A Prospective Study on Functional Outcome of Open Reduction and Internal Fixation of Acetabular Fractures

The current study is a prospective study on the functional outcome of open reduction and internal fixation of acetabular fractures. About30 patients were analyzed for the functional outcome of acetabularfractures treated by open reduction and internal fixation over a period of one year and eight months from March 2017 to October 2018 with a minimum follow up period of 9 months at Sree Balaji Medical College & Hospital, Chromepet, Chennai. The mean age ofthe patient was 37.96 year ranging from 20 -60 years. The Joel Matta score was used for calculation of radiological outcome of 30 patients. The results were excellent in 19 (66.3%), good in 8 (26.6%), fair in 3 (10%), and poor in 0 (0%) patients. Functional outcome of displaced acetabular fractures more than 2 mm displacement was found to have excellent results on open reduction and internal fixation

A clinical and surgical challenge: Retrorectal tumors

Aims: Retrorectal tumors are rare, mostly benign tumors and named due to their localization. Diagnoses of these tumors are usually delayed because of nonspecific complaints and symptoms. Magnetic resonance imaging has beneficial uses both for diagnosis and treatment. In this study, we reviewed a case series of retrorectal tumors. Subjects and Methods: The patients who were diagnosed with retrorectal tumors between 2008 and 2015 were analyzed. This investigation was conducted at a Tertiary Education and Research Hospital. Sixteen patients were included in this study. Patients' demographic data, imaging workups, surgical operation reports, pathologic examination results, postoperative complications, and follow-up results were examined. Descriptive statistics, median, and standard deviation for continuous variables were used. The primary outcomes measured were diagnostic conflict, knowledge, and preference for surgery. Statistical Analysis Used: Definitive statistical methods (mean, standard deviation, median, frequency, and percentage) were used to evaluate the study data. Results: One patient refused operation and one was in preoperative preparation period. Fourteen of sixteen patients were operated. Two (14.3%) of operated patients have malignant histopathological result (one gastrointestinal stromal tumor, one ganglioneuroblastoma). Rest of the operated patients' histopathological reports was as follows: Four schwannomas, three epidermoid cysts, two tailgut cyst, one dermoid cyst, one teratoma, and one angiomyolipoma. Eight patients were operated by posterior incision, five patients with transabdominal approach, and one patient with combined approach. Conclusions: Retrorectal tumors are rare cases, and treatment of retrorectal tumors is surgery and should be operated in referenced hospitals to avoid diagnostic and therapeutic problems.

Dose-response relationship of radiation-induced pulmonary fibrosis in mouse models based on CT-derived parameters / 中华放射肿瘤学杂志

Objective To investigate the radiation induced pulmonary fibrosis with a dose-response mouse model, based on the CT image changes of pulmonary fibrosis.Methods Female C57BL6 mice aged 8-10 weeks were randomly divided into 20 Gy or escalated doses of X-ray whole thoracic irradiation ( WTI) groups. CT scan was performed at different time points before and after radiation. The average lung density and lung volume changes were obtained by three-dimensional segmentation algorithm. After gene chip and pathological validation, the parameters of CT scan were subject to the establishment of logistic regression model. Results At the endpoint of 24 weeks post-irradiation, the lung density in the 20 Gy irradiation group was (-289.81± 12.06) HU, significantly increased compared with (-377.97± 6.24) HU in the control group ( P<0.001) . The lung volume was ( 0.66±0.01) cm3 in the control group, significantly larger than ( 0.44±0.03) cm3 in the irradiated mice ( P<0.001) . The results of quantitative imaging analysis were in accordance with the findings of HE and Mason staining, which were positively correlated with the fibrosis-related biomarkers at the transcriptional level ( all R2=0.75, all P<0.001) . The ED50 for increased lung density was found to be ( 13.64± 0.14) Gy ( R2=0.99, P<0.001) and ( 16.17± 4.36) Gy ( R2=0.89, P<0.001) for decreased lung volume according to the logistic regression model. Conclusions Quantitative CT measurement of lung density and volume are reliable imaging parameters to evaluate the degree of radiation-induced pulmonary fibrosis in mouse models. The dose-response mouse models with pulmonary fibrosis changes can provide experimental basis for comparative analysis of high-dose hypofractioned irradiation-and half-lung irradiation-induced pulmonary fibrosis.

Clinical evaluation of bacterial colonization of bronchiectasis

Background: Bronchiectasis is a chronic pulmonary disease characterized by abnormal irreversible dilatation of one or more bronchi often with wall thickening. In Bronchiectasis initial colonization of the lower respiratory tract by different microorganisms as the first step leading to the inflammatory response. Persistence of microorganisms in the airways because of impairment in mucus clearance may lead to a vicious circle of events characterized by chronic bacterial colonization, persistent inflammatory reaction and progressive tissue damage and morbidity life. Aim of the study: To evaluate the Bronchial inflammatory response and its relationship to bacterial colonization in Bronchiectasis. Materials and methods: This study was done for a period of 7 months from February 2016 to August 2016 in Department of Thoracic Medicine, Government Villupuram Medical College and Hospital, Villupuram. The Bacterial flora from Lower Respiratory tract of Bronchiectasis patients who attended the Thoracic medicine outpatient department with diagnosis confirmed by a radiologist were studied. Bronchoalveolar lavage was done as an invasive procedure in 90 patients with bronchiectasis and from 6 patients admitted with chronic upper respiratory symptoms as laboratory control in Interleukin-8 estimation. Results: Among 90 study population, analysis showed females were 58% and males were 42%. Cylindrical bronchiectasis 53%, followed by cystic bronchiectasis 36% in predominance: and positive culture growth rate for sputum samples were 68% and BAL samples were 77%. The microorganisms isolated predominantly were H. influenza, Pseudomonas, Streptococci, Staphylococci, and etc. R. Nedunchezhian, A. Sundrarajaperumal, D. Ranganathan, V. Sundar. Clinical evaluation of bacterial colonization of bronchiectasis. IAIM, 2019; 6(6): 92-99. Page 93 Conclusion: Increased incidence of bronchiectasis in females (58%). Cylindrical bronchiectasis was the commonest type followed by Cystic bronchiectasis regarding etiology of Bronchiectasis, 42% of bronchiectasis was Idiopathic followed by post infectious 21%. With the concordant value of 75% for sputum culture and bronchoalveolar lavage fluid culture, the Sputum culture is the non-invasive, alternative technique for bronchoalveolar lavage fluid culture

Estrategia de estudio en niños con primera infección febril del tracto urinario / Study strategy for children with first febrile urinary tract infection

INTRODUCCIÓN: el estudio de los pacientes con primera infección febril del tracto urinario es un aspecto controversial en la actualidad. OBJETIVO: proponer una estrategia de estudio de los pacientes con primera infección febril del tracto urinario. MÉTODOS: se realizó un estudio prospectivo, longitudinal de 235 pacientes ingresados en la sala de Nefrología, en el período comprendido de mayo 2007 a diciembre 2011. Las variables de estudio fueron: edad, sexo, duración de la fiebre y su intensidad, conteo global de leucocitos sanguíneos, velocidad de sedimentación globular, proteína C reactiva, ultrasonido renal y vesical, reflujo vesicoureteral, agente etiológico, primera y segunda gammagrafía renal y condición clínica. Para la asociación entre variables cualitativas se utilizó la prueba de X2 y el test exacto de Fisher, y para las cuantitativas continuas se utilizó la prueba t de Student. RESULTADOS: del total de los casos estudiados, 125 presentaron alteraciones gammagráficas en la fase aguda de la infección, lo que representó el 53,2 %. A través de receiver operating characteristic curve (ROC), se analizó la capacidad predictiva de las variables clínicas y de laboratorio. La condición clínica fue el mejor predictor de la presencia de pielonefritis. A partir de todos estos resultados, se diseñó un flujograma de tratamiento de pacientes pediátricos con una primera infección febril del tracto urinario. CONCLUSIONES: la condición clínica fue el mejor predictor para el diagnóstico de pielonefritis aguda, lo cual, unido al conocimiento del microorganismo infectante, ayuda en la propuesta de estudio del paciente con primera infección febril del tracto urinario, y se limita la realización de estudios radiológicos.

INTRODUCTION: the study of patients with first febrile urinary tract infection is a controversial issue at present. OBJECTIVE: to submit a research study strategy for patients with first febrile urinary tract infection. METHODS: prospective longitudinal study of 235 patients admitted to the nephrology service from May 2007 to December 2011. The study variables were age, sex, duration and intensity of febrile condition, blood leukocyte count, globular sedimentation velocity, reactive C protein, renal and bladder ultrasound, vesicoureteral reflux, etiological agent, first and second renal scintigraphies and the clinical condition. For the association of qualitative variables, the Chi-square test and Fisher's exact test were used whereas Student's t test was the choice for continuous quantitative variables. RESULTS: of the total number of cases under study, 125 presented with scintigraphic alterations in the acute phase of infection, which accounted for 53.2 %. By means of the receiver operating characteristic curve, the predictive capacity of clinical and laboratory variables were analyzed. The clinical condition was the best predictor of pyelonephritis. On the basis of these results, it was possible to design treatment flow diagram of pediatric patients with first febrile urinary tract infection. CONCLUSIONS: the clinical condition was the best predictor of the acute pyelonephritis diagnosis which, along with determination of the infective microorganism, supports the proposal of the study strategy for patients with first febrile urinary tract infection, thus the performance of radiological studies is restricted.

Correlation of clinico-pathologic and radiologic parameters of response to neoadjuvant chemotherapy in breast cancer.

CONTEXT: As of today, there is no validated standard method to assess clinical response of breast cancer to neo- adjuvant chemotherapy (NACT). Some centers use clinical dimensions while others use radiological measurements to evaluate response according to RECIST criteria. AIMS: The aim was to correlate and compare the clinical, radiological, and pathological parameters for assessing the tumor response in patients of breast cancer receiving NACT. SETTINGS AND DESIGN: Single institution, prospective nonrandomized study conducted over a 2-year period. MATERIALS AND METHODS: Patients with diagnosed breast cancer were assessed for response to NACT prior to surgery using clinical and radiological techniques. This was correlated with pathological reponse which was assessed by measuring gross dimensions and Miller-Payne grading of response to chemotherapy. STATISTICAL ANALYSIS USED: Spearman’s rho nonparametric. RESULTS: Fifty two patients completed the evaluation (out of 313 cases of ca breast treated during the same period) with a median age of 52.5 years. We noted a 26.9% clinical complete response (CR) and 19.2% had pathological CR. Clinical evaluation had a sensitivity and specificity of 73.5% and 88.5% respectively compared to 14.2% and 100% respectively for radiological assessment. CONCLUSIONS: Clinical assessment of response to NACT shows a higher sensitivity compared to radiological assessment. However the overall low sensitivity and specificity rates of clinical assessment mandate a search for a better method of evaluation.

Radiological Efficacy of Cervical Lateral Mass Screw Insertion and Rod Fixation by Modified Magerl's Method (Yoon's Method) with Minimum 2 Years of Follow-up

OBJECTIVE: Cervical lateral mass screw insertion and rod fixation is a useful method for stabilizing the cervical disease, so various modified techniques were present. Many surgeons had reported the biomechanical safety according to the screw positioning method in the cervical spine, but the modified Magerl's method (Yoon's method) was not well studied. So, this study assessed the radiological efficacy of the modified Magerl's method with long-term follow-up. METHODS: This study retrospectively reviewed 323 lateral mass screws of 50 patients who had followed-up at least 2 years. Radiologic data were analyzed as parameters of complications after operation, including kyphotic or lordotic change, bone fusion, pull-out or malposition of screw, foraminal stenosis, adjacent disc degeneration or aggravation, pseudoarthrosis, and vertebral artery injury. RESULTS: The mean follow-up period was 32 (24 to 52) months. There were kyphotic changes in 4.0%(2 of 50 cases). Unsuccessful bone fusion occurred in 4.0%(2 of 50 cases). Among the 323 screws, screw pull-out (4.0%. 2 of 50cases, 3 of 323 screws), foraminal invasion (1.2% of total screws), and facet injury (0.6% of total screws) occurred. CONCLUSION: The lateral mass screw insertion and rod fixation by the modified Magerl's method (Yoon's method) is a safe and reliable technique with low rate of complication related to instruments in minimum 2 years follow-up.

Factors Affecting Clinical Results after Corrective Osteotomy for Lumbar Degenerative Kyphosis

STUDY DESIGN: This study is a prospective, clinical study for lumbar degenerative kyphosis. PURPOSE: To determine the factors affecting postoperative clinical outcomes in patients who undergo corrective osteotomy for lumbar degenerative kyphosis. OVERVIEW OF LITERATURE: Only a small number of studies have reported clinical results for surgery for lumbar degenerative kyphosis. There are almost no studies about prognostic factors that predict postoperative clinical results. METHODS: This study involved 25 patients who were diagnosed with lumbar degenerative kyphosis and who underwent corrective osteotomy following gait analysis. A pedicle subtraction osteotomy was done at the third lumbar vertebra (L 3). Regarding the fusion level, surgery was done within a range from T10 proximally to S1 distally. Of these, for rigid fixation of a distal part, an iliac screw was used. Pain was evaluated using a 10-point pain scale and a questionnaire about activities. We also evaluated cosmesis and subjective satisfaction using a modified version of the Scoliosis Research Society Outcome-22 (SRS-22) instrument. This assessment was done using a 5-point scale which was designed by us. We assigned patients to group A (good clinical outcomes) if their postoperative pain score was lower than 4 (of 10 points) and if scores indicating activity, cosmesis and subjective satisfaction were higher than 11 (of 15 points). All other patients were assigned to group B (poor clinical outcomes). RESULTS: Clinical outcomes were good in 64% of patients (16/25) and poor in 36% (9/25). Regarding cosmesis and subjective satisfaction, there were significant differences between the two groups. There were also significant differences in physical factors of individual patients such as body mass index (BMI): 23.78 +/- 2.79 in group A and 26.44 +/- 2.75 in group B. On gait analysis, there was a significant difference in the dynamic pelvic tilt: 7.5 +/- 3.3degrees in group A and 11.72 +/- 1.89degrees in group B. CONCLUSIONS: There is no correlation between preoperative degree of kyphotic deformity and clinical outcomes. The degree of anterior rotation of pelvic tilt does not change significantly; rather, compensatory mechanisms of the pelvis and BMI were found to have more influence. Because neither the degree of satisfaction with clinical outcomes nor the increased activity was relatively higher, a more sincere decision should be made before recommending corrective osteotomy for degenerative lumbar kyphosis.

Increasing pathomorphism of pulmonary tuberculosis: an observational study of slow clinical, microbiological and imaging response of lung tuberculosis to specific treatment. Which role for linezolid?

During recent years, a progressive emerging of tuberculosis occurred, related to the overall increased age of general population, primary and secondary (iatrogenic) immunodeficiencies, the availability of invasive procedures, surgical interventions and intensive care supports, bone marrow and solid organ transplantation, and especially the recent immigration flows of people often coming from areas endemic for tuberculosis, and living with evident social-economical disadvantages, and with a reduced access to health care facilities. Since January 2006, at our reference centre we followed 81 consecutive cases of pulmonary tuberculosis, with 65 of them which remained evaluable for the absence of extrapulmonary complications, and a continuative and effective clinical and therapeutic follow-up. The majority of episodes of evaluable pulmonary tuberculosis (49 cases out of 65: 75,4 percent) occurred in patients who immigrated from developing countries. In two patients multiresistant (MDR) Mycobacterium tuberculosis strains were found, while two more subjects (both immigrated from Eastern Europe) suffered from a disease due to extremely resistant (XDR) M. tuberculosis strains. Although enforcing all possible measures to increase patients' adherence to treatment (empowerment, delivery of oral drugs under direct control, use of i.v. formulation whenever possible), over 72 percent of evaluable patients had a very slow clinical, microbiological, and imaging ameliorement (1-6 months), with persistance of sputum and/or bronchoalveolar lavage (BAL) fluid positive for M.tuberculosis microscopy and/or culture for over 1-4 months (mean 9.2±3.2 weeks), during an apparently adequate treatment. When excluding patients suffering from XDR and MDR tuberculosis, in four subjects we observed that off-label linezolid adjunct together with at least three drugs with residual activity against tuberculosis, led to a significantly more rapid clinical-radiological improvement...

Radiological Assessment of Component Position and Limb Alignment in Coronal Plane after Total Knee Replacement with Image-free Navigation System

PURPOSE: We compared radiological measurements of component position and limb alignment in the total knee replacement(TKR) using image-free navigation system with those of conventional jig-based TKR. MATERIALS AND METHODS: TKR was performed in 52 knees(Group A) using image-free navigation system(Version 3.0, Stryker orthopedics, Kalamazoo, Michigan) and we compared them with same number of conventional jig-based TKR(Group B) in 43 patients from Mar. 2005 to Feb. 2006 in regard to coronal alignment of femoral(alpha) and tibial(beta) component, and mechanical femorotibial angle(mFTA;omega) on postoperative radiolographs. The differences in measure- ments of each group based on optimum angle and acceptable range(optimum angle+/-2 degrees) were used independent T-test and Pearson chi-square test respectively. The level of significance is less than 0.05 point. RESULTS: Postoperative radiographs for component position revealed the mean alpha angle was 90.0+/-1.3 degrees in group A and 88.7+/-2.2 degrees in group B, mean beta angle was 90.3+/-1.5 degrees in group A and 89.3+/-2.2 degrees in group B. Group A also showed significant difference in coronal alignment(alpha and beta) of components(p=0.001 and p=0.02) based on acceptable range. Long-leg standing view for limb alignment revealed mean mFTA was 1.4+/-1.3 degrees in the group A and 2.9+/-2.0 degrees in the group B(p=0.00). CONCLUSION: Total knee replacement using image-free navigation system revealed better results in coronal alignment of components as well as restoration of limb alignment based on optimum angle and acceptable range.