Revision of Failed Open Reduction of Developmental Dysplasia of the Hip

Background@#The most common causes of re-dislocation after open reduction are inadequate exposure and failure to release the obstructing soft tissues inside and around the hip. @*Methods@#This clinical study included 33 consecutive children (34 hips) who underwent a revision surgery after failed open reduction of developmental dysplasia of the hip (DDH). @*Results@#According to the McKay clinical criteria, the results were good in 28 cases (82.4%), fair in 4 cases (11.8%), and poor in 2 cases with re-dislocation (5.9%). Radiological results according to the modified Severin criteria were as follows: 28 hips (82.4%) were identified as category 2 (good), 4 hips (11.8%) category 4 (fair), and 2 hips (5.9%) category 5 (poor). @*Conclusions@#Revision surgery for DDH is demanding and the long-term consequences are usually serious, but stable, concentric reduction should be obtained either at the first or second open reduction by addressing the causes of failure. Failed acetabulum remodeling and technical errors with inadequate soft-tissue release were the most common causes of failure in the primary operation. Based on the results, the outcome of revision surgery after failed open reduction for DDH was good.

Comparison of immediate and intermediate-term outcomes of intravascular ultrasound-guided versus angiography-guided intervention for type C coronary lesions

Background: the intravascular ultrasound [IVUS] is an invasive access technique that allows analysis of characteristics [qualitative and quantitative] of coronary atherosclerosis. Percutaneous coronary intervention [PCI] of complex lesions [i.e., American College of Cardiology/ American Heart Association class type C] remains challenging and the outcome may be compromised. The use of intravascular ultrasound [IVUS] to guide PCI was suggested to improve outcome

Objectives: aim of this study was to compare intravascular ultrasound-guided and angiography-guided Intervention for Type C coronary lesions regarding major adverse cardiac events [MACE]

Patients and Methods: Our study was conducted on patients undergoing elective PCI for type C coronary lesions in Cardiology Department in Ain Shams University hospitals. The study included 50 patients who underwent IVUS guidance PCI for Type C lesions and 50 patients who underwent only angiographic guidance PCI for Type C lesions. We evaluated the impact of IVUS guidance on clinical outcomes of patients undergoing PCI for complex lesions defined as ACC/AHA type C. Major adverse cardiovascular events [MACE], a composite end-point of all-cause mortality, Q-wave myocardial infarction and target lesion revascularization, were compared between the 2 groups. Mean follow-up duration was 12 months

Results: baseline clinical characteristics were similar in both patient groups. Adding IVUS to the procedure lengthened the procedure time. On the other hand, lower amount of radiographic contrast was required in the IVUS guided group during the procedure. Regarding the target coronary vessel in our study was similar in both groups with no significant difference. In addition, the number of ostial, proximal, mid and distal lesions was similar between the two studied groups. Patients with IVUS-guided PCI underwent more direct stenting, more postdilatation, larger maximal stent diameter and greater number of implanted stents. Consequently, the final diameter stenosis was significantly better in IVUS guided group. A strategy of routine IVUS for drug-eluting stent implantation in complex coronary lesions did not improve the 1-year MACE rates

Conclusion: use of intravascular ultrasound [IVUS] is associated with lower amount of radiographic contrast used during the procedure, more procedural time, more post dilatation and less postintervention final diameter stenosis. In addition, use of intravascular ultrasound [IVUS] in complex lesions allows proper assessment of minimal lumen area, optimizing PCI procedures and confirming stent well apposition

Fixation of Intertrochanteric Valgus Osteotomy with T Plate in Treatment of Developmental Coxa Vara

BACKGROUND: Although the valgus subtrochanteric osteotomy is considered as a standard surgical treatment for coxa vara, there is no consensus on the optimal method of fixation and osteotomy technique. Fixation of the osteotomy has been achieved by various methods including external fixation and internal fixation with pins and cerclage and a variety of plates. The aim of this study is the evaluation of the results of developmental coxa treated by Y intertrochanteric valgus osteotomy fixed with a T-buttress plate compared with other methods of fixation in the literature. METHODS: Eighteen corrective valgus intertrochanteric femoral osteotomies were performed in 18 patients (18 hips) for treatment of unilateral developmental coxa vara deformity and fixed with a T plate. There were 12 males and 6 females. The right hip was affected in 10 patients and the left hip in 8 patients. Clinically, patients were evaluated by Larson hip score. Radiographically, anteroposterior view of the pelvis and frog leg lateral views of the affected hip were taken preoperatively and compared with the findings at the final follow-up. RESULTS: The average follow-up was 29 months (range, 24 to 36 months). Clinical results showed improvement of the mean Larson hip score from 57.8 to 97.0 (p < 0.001). Radiological results showed that all osteotomies were completely united in 2.4 months (range, 2 to 3 months) with the achievement of the planned correction angle. The average correction of Hilgenreiner's epiphyseal angle improved from 78.2° to 27.8° (p < 0.001) at the final follow-up. The femoral neck shaft angle was improved from 93.7° to 129.9° (p < 0.001) at the final follow-up. Shortening of the affected limb was corrected from 2.8 cm to 1.3 cm (p < 0.001) at the last follow-up. No major serious complications were recorded in the present study. CONCLUSIONS: Intertrochanteric valgus osteotomy of the proximal femur fixed with a T plate may be efficient for treatment of developmental coxa vara. With careful planning, it can result in a low complication rate and insignificant or minimal recurrence rate.

Early evacuation of posttraumatic clotted hemothorax or retained pleural fluid: result of vats versus conventional thoracotomy

To compare the outcome of VATS versus conventional thoracotomy in the early evacuation of posttraumatic clotted hemaothorax or retained pleural fluid in patients with chest trauma after failure of the initial management with tube thoracostomy. Between January 2001 and December 2005, fifty-four patients with posttraumatic clotted hemothorax or retained pleural fluid were included in this study. They were claimed to have clotted hemothorax or retained pleural fluid after 3 to 5 days posttruama by chest roentgenogram and chest CT. The patients were divided into 2 groups, group I [VATS group] and group II [thoracotomy group]. Group I patients [VATS group] included 23 patients, VATS was performed for evacuation of posttraumatic clotted hemaothorax or retained pleural fluid. Group II patients [thoracotomy group] included 31 patients; conventional thoracotomy was performed for management of posttraumatic clotted hemothorax. There was no statistical significant difference between the mean ages of both groups, as the mean age of the VATS group patients was 33 +/- 8 years, while it was 32.7 +/- 7 years for the thoracotomy group patients. The mean preoperative ICT period was [6 +/- 1.5 days VS 7 +/- 2 days respectively]. It was statistically non-significant There was statistical significant difference [P-value

Early and mid term results of surgical repair of coarctation of the aorta: experience of Benha in 19 patients with simple coarctation of the aorta

To evaluate early and mid-term results of surgical repair of coarctation of the aorta in patients with isolated [simple] coarctation of the aorta. Between March 2000 and February 2005, nineteen patients diagnosed as cases of isolated coarctation of the aorta [with or without PDA] using Echocardiography .They underwent resection of the coarctated segment with end-to-end anastomosis. The patients were followed up for a mean period 23.8 +/- 7.4 months. In each visit, the patient was clinically evaluated for blood pressure, gradient [by echocardiography], neurological and recoarctation symptoms. The age ranged from 6 months to 9 years [mean of 4.4 +/- 2.8 gears] and 12 patients of them [63%] were males. The patients presented with different symptoms in the form of claudications in 12 patients [63%], headache in 10 patients [54%], chest pain in 3 patients [16%], and repeated chest infections in 7 patients [36%]. On examination, 14 patients [73%] had weak femoral pulse, and 11 patients [58%] had systolic continuous murmur conducted to the back. All the patients had hypertension which was defined as blood pressure greater than that of the 90th percentile for age, On measuring blood pressure, the mean upper limb blood pressure was 129/83 +/- 6.7/5.7 mm Hg, and the mean gradient was 35.4 +/- 6.8mm Hg. Operatively, the mean operative time was 149.2 +/- 14.6 minutes, the mean cross clamp time was 25.7 +/- 2.4 minutes, the mean intercostal tube [ICT] period was 2.7 +/- 0.8 days, the mean ICU stay was 1.6 + 0.6 days and the mean hospital stay was 9.9 +/- 1.6 days. There was no operative or hospital mortality. There was immediate postoperative increase in mean blood pressure which was 131/82 +/- 6/3 mm Hg, this increase was controlled with infusion of antihypertensive drugs. However, all the patients had dramatic improvement in blood pressure before discharge as the mean blood pressure on discharge was 114/67 +/- 6/4 mm Hg and the mean gradient on discharge was 13.3 +/- 5.1mm Hg. On follow up, the signs of hypertension occurred in total of 4 patients [21%], unfortunately, 2 of them died due to heart failure [11 and 15 months postoperatively]. The other 2 patients with postoperative hypertension were on one antihypertensive medication to control blood pressure. There was significance difference [P Value less than 0.05] between both mean blood pressure as well as mean gradient on admission and both on discharge, also, there was significant difference between both mean blood pressure and mean gradient on admission and both on 30 months after surgery. Surgical repair of isolated coarctation of the aorta by the technique of excision of the coarctated part with end-to-end anastomosis is essential in young patients to avoid subsequent morbidity and premature mortality. The short-term and mid-term results were satisfactory and encouraging

Surgical and anesthetic considerations for patients undergoing minimally invasive coronary artery bypass surgery mini- sternotomy and mini -thoracotomy approaches

Minimally invasive surgical techniques for coronary bypass grafting [CABG] have not been advanced until recently. Successful grafting of the internal mammary artery [IMA] to the coronary arteries has been a surgical practice since 1987[1]. To retain the benefits of IMA grafting and to offset the invasiveness of the conventional CABG , Robison et al. have recently described a minimally invasive approach to CABG using a mini-anterior mediasternotomy approach [2]. Arom et a1. have also described a partial sernotomy approach ,Whereas Subramanian et al. have described a minimally invasive access using a mini lateral thoracotomy [3]. All these approaches can be performed under direct vision. MIDCAB [minimally invasive direct vision coronary artery bypass]. This study discuss these individual surgical techniques and examines the anesthetic concerns for patients undergoing minimally invasive CABG with both the ministernotomy and minithoracotomy approaches

Surgical correction of congenital chest wall deformities: technique and early experience in Kasr El Aini hospital

Background: We herewith describe the technique we used in the one-setting surgical correction of different types of congenital chest wall [sternal or rib deformities]: deficient ribs or sternum; pectus excavatum, and the pectus carinatum defects

Patients and Methods: Our study was prospectively-undertaken from 2003 till 2006, in Kasr El Aini University Hospitals, Abul Reesh National Insurance Hospital for Students, and Tanta University. It enrolled 12 patients [7 males and 5 females] having 3 types of congenital sternal deformities: Cleft or Deficient Sternum [DS] [5 patients, 41.6%]; Pectus excavatum [PE] [6 patients, 50%]; and Pectus carinatum [PC] [1 patient, 8.3%]. Our youngest patient - at the time of surgical correction - was a 4 months-old male baby with deficient sternum; while the oldest was a 15-years old young man with pectus carina- tum. The mean age of our patients was 4 years +/- 5.5 months [range 4 months - 15 years]. Patients having PE [or their parents] mainly complained of cosmetic deformity followed by recurrence of chest infection; while CS patients [or their parents], expressed fear of possible trauma to the inadequately-protected heart. Follow-up period was done for all patients for a whole year postoperatively by means of clinical examination and questionnaire questions to the patient [or his or her relatives] asking them to share in the patients evaluation in comparison with the original complaint stating their opinion in grades as : excellent, good, fair [or accepted], and poor

Results: We had no mortality. No significant intraoperative morbidities were found. Blood loss was minimal and no transfusion was required. Postoperatively, transient mild unilateral seroma below the pectoralis muscle [needed a 5-days vacuum drainage] was noticed in 1 patient [8.3%]; mild Chest wall pain [ameliorated by oral and local analgesia] in 1 patient [8.3%]; and lag of cartilage regeneration leading to small anterolateral soft space [managed with increased oral calcium intake] in another patient [8.3%]. No other types of morbidity occurred eg: blood loss needing transfusion; Cardiac arrhythmias; or recurrence of sternal depression [pectus cases]. Postoperative hospital stay time was relatively short with a mean of 8 k 3.5 days [range 4 -13 days]. According to the patients [and or childis parents] words, the postoperative functional results were described as: excellent in 6 patients [50%]; good in 4 patients [33.3%]; and acceptable in 2 patients [16.6%]. Generally-speaking, patients and or their parents accepted the surgical results quite well and reported an obvious decline in the frequency of chest infections, and a favorable improvement in morals together with an increased tolerance for prolonged physical activity

Conclusion: our immediate and short-term results showed that marked congenital sternal de- formities should be surgically corrected once diagnosed after stabilization of the patients clinical condition. The technique[s] we used achieved adequate stabilization with a sound degree of patient safety. The postoperative results were satisfactory and acceptable for surgeons, patients, and their relatives. Longer follow-up results are still awaited

Serum insulin like growth factor 1 and insulin like growth factor binding protein 1 in primary antiphospholipid syndrome

To study maternal serum concentrations of insulin growth factor [IGF-I] and insulin growth factor binding protein [IGFBP-1] in women with primary antiphospholipid syndrome [PAPS]. A prospective study. Hospital of Obstetrics and Gynecology, Ain Shams University. Ten women with Primary Antiphospholipid Syndrome [PAPS] and Ten normal pregnant women were included in this prospective study. The mean age for both groups did not show significant difference. Patients with PAPS delivered earlier and with a lower birth weight. The difference between both groups were significant for both gestational age at labor and birth weight [p<0.0001]. Serum IGF-1 was lower in PAPS than the control group throughout pregnancy. The level of IGF-1 decreased significantly in the PAPS group [p<0.0001]. The level of IGF-1 increased significantly in the control group late in pregnancy [p=0.0317]. Serum IGFBP-1 was higher in the PAPS group than the control group in early and late pregnancy [p<0.0001]. The level of IGFBP-1 increased significantly in the PAPS group and in the control group [p<0.0001]. Primary Antiphospholipid Syndrome [PAPS] is associated with a progressive decrease in the levels of serum IGF-1 during pregnancy. The levels of IGFBP-1 increased in all pregnant women but were higher in patients with Primary Antiphospholipid Syndrome [PAPS]

Bacterial nosocomial infections in chronic liver diseases

This study aimed to survey nosocomial infection in 90 patients with different stages of chronic liver disease in addition to 20 patients without liver diseases as a control group. 37.8% of the patients developed nosocomial infections during the course of their hospitalization compared with 20% of control subjects. A spontaneous bacterial peritonitis accounted for 44.1%, infection of respiratory tract accounted for 35.3%, followed by urinary tract infections [14.7%] and bacteremia [11.8%], intravenous cannula site infection [11.8%] and cellulitis [2.9%]. In conclusion, patients with liver cirrhosis are at an increased risk of developing nosocomial bacterial infections which add to poor prognosis and are associated with significantly high morbidity and mortality