Total hip arthroplasty for post-firearm hip arthritis complicated by coloarticular fistula: A case report / 中华创伤杂志(英文版)

Hip firearm injuries are rare injuries that could lead to serious complications, such as posttraumatic hip arthritis and coloarticular fistula. We report a case of a 25-year-old male who sustained a pelvic injury caused by a single bullet which led to a bilateral acetabular fracture, concomitant with a colon injury treated on an emergency basis by a diverting colostomy; acetabular fractures were treated conservatively by traction. After the patient recovered from the abdominal injury, he was presented with bilateral hip pain and limited motion; plain radiographs showed bilateral hip arthritis with proximal migration of the femoral head and bilateral acetabular defect classified as Paprosky type ⅢA. Reconstruction of the hips was performed using the same technique: impaction bone grafting for acetabular defect reconstruction and a reversed hybrid total hip arthroplasty (THA) 6 months apart. The patient presented with loosening of the left THA acetabular cup 3 years later, which was revised; then he presented with a discharging sinus from the left THA with suspicion of coloarticular fistula, which was confirmed using CT with contrast material. A temporary colostomy and fistula excision were performed, and a cement spacer was applied to the hip. After clearing the infection, a final revision THA for the left hip was performed. Treating post-firearm hip arthritis by THA is challenging, especially in the situation of neglected cases with the presence of an acetabular defect. Concomitant intestinal injury increases the risk of infection with the possibility of coloarticular fistula formation, which could present later. Working with a multidisciplinary team is paramount.

Information about COVID-19: Lessons learned from Mali

Introduction. In Mali, information related to COVID-19 is regularly shared by the coordination board against COVID-19 through daily official press releases and situation reports. The goal of this study was to analyze data related to the tested samples; and the confirmed, contacts, recovered and dead cases in order to take lessons for the future. Population and methods. Data from the first 100 days after the detection of the first cases in Mali were collected and recorded on an Excel file before they got analyzed using SPSS 25.0 software. Analyses were descriptive and correlational. Results. We included 14938 tested samples, 2260 confirmed cases, 12864 contact cases, 1502 recovered cases and 117 deaths were reported during the first 100 days of the epidemic. There was a positive correlation between the number of confirmed cases; and the number of tested samples, the number of recovered cases and the number of deaths. These results suggest that the number of confirmed cases increase with the number of tested samples. Conclusion. These results call for more testing and encourage the identification, location and follow-up of COVID-19 cases. They can also be used to support the improvement of data quality and the response to COVID-19. As a result, they can contribute to improve population health

Role of fluorescence in situ hybridization in the diagnosis of malignant biliary stricture

Introduction: Biliary stricture is a fixed narrowing of a focal segment of the bile duct that result in proximal biliary dilatation and clinical features of obstructive jaundice. A wide spectrum of hepatobiliary and pancreatic diseases, both benign and malignant, can result in the development of biliary strictures. Although trans abdominal ultrasound, computed tomography, and magnetic resonance imaging are sensitive for detecting bile duct pathology, they do not reliably distinguish strictures as being malignant or benign. FISH utilizes fluorescently labeled DNA probes to chromosomal centromeres or unique loci to detect cells that have numerical or structural abnormalities indicative of malignancy

Aim of the study: To evaluate the accuracy of FISH in the diagnosis of malignant biliary stricture

Patient and methods: Forty eight patients with indeterminate bile duct stricture presented with obstructive jaundice were prospectively enrolled and underwent ERCP and FISH over a period of 20 month from June 2013 to February 2015. Four patients were excluded because of loss follow-up. Thus, 44 patients were included in data analysis [17 males and 27 females]

Results: The final diagnosis of stricture type was 32 malignant and 12 benign cases. FISH was positive in 30 cases and negative in 14 cases, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 93.75, 100.00, 100.0, 85.7, 95.5 and 0.969 respectively

Conclusion: FISH increase the diagnostic accuracy of malignant biliary stricture. The sensitivity of FISH could improve the clinical management of patients being evaluated for malignant bile duct stricture by enabling a definitive diagnosis at an earlier stage in the clinical evaluation

Stepwise management of postcholecystectomy problems by surgery and endoscopy

Background: The term of postcholecystectomy syndrome [PCS] comprises a heterogeneous group of symptoms and signs in patients who have previously undergone cholecystectomy. Patients of PCS may present with abdominal pain, jaundice or dyspeptic symptoms, man y of these complaints can he attributed to complications including bile duct injury, biliary leak, biliary fistula and retained stones. Late sequelae are bile duct strictures and secondary liver cirrhosis. A multidisciplinary approach between surgeons, radiologist and endoscopist offers the best chances for an initial diagnosis and therapeutic option

The aim of this work: Is to study thoroughly and evaluate the different techniques, surgery endoscopy and combined used for management of postcholecystectomy problems

Patients and methods: This is a descriptive study carried on 105 patients from the surgery department, and endoscopy unit of Assuit University Hospital from January 2010 - to July 2012

Results: Most of our patients [97.1%] diagnosed in postoperative period and only 2.9% of injuries are recognized intraopertively. Sixty eight of 105 [64.7%] of patients has bile leakage, retaned stones and stricture was treated endoscopically. The remaining [35.3%] were treated surgically. Long-term follow-up revealed two cases [5.4%] with anastomatic stricture, which were managed by refashioning HJ with left ductal approach

Conclusion: [I] Minor bile duct injuries can be well treated by endoscopic techniques. [II] Mayor injuries of bile ducts require operative intervention alter good and adequate preparation, [III] Raux-en-YHJ is the gold standard operation for these major bile duct injuries

Impact of chewing Khat on the mode of delivery of Yemeni pregnant women

Khat chewing is common among Yemeni women, even during pregnancy where it may affect the wellbeing during pregnancy and during delivery of these pregnant women. This study was conducted to determine the impact of Khat chewing on the mode of delivery of pregnant Yemeni women. This is a prospective study for 60 regular Khat chewing pregnant women and 120 non-Khat chewing pregnant women, selected from those attended with singleton pregnancy in their first or second trimester from the ANC unit of AL-Gamhouri Teaching Hospital in Taiz [Republic of Yemen]. Khat chewer pregnant women, when compared with the control, showed statistically significant risk of 6.06 times to deliver at gestational age earlier than 37 weeks and insignificant risk of 2.27 times to deliver after 42 weeks. They showed a statistically significant risk of 2.65 times to deliver by cesarean section [CS] and insignificant risk of 4.86 times for instrumental delivery. This study concluded that Khat chewing is associated with higher rate of cesarean and instrumental deliveries that may affect maternal and fetal wellbeing

[Protective effect of coenzyme Q10 against exercise-induced oxidative stress-mediated muscle fatigue in professional sportsmen]

Sternuous physical exercise may lower endogenous antioxidant bioactivity as a result of excessive generation of reactive oxygen species [ROS] and overproduction of lactic acid. Excessive ROS production can lead to intensive peroxidation of cell membrane lipids in erythrocytes and muscle cells. Exercise-induced oxidative stress and excessive lactic acid production can therefore accelerate muscle fatigability and exhaustion during physical activity. The aim of this study was to evaluate the effect of maximal physical exercise on plasma malondialdehyde [MBA], and lactate levels in both untreated and coenzyme Q10 [CoQ10]-pretreated Karate sportsmen as compared to individuals with normal physical activity. The effect of CoQ10 -pretreatment on physical endurance and fittness was also studied. Mean plasma MBA and lactate concentrations were significantly lower in Karate sportsmen than in individuals with normal physical activity [control group] immediately after extreme physical exercise. Also, mean plasma MDA and lactate concentrations were significantly lower in CoQ10-pretreated sportsmen than in untreated sportsmen following exhaustive physical exercise. Besides, CoQ10-pretreated Karate sportsmen showed significant increase in exercise tolerance [endurance] compared to untreated sportsmen. We conclude that CoQ10 may improve physical endurance and fittness and reduce muscle fatigue in athletes probably through augmenting endogenous antioxidanmt defenses

Study of some biochemical assays in serum and ascitic fluid for differentiation between cirrhotic and malignant ascites

The clinical diagnosis of ascites is an easy task but the etiological diagnosis of the type of ascites is occasionally a different problem. Many studies have investigated the possibility of using a single marker to detect cancer in ascitic patients; but no analysis of ascitic fluid including cytology has been shown to be specific and sufficiently sensitive for either hepatic or extrahepatic cancer. To evaluate the role of various biochemical parameters including cholesterol, LDH, total protein, albumin and glucose for the differentiation of cirrhotic ascites from malignancy related ascites, fifty ascitic patients were classified into three main groups: Group I: included 20 patients with cirrhotic ascites. Group II: included 15 ascitic patients with hepatocellular carcinoma on top of liver cirrhosis. Group III: included 15 ascitic patients with extrahepatic malignancy without liver cirrhosis. All patients were subjected to: clinical history and examination, various imaging, routine laboratory investigations, histopathological examination, cytological examination of ascitic fluid, and biochemical analysis of both serum and ascitic fluid. We found that, although cytological examination of ascitic fluid is specific, it is less sensitive than ascitic fluid biochemical analysis in determining the cause of ascites. The accuracy of ascitic fluid cholesterol LDH, SAAG, A/S LDH ratio, A/S cholesterol ratio, A/S protein ratio, AFTp and ascitic/blood glucose ratio in discrimination of exudative malignant ascites from transudative cirrhotic ascites are [91%, 91%, 91%, 86%, 83%, 83%, 80% and 71%] respectively. Ascitic fluid biochemical analysis may be useful than cytological examination in follow-up of cirrhotic ascitic patients aiming to early detection of complication

Cyst Excision versus hypertonic saline injection in the treatment of hepatic hydatid cyst

The aim of this prospective comparative study was to evaluate the feasibility and results of percutaneous drainage and surgical excision in the treatment of hepatic hydatid cysts. It included a total of 11 patients with proved hepatic hydatid cysts. Cyst excision was done in five cases, while percutaneous injection of hypertonic saline solution was done in the remaining six cases. No major intra- or postoperative complications occurred in the excision group, while a complete resolution of the cysts in the injection group was obtained in a period of up to 24 months. No recurrence occurred in either group during the follow up period