Surgical management of aseptic femoral shaft non-union after intramedullary fixation

Background: Several treatment modalities are available for handling of femoral nonunion after intramedullary nailing. These alternatives include nail dynamisation, external fixation, exchange nailing and Plate osteosynthesis. This treatment can be used as augmentation technique over a previous used intramedullary nail, with or without bone grafting

Objective: To evaluate the outcome of femoral nonunion after intramedullary fixation by locked nail and management of 30 cases of aseptic femoral nonunion with nail exchange or augmentation with plate

Patients and Methods: We reviewed 30 patients with femoral fracture nonunion after interlocking intramedullary nailing treated either with exchange nailing with or without bone graft or plate augmentation and bone grafting with the nail in situ. The mean time from primary nailing to exchange nailing or plate augmentation and bone grafting was 9.80+/-5.45 months for achieving stability of the fracture. We did exchange nailing with larger diameter nail or applying DCP plate on the lateral aspect of the femur

Results: 27 patients achieved solid union in time ranged from 6-12 months with mean of 7.54+/-2.18

Conclusion: Exchange reamed intramedullary nailing has low morbidity, may obviate the need for additional bone grafting, and allows full weight-bearing and active rehabilitation provides extremely rigid fixation, and provides reason to allow patients to bear weight early in the postoperative period. Bone graft could be precisely placed in the fracture site if necessary

Assessment of pelvic parameters before and after postero-lateral interbody fusion surgery in patient with lumbo-sacral instability

Background: pelvic incidence [PI] is a fundamental pelvic anatomic parameter that is specific and constant for each individual and determines pelvic orientation as well as the size of lumbar lordosis [LL]. Pelvic incidence [PI] is a descriptor of pelvic morphology and not of pelvic orientation: therefore, its angular value is unaffected by changes in human posture. The pelvic tilt [PT] and the sacral slope [SS] are position-dependent variables and are very useful to characterize the spatial orientation of the pelvis. Pelvic incidence, sacral slope and pelvic tilt are particularly useful because it can be demonstrated that pelvic incidence [PI] is the arithmetic sum of the sacral slope [SS] + pelvic tilt [PT]

Objective: this study aimed to determine the effect of Postero-Lateral Inter Body Fusion Surgery [PLIF] in 25 patients with Lumbo-Sacral instability by measuring these three pelvic parameters by plain x- ray before and after surgery

Patients and Methods: when compared to normal populations, pelvic incidence [PI] is significantly higher in spondylolisthesis and the difference in PI tends to increase in a direct linear fashion as severity of the spondylolisthesis increases. The cause effect relationship between pelvic morphology and spondylolisthesis remains to be clarified. Taking into consideration the pelvic parameters stimulated a renewed interest for the radiological evaluation and classification of spino-pelvic alignment in L5-S1 spondylolisthesis

Results: we found that Postero-Lateral Inter Body Fusion Surgery [PLIF] is sucssessful operation for treatment of lumbo sacral instability such as degenerative spondylolisthesis, isthmic spondylolisthesis and post laminectomy instability. In comparison with lateral view x-ray before and after the operation, the pelvic incidence increased and pelvic tilt decreased

Conclusion: PLIF is successfully used to treat degenerative and isthmic spondylolisthesis. PLIF is successful regardless of age, sex and concomitant morbidities such as diabetes mellitus, hypertension and ischemic heart disease

Comparative study between percutaneous acetic acid injections and percutaneous ethanol injection in the management of hepatocellular carcinoma

This study was conducted on 30 patients with hepatocellular carcinoma [Hcc-3-6 cm in the largest diameter].They were divided into two equal groups: The first group was treated by a single or multiple sessions of percutaneous ethanol injection, while the second group was treated by a single or multiple sessions of percutaneous acetic acid injection. All patients were subjected to full history takings clinical examination, and routine laboratory investigations including alpha feto-protein. Radiological assessment was carried out using abdominal ultrasonography and triphsic computed tomography. The patients were clinically followed up and assessed at one, and three months after therapy by abdominal triphasic computed tomography, ultrasound and alpha feto-protein [AFP]. There was no significant difference between the studied groups as regard age and sex distribution or the clinical features. Hepatomegaly was detected in 4 [26.7%] in groups I and II. Splenomegaly was detected in 10 [66.7%] in group I and 11[73.3%] in group II. No ascites was detected by shifting dullness in all patients of both groups. Regarding the ultrasonographic criteria, 24 [80%] patients had their focal lesions in the right lobe. Most of the focal lesions were from 3-4 cm in diameter 24 [80%], mostly hypoechoic [85%]. Also, the diameter of focal lesions increased in 10 [66%] patients of group I in comparison to 12 [80%] patients of group II. Spiral CT one month after the procedure showed complete ablation was achieved in 10 patients [66.7%] of group I and in 13 patients [86.7%] of group II. Although percutaneous acetic acid injections showed higher rate with complete ablation, the difference was not statistically significant in comparison with the other group

Toxoplasma antibodies in complicated and uncomplicated pregnancy

This study was performed to evaluate the level of anti-toxoplasma antibodies among patients with miscarriage due to different causes as compared to un-complicated pregnant controls. It was carried out on 70 female patients with a history of complicated pregnancies and 30 ones with normal pregnancy as a control were selected, among those referred from Obstetrics and Gynaecology out-patient clinics and in-patient departments, AL-Azhar University Hospitals. Their ages ranged from 19 to 34 years . They were all Rh positive and free from brucellosis, syphilis and malignancy. Results showed that all controls [uncomplicated pregnancy] were IHA-IgG and ELISA-IgM negative. However, three of the controls [10%] were ELISA. IgG positive. As to the women with complicated pregnancy 59% were IHAT positive. When using ELISA, 57% were IgG positive and 43% were IgM positive. The results revealed a significant difference between the complicated cases and controls. The diagnosis of abortion, stillbirth, premature labour, or neonatal death due to toxoplasma infection needs careful and laborious evaluation. ELISA [IgG and IgM] is more sensitive and specific than IHAT. All premature born babies showed no signs of congenital toxoplasmosis. All these subjects were living in the same geographical area with more or less similar social and economical standard