Lupus and Perioperative Complications in Elective Primary Total Hip or Knee Arthroplasty

BACKGROUND: The number of patients with systemic lupus erythematosus (herein, lupus) undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) is increasing. There is disagreement about the effect of lupus on perioperative complication rates. We hypothesized that lupus would be associated with higher complication rates in patients who undergo elective primary THA or TKA.METHODS: Records of more than 6.2 million patients from the National Inpatient Sample who underwent elective primary THA or TKA from 2000 to 2009 were reviewed. Patients with lupus (n = 38,644) were compared with those without lupus (n = 6,173,826). Major complications were death, pulmonary embolism, myocardial infarction, stroke, pneumonia, and acute renal failure. Minor complications were wound infection, seroma, deep vein thrombosis, hip dislocation, wound dehiscence, and hematoma. Patient age, sex, duration of hospital stay, and number of Elixhauser comorbidities were assessed for both groups. Multivariate logistic regression models using comorbidities, age, and sex as covariates were used to assess the association of lupus with major and minor perioperative complications. The alpha level was set to 0.001.RESULTS: Among patients who underwent THA, those with lupus were younger (mean age, 56 vs. 65 years), were more likely to be women (87% vs. 56%), had longer hospital stays (mean, 4.0 vs. 3.8 days), and had more comorbidities (mean, 2.5 vs. 1.4) than those without lupus (all p < 0.001). In patients with THA, lupus was independently associated with major complications (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.1 to 1.7) and minor complications (OR, 1.2; 95% CI, 1.0 to 1.5). Similarly, among patients who underwent TKA, those with lupus were younger (mean, 62 vs. 67 years), were more likely to be women (93% vs. 64%), had longer hospital stays (mean, 3.8 vs. 3.7 days), and had more comorbidities (mean, 2.8 vs. 1.7) than those without lupus (all p < 0.001). However, in TKA patients, lupus was not associated with greater odds of major complications (OR, 1.2; 95% CI, 0.9 to 1.4) or minor complications (OR, 1.1; 95% CI, 0.9 to 1.3).CONCLUSIONS: Lupus is an independent risk factor for major and minor perioperative complications in elective primary THA but not TKA.

The Association of Delirium with Perioperative Complications in Primary Elective Total Hip Arthroplasty

BACKGROUND: Our goal was to determine whether postoperative delirium is associated with inpatient complication rates after primary elective total hip arthroplasty (THA). METHODS: Using the National Inpatient Sample, we analyzed records of patients who underwent primary elective THA from 2000 through 2009 to identify patients with delirium (n = 13,551) and without delirium (n = 1,992,971) and to assess major perioperative complications (acute renal failure, death, myocardial infarction, pneumonia, pulmonary embolism, and stroke) and minor perioperative complications (deep vein thrombosis, dislocation, general procedural complication, hematoma, seroma, and wound infection). Patient age, sex, length of hospital stay, and number of comorbidities were assessed. We used multivariate logistic regression to determine the association of delirium with complication rates (significance, p < 0.01). RESULTS: Patients with delirium were older (mean, 75 ± 0.2 vs. 65 ± 0.1 years), were more likely to be male (56% vs. 52%), had longer hospital stays (mean, 5.7 ± 0.07 vs. 3.8 ± 0.02 days), and had more comorbidities (mean, 2.8 ± 0.03 vs. 1.4 ± 0.01) (all p < 0.001) versus patients without delirium. Patients with delirium were more likely to have major (11% vs. 3%) and minor (17% vs. 7%) perioperative complications versus patients without delirium (both p < 0.001). When controlling for age, sex, and number of comorbidities, delirium was independently associated with major and minor complications (odds ratio, 2.0; 95% confidence interval, 1.7 to 2.3). CONCLUSIONS: Delirium is an independent risk factor for major and minor perioperative complications after primary elective THA.

Prevalence of aggressive periodontitis in 15-18 years old schoolgirls in Tehran, Iran

Aggressive periodontitis is one of the periodontal diseases, which affects systemically healthy individuals usually under the age of 30 years old. The disease is characterized by rapid bone destruction which is not in accordance with the quantity of bacterial plaque. The purpose of the present study was to determine the prevalence of aggressive periodontitis among 15-18 years old female students in Tehran high schools. In this cross sectional study,, 2870 students were selected from all educational areas of Tehran during 1382-83 based on systematic clustered random sampling .Probing pocket depth on 6 areas of incisors and first molars were examined in each subject. Students with pocket depth equal to or more than 4 mm on more than one tooth were referred to Shahed Dental School for radiographic examination. For cases in which the distance between the crest of interdental septa and CEJs were equal to or more than 2 mm, full clinical and radiographic examination was performed. Among the subjects of study, only 4 fulfilled the diagnostic criteria of localized aggressive periodontitis. Nobody was diagnosed with generalized aggressive periodontitis. The prevalence of aggressive periodontitis among 15-18 years old schoolgirls was 0.14%. The results of the present study were similar to previous studies with the same age groups and diagnostic criteria in other countries. For determination of total prevalence in Tehran, similar studies in schoolboys are recommended

Acute renal failure: analysis of aetiological factors and outcome

To analyse the causes of acute renal failure [ARF] and management and outcome in these cases. All patients with ARF coming to SlUT between January 1990 and December 1998 were studied. A total of 1716 ARF cases were seen. Of these 43% had medica1, 28%surgical and 17% obstetrical causes. Haemodialysis was required in 88% of patients. Overall mortality was 18%. Causes of ARF in this part of the world is different from the western world. Preventable causes e.g. gastroenteritis, obstetrical haemorrhages, torture induced rhabdomyolysis and malaria, contribute to large percentage of the ARF population

Study of the thyroid gland involvement in laryngeal and hypopharyngeal cancers

Twenty case of laryngeal and hypopharyngeal cancers treated with radical surgery were studied. These were 16 males and four females with their ages ranging from 43 to 71 years. The cases included: four supraglattic cancers, five cordal cancers, one case of subglottic cancer, four cases of postcricoid cancer and one case of cancer of the pyriform fossa. All cases were squamous cell carcinomas. Serial sectioning of the thyroid gland showed its involvement in three instances: one case of postcricoid carcinoma that spread to the gland via lymphatic channels; and two cases of transglottic cancers. In one of these, tumor spread through the thyroid cartilage to involve the thyroid gland occured; while in the other case, involvement of the gland was by direct spread from the involved prelaryngeal lymph node. Total thyroidectomy is essential when resecting post-cricoid or subglottic cancers

Fine needle aspiration biopsy in the management of thyroid nodules

During a 15 month period, aspiration biopsy cytology was carried out on 54 patients presenting with solitary thyroid nodules. The cytological findings were compared with the histopathologic diagnoses in the surgically biopsied cases. The procedure showed a high accuracy in the differentiation of benign lesions from malignant ones, and in the specific diagnosis of the types of lesions. The method safe, simple and more specific than other currently available non-histologic techniques, used in thyroid nodule evaluation and management

Effects of ketotifen [Zaditen] on the allergic respiratory nasal mucosa-clinical, histopathological and histochemical study

Ketotifen [Zaditen-Wander Pharmaceutics] is an anti-allergic drug used in the prophylaxis of bronchial asthma. In this study a trial was made to verify the effect of this drug on established allergic rhinitis conditions. Its efficiency as documented by studying the clinical picture, histopathological and histochemical changes occurring in the nasal mucosa in response to its oral administration. Thirty patients with perennial allergic rhinitis were the material of this research. On the results of this trial therefore ketotifen, in a dose of 1 mg twice daily, may provide an effective form of symptomatic control for allergic rhinitis sufferers. It proved safety on prolonged administration than the other conventionally used antihistaminics

histological and mycological study on cancer larynx

This study was designed to evaluate the incidence of mycotic infection in cancer larynx and to point out the predisposing factores. Biopsies were taken from the laryngeal lesions and subjected to histopathological and mycological studies. The results showed that 40% of our cases had superficial, non invasive fungal infection while 6.5% of the patients had invasive or deep fungal infection. All cases gave negative serological results as regards antibodies. Further more the present results showed that the vast majority of the cases of cancer larynx were of the squamous cell type [93.5%]