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Periprosthetic gout flare is a rare arthritic condition after total knee arthroplasty, but the symptoms of gout may have often been mistaken as acute periprosthetic infection given their similarity. Misdiagnosis as periprosthetic infection can lead to unnecessary surgery, long-term dependence on anti-biotics, and even malfunction of the involved knee joint. Here, we report a case study of a patient with immunodeficiency condition of long-term oral glucocorticoid and diabetes mellitus, who had undergone a knee replacement 8 weeks before. The initial symptoms of fever and joint pain together with the dysfunction of her right knee with elevated inflammatory markers, such as increased serum leukocytes, erythrocyte sedimentation rate, C-reactive protein, and synovial cell counts led to a diagnosis of acute periprosthetic infection. Arthrocentesis and bacterial culture were performed preoperatively. According to the current Musculoskeletal Infection Society (MSIS) criteria for diagnosis of periprosthetic infection, the case was classified as periprosthetic infection and a prosthesis retained debridement surgery was performed. However we got negative culture results in all the pre-operative and intro-operative samples. The symptoms as well as the laboratory inflammatory markers improved shortly after the debridement surgery until the 11th day when all the similar systemic and local symptoms recurred. With a remedial crystal analysis of synovial fluid from the patient, gouty flare was found to be the cause of acute arthritis finally. Accor-dingly, after anti-gout medications were administrated, the symptoms associated with acute arthritis gra- dually subsided, and there was no recurrence during a 24-month follow-up. This article described the cli-nical manifestation, diagnosis and differential diagnosis, treatment of a case of periprosthetic gout. Although relatively rare, gout should be considered as a differential diagnosis in suspected periprosthetic infection. Current criteria for periprosthetic infection can not exclude the diagnosis of periprosthetic gout flare, it is therefore imperative that the analysis of joint aspirate for crystals be conducted to determine the correct course of treatment, or unnecessary surgical procedure may be performed in periprosthetic gout case.
Subject(s)
Humans , Female , Arthroplasty, Replacement, Knee/methods , Gout/complications , Prosthesis-Related Infections/surgery , Symptom Flare Up , C-Reactive Protein/analysis , Biomarkers/analysisABSTRACT
Objective@#To investigate the effect of anal sphincter training combined with manual protection to reduce the risk of obstetric anal sphincter rupture.@*Methods@#Totally 720 primipara were randomly divided into two groups by random number table method, with 360 cases in each group. The control group was given manual protection during midwifery. The observation group was given anal sphincter training before delivery and manual protection during midwifery. Postpartum anal pressure (anal resting pressure, anal systolic pressure), rectal pressure (rectal resting pressure, rectal defecation pressure) were measured. The incidence of postpartum anal incontinence (gas incontinence, liquid fecal incontinence, and solid fecal incontinence), defecation (urgent defecation, anal pain during defecation, pushing rectal defecation, protrusion of anal canal after defecation) and rupture of anal sphincter were recorded.@*Results@#Postpartum rectal resting pressure and rectal defecation pressure were (4.50±0.44) and (65.41±10.66) mmHg (1 mmHg=0.133 kPa) in the observation group and (5.68±0.61) and (56.75±9.83) mmHg in the control group, respectively. There were significant differences between the two groups (t=6.011, 8.027, P<0.01). The incidence of postpartum gas incontinence, liquid fecal incontinence and solid fecal incontinence were 2.22% (8/360), 0.56% (2/360) and 0.56% (2/360) respectively in the control group and 0.56% (2/360) in the observation group. The incidence of postpartum gas incontinence, liquid fecal incontinence and solid fecal incontinence were 0.56% (2/360), 0.27% (1/360) and 0.27% (1/360), respectively. There were significant differences between the two groups (χ2=4.120, P<0.05). The incidences of postpartum urgency, anal pain, pushing and pressing rectal defecation and anal canal prolapse were 3.33% (12/360), 3.89% (14/360), 3.89% (14/360), 3.89% (14/360), 1.11% (4/360) in the control group and 1.67% (6/360), 2.22% (8/360), 1.67% (6/360) and 0.56% (2/360) in the observation group, respectively (χ2=5.101, P<0.01). The incidence of rupture of anal sphincter was 0.56% (2/360) in the observation group and 3.33% (12/360) in the control group. There was significant difference between the two groups (χ2=5.887, P<0.05).@*Conclusion@#Anterior anal sphincter training combined with manual protection during midwifery can effectively reduce the risk of anal sphincter rupture and protect the rectal and anal functions of pregnant women.
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Objective To investigate the effect of anal sphincter training combined with manual protection to reduce the risk of obstetric anal sphincter rupture. Methods Totally 720 primipara were randomly divided into two groups by random number table method, with 360 cases in each group. The control group was given manual protection during midwifery. The observation group was given anal sphincter training before delivery and manual protection during midwifery. Postpartum anal pressure (anal resting pressure, anal systolic pressure), rectal pressure (rectal resting pressure, rectal defecation pressure) were measured. The incidence of postpartum anal incontinence (gas incontinence, liquid fecal incontinence, and solid fecal incontinence), defecation (urgent defecation, anal pain during defecation, pushing rectal defecation, protrusion of anal canal after defecation) and rupture of anal sphincter were recorded. Results Postpartum rectal resting pressure and rectal defecation pressure were (4.50±0.44) and (65.41±10.66) mmHg (1 mmHg=0.133 kPa) in the observation group and (5.68±0.61) and (56.75± 9.83) mmHg in the control group, respectively. There were significant differences between the two groups (t=6.011, 8.027, P<0.01). The incidence of postpartum gas incontinence, liquid fecal incontinence and solid fecal incontinence were 2.22% (8/360), 0.56% (2/360) and 0.56% (2/360) respectively in the control group and 0.56% (2/360) in the observation group. The incidence of postpartum gas incontinence, liquid fecal incontinence and solid fecal incontinence were 0.56% (2/360), 0.27% (1/360) and 0.27% (1/360), respectively. There were significant differences between the two groups ( χ2=4.120, P<0.05). The incidences of postpartum urgency, anal pain, pushing and pressing rectal defecation and anal canal prolapse were 3.33% (12/360), 3.89% (14/360), 3.89% (14/360), 3.89% (14/360), 1.11% (4/360) in the control group and 1.67% (6/360), 2.22% (8/360), 1.67% (6/360) and 0.56% (2/360) in the observation group, respectively ( χ2=5.101, P<0.01). The incidence of rupture of anal sphincter was 0.56% (2/360) in the observation group and 3.33% (12/360) in the control group. There was significant difference between the two groups ( χ2=5.887, P<0.05). Conclusion Anterior anal sphincter training combined with manual protection during midwifery can effectively reduce the risk of anal sphincter rupture and protect the rectal and anal functions of pregnant women.
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Objective To discuss the clinical efficiency of endoscopic submucosal dissection (ESD) in treatment of early gastric cancer (EGC) and precancerous lesions. Method Clinical data of 106 patients with EGC or precancerous lesions who received the treatment of ESD from June 2012 to June 2015 was collected. Then analyzing the treatment effect, complications, postoperative pathology and long-term efficacy of ESD. Results The overall en bloc resection rate was 100.0％, the mean operation time was (61.8 ± 17.3) min and the mean diameter of the lesions was (2.7 ± 1.3) cm. No endoscopic massive haemorrhage occurred; The incidence of perforation and postoperative delayed bleeding was 6.6％ and 5.7％ respectively, which were cured by endoscopic treatment and there was no surgical treatment. Postoperative pathological results showed high differentiated adenocarcinoma in 23 cases, moderately differentiated adenocarcinoma in 29 cases, poorly differentiated adenocarcinoma in 19 cases, signet ring cell carcinoma in 3 cases and high grade intraepithelial neoplasia in 32 cases. Among them, 7 cases with basal tumor invasion, and there were no margin positive cases. So the R0 resection rate was 93.4％ and the R1 removal rate was 6.6％. The 7 cases with R1 resection reached R0 resection after second endoscopic treatment. 5 cases recurred within 1 years after the operation, and the recurrence rate was 4.7％. Up to December 2016, 3 patients died, the median follow-up period was 34 months and the 3 year survival rate was 97.9％. Conclusion ESD is safe and feasible in the treatment of EGC and precancerous lesions with the advantages of less trauma, faster recovery, less complications and reliable curative effect. Its clinical efficiency is similar to surgery.
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Objective To investigate the prevalence for endemic fluorosis of drinking water type and to discuss the relationship between endemic fluorosis and urinary fluorine in Linyi county, Shanxi province. Methods In 2006, three counties were selected as heavy, medium and control areas according to the distributing feature of the disease. The dental fluorosis in each spots was examined by Dean method. The levels of urinary fluorine were determined by fluorine selective ion electrode. The skeletal fluorosis of adults were examined by X-ray. Results There was evident differences of dental fluorosis and skeletal fluoresis among the heavy and the medium endemic fluorosis and control areas(X~2 = 410.945, P < 0.01 ), the prevalence of dental fluoresis in the medium area and the heavy area were 92.34% (253/274), 90.09% ( 291/323), significantly higher than in the control area[23.27% (64/275), X~2 = 274.927,268.287, all P < 0.01]. The heavy area had the highest rate of the skeletal fluorosis rate [59.75% (141/236) ], the medium area had the middle-level of the skeletal fluorosis rate[24.76%(52/210), X~2 = 183.578, P< 0.01]. Urine fluorine contents in both beavy[ (4.69 ± 0.17)mg/L] and medium areal (4.86 ± 0.13)mg/L] were higher than that in the control areas[ (1.75 ± 0.04)mg/L, H = 411.197, P< 0.01], and there was linear relevance between the different degree of skeletal fluorosis and urine fluorine contents (r = 0.508, P < 0.01). Conclusions The local fluoresis condition of Linyi county in Shanxi province was serious. The degree of skeletal fluorosis is associated with the fluoride content in urine.
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<p><b>OBJECTIVE</b>To investigate the etiologies and prevention of patellar instability after total knee arthroplasty (TKA).</p><p><b>METHODS</b>From September 1997 to April 2005, 94 patients (105 knees) underwent TKA without patellar resurfacing. All of them were osteoarthritis. Ten patients (14 knees) were performed with Rotation Knee (RK) prostheses. Forty patients were performed with mobile bearing TACK prostheses, and 44 patients with GEMINI prostheses. Subluxation and tilt of patella were evaluated by X-rays before or after operation.</p><p><b>RESULTS</b>The incidence of patellar instability after operation was 28.6% in patients who had genu valgus deformity, and was 29.5% in whom had patellar instability preoperative. The incidence of patellar instability in RK, TACK, and GEMINI group was 28.6%, 20.9%, and 16.7% respectively after operations. Four patients had obvious femoral or tibial components malrotation.</p><p><b>CONCLUSIONS</b>The etiologies of patellofemoral instability include pre-operative conditions, prosthetic design, and improper positioning of the prosthetic component. So the suitable component design and skillful operative technique will help the surgeon to avoid this complication.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Arthroplasty, Replacement, Knee , Methods , Follow-Up Studies , Joint Instability , Osteoarthritis, Knee , General Surgery , Patella , Postoperative ComplicationsABSTRACT
<p><b>OBJECTIVE</b>To investigate the change in joint line after knee arthroplasty.</p><p><b>METHODS</b>A total of 43 patients had 25 primary cruciate-retaining total knee replacements (Link Gemini MKII) and 25 rotational knee replacements (Link Endo-Model Rotational Knee System) sacrificing collateral ligaments and cruciate ligaments. Lateral radiographs were made both preoperatively and postoperatively. The change in the relative position of the joint line preoperatively and postoperatively was defined as the difference between the perpendicular distance from the weight-bearing surface of the tibial plateau to the tibial tubercle of the natural tibia (JL) and perpendicular distance from the weight-bearing surface of the prosthetic tibial component to the tibial tubercle (JL'). This distance was JL'-JL. The statistical differences between 2 groups were analyzed.</p><p><b>RESULTS</b>The distance of JL'-JL was 2.0 mm (-1.3 - 7.2 mm) in 22 patients with Gemini replacement, whereas the distance was 3.1 mm (-1.5 - 12.3 mm) in the other patients with rotational knee system. The difference was significant.</p><p><b>CONCLUSIONS</b>If the collateral ligaments and cruciate ligaments are removed during the knee replacement operations, the prosthetic joint line is likely to be malpositioned proximally. The fibular styloid and medial or lateral epicondylar reference points can be used to determine proper position of the joint line during operation.</p>