flow to uterus subsequent to detorsion.
Tibial plateau and distal femoral fractures are common injuries presenting a significant operative challenge. Complexity of the fracture often needs multi-planar surgical access. A combined ...two-staged procedure is frequently suggested both in supine and prone position to address this issue. However, this will significantly increase the operative time and eventually impact the outcome, in addition to the complications associated with prone positioning. In this study we used a standard orthopaedic table to position these patients in order to grant access to the postro-medial and a postro-lateral structures while the patient stays in supine setup, at the same time, giving the flexibility to change the alignment from valgus to varus and vice versa. This facilitates fracture reduction while addressing the anatomical structure of the knee. A further advantage is the unobstructed imaging access throughout the surgical fixation. This facilitates the reduction in operative time hence leading to a better outcome in these difficult fractures. We tested this positioning technique in more than 40 patients over a 4-year period at two different centres in the United Kingdome. We found that this approach is safe, reproducible and relatively easy to set up in the two centres.
Purpose
To compare loop elongation after 5000 cycles, loop-elongation at failure, and load at failure of the fixed-loop G-Lok device and three adjustable-loop devices (UltraButton, RigidLoop ...Adjustable and ProCinch RT), during testing over extended cycles under high loading.
Methods
Five devices of each type were tested on a custom-built rig fixed to an Instron machine. The testing protocol had four stages: preloading, cyclic preconditioning, incremental cyclic loading and pull-to-failure. Outcome measures were loop elongation after 5000 cycles, loop-elongation at failure, and load at failure.
Results
The loop elongation after 5000 cycles for G-Lok was 1.46 ± 0.25 mm, which was comparable to that of RigidLoop (1.51 ± 0.16 mm,
p
= 1.000) and ProCinch (1.60 ± 0.09 mm,
p
= 1.000). In comparison, the loop elongation for UltraButton was 2.66 ± 0.28 mm, which was significantly larger than all other devices (
p
= 0.048). The failure load for all devices ranged between 1455 and 2178 N. G-Lok was significantly stronger than all adjustable-loop devices (
p
= 0.048). The elongation at failure was largest for UltraButton (4.20 ± 0.33 mm), which was significantly greater than G-Lok (3.17 ± 0.33 mm,
p
= 0.048), RigidLoop (2.88 ± 0.20 mm,
p
= 0.048) and ProCinch (2.78 ± 0.08 mm,
p
= 0.048). There was no significant difference in elongation at failure for the rest of the devices.
Conclusions
Our study has shown that the G-Lok fixed-loop device and the three adjustable-loop devices (UltraButton, RigidLoop Adjustable and ProCinch RT) all elongated less than 3 mm during testing over an extended number of cycles at high loads, nonetheless, the fixed loop device performed best in terms of least elongation and highest load at failure.
Several risk factors for adult acquired flatfoot deformity (AAFD) have been identified in literature. To this date, little attention has been paid to the lateral ligament complex and its influence on ...AAFD, although its anatomic course and anatomic studies suggest a restriction to flatfoot deformity. The aim of this study was to assess the influence of the anterior talofibular ligament (ATFL) on AAFD and on radiologic outcome following common operative correction by lateral calcaneal lengthening.
We reviewed all patients that underwent lateral calcaneal lengthening for correction of AAFD between January 2008 and July 2018 at our clinic. Patients were grouped according to the preoperative MRI findings into those with an intact ATFL and those with an injured ATFL. Two independent readers assessed common radiographic flatfoot parameters on preoperative and postoperative radiographs.
Sixty-four flatfoot corrections in 63 patients were included, whereby the ATFL was intact in 29 cases, and in 35 cases the ligament was injured. An ATFL lesion was overall radiologically associated with increased flatfoot deformity with a statistically significant difference between the two groups for preoperative talometatarsal-angle (p = 0.002), talocalcaneal-angle (p = 0.000) and talonavicular uncoverage-angle (p = 0.005). No difference between the two groups could be observed regarding the success of operative correction or operative consistency after lateral calcaneal lengthening.
The ATFL seems to influence the extent of AAFD. In patients undergoing lateral calcaneal lengthening, the integrity of the ligament seems not to influence the degree of correction or the consistency of the postoperative result.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract
Benign fibrous histiocytoma (BFH) of bone is quite rare, and here we report the second case of such tumor originating from sacrum, with the first being reported in an 18-year-old female. The ...overlapping clinical, radiological, and histopathological findings make it a difficult diagnosis along with the fact that it is a rare diagnosis. In this case report, we present the diagnostic difficulties and optimal treatment for such cases. A 46-year-old male w presented to OPD with complaint of numbness in left foot since 1 month, and intermittent urinary incontinence for 2 weeks. On examination, the straight leg raising test was positive of left side, extensor hallucis longus (EHL) was weak in both lower limbs, and bilateral ankle jerks were diminished. MRI showed well-defined lobulated solid mass lesion, which is T1 hypointense and T2 hyperintense and homogeneously involving the S1 vertebral body, with involvement of the right sacral ala, and right sacral foramen seen at S1 and S2 levels extending into the spinal canal till L4 level. Excision through a posterior midline incision was performed taking care to preserve the traversing nerves. Postoperatively, remarkable improvement in pain with no major residual neurological deficit was observed. Patient was followed-up till 9 months; patient’s incontinence improved over a period of 3 months and has stayed the same until the last follow-up.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Category:
Hindfoot
Introduction/Purpose:
Different factors are well known influencing the development of adult acquired flatfoot (AAF) deformity. So far less attention was paid to the lateral ...ligament complex. The idea that the anterior talofibular ligament (ATFL) probably influences AAF could be obvious concerning its anatomical course. Goal of this study is to assess the influence of ATFL on AAF and on operative AAF correction by lateral calcaneal.
Methods:
We reviewed all patients that undergone lateral calcaneal lengthening in AAF from 01/01/2008 to 07/31/2018 in our clinic. Patients were grouped in patients with intact ATFL and in those with injured ligament. Two independent readers performed assessment of common radiographic flatfoot parameters in preoperative and postoperative radiographs.
Results:
Statistical significant difference between two groups could be observed for preoperative talonavicular uncoverage angle (p=0.018) and talocalcaneal angle (p=0.032), with more severe AAF in patients with injured ATFL. The other common radiographic parameters showed no significant difference, although a tendency to a more severe AAF could be observed within the group with damaged ATFL. No difference could be observed in surgical outcome or consistency after lateral calcaneal lengthening between two groups.
Conclusion:
ATFL seems to take impact in AAF concerning talonavicular uncoverage angle and talocalcaneal angle. In patients undergoing lateral calcaneal lengthening the integrity of the ligament seems not to influence the degree of correction or the consistency of the postoperative result.
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