Efficacy and safety of intraoperative radio frequency ablation in management of hepatocellular carcinoma

The present study is a prospective one involving 15 consecutive patients with hepatocellular carcinoma [HCC] from January 2003 to December 2005. Clinical and laboratory examinations, abdominal ultrasonography and spiral CT scanning were performed. All patients were subjected to intraoperative radiofrequency ablation of HCC after confirmation by core biopsy. Enhanced dynamic CT was done at 1 month postoperative and every 3 months during follow-up period. Males were 12 with age of 41-69 year [53.2 +/- 7.4]. Underlying cirrhosis due to viral hepatitis was in all, and HCV was the most common [75%], and patients [85%] were categorized in Child B classification. Serum alpha feto protein was above 400 ng/ml in 60%. 12 patients had unifocal HCC [nodules mean diameter of less than 3 cm in 6, 3 to 5 cm in 4, and more than 5 cm in 2], and 3 patients had multifocal HCC [nodules mean number of less than 3 cm in 2 and 3 to 5 cm in 1]. The mean number of RF application session to achieve complete necrosis in patients with were 1.52 [unifocal] and 2.49 [multifocal HCC]. The mean hospital stay was 14.9 days, with neither mortality nor major complications, but Minor complications in 30%. After one month, complete ablation of HCC nodules was achieved in 10 patients with reduction of alpha fetoprotein in 11 patients. 2/5 with partial ablation were multifocal nodules. Total mortality during follow-up in late post-operative period [1 year] was 6 out of 15 patients. 5 of them are the patients with partial ablation. 3 patients out of 9 patients developed evidence of local recurrence detected by enhanced dynamic CT and raising of serum alpha fetoprotein

Dynamic derotation plate for trochanteric fractures

Trochanteric fractures in elderly is common injury, routinely treated by internal fixation with DHS. However, half of those fractures are unstable, and in osteoporotic patients failure rate is as high as 20%. We propose that rotation of the proximal fragment around single axis screw is common mode of failure, as it leads to loss of contact medially. Use of two screws in the proximal fragment prevent this complication. Derotation screw alone or through trochanteric stabilization plate, does not make a fixed angle, and can still rotate with the proximal fragment. A new plate has been designed that it overlies the proximal 2 holes of the DHS plate with oval hole to allow back out of the lag screw. Proximal extension of the plate has 8 mm. long tunnel that accommodate 4.5 mm. shaft screw. This makes a fixed angle while allowing dynamic compression by being parallel to the lag screw. Twenty patients with unstable trochanteric fractures have been treated prospectively by DHS and the new plate. They were 12 females and 8 males with an average age of 60.3 years. Follow up duration was of minimum 1 year. Intraoperative and postoperative data were collected and analysed, as well as the complications. There were no single postoperative loss of fixation or reoperation. Union rate and time to weight bearing was comparable to results of overall trochanteric fractures treated by DHS in the literature, and better than similar groups of unstable fractures. Excellent clinical results with law failure rate confirm the hypothesis of improved mechanical efficiency of the DHS by the new Dynamic Derotation plate. We advice its use as addition to DHS in unstable trochanteric fractures

Accuracy of sonography in patients with clinically indeterminate groin hernia

The objective of our study was to investigate the accuracy of sonography in patients with symptoms suggestive of a hernia and normal or equivocal clinical examination findings. Fifty-nine consecutive patients [47 men, 12 women; median age, 51 years; range, 19-82 years] were enrolled in a prospective study of sonography for investigation of inguinofemoral pain. All patients were referred with a history suggestive of hernia but with equivocal clinical features. All patients underwent sonography examinations. The imaging variables recorded for each side were normal [including posterior inguinal wall bulging], hernia [indirect, direct, femoral, and abdominal wall], or nondiagnostic. The percentage of exact agreement, sensitivity, and specificity were calculated for sonography, and were compared with surgery when performed. Surgery was performed in 18 patients [31%] on 21 sides and found hernia [n = 20] and patulous posterior inguinal wall [with no hernia] [n = 1]. Compared with surgery, the results of sonography, respectively, were exact agreement, 91% [107/118], sensitivity 90% [19/21], and specificity 95% [20/ 21]. Sonography had only one false-negative finding. Sonography is an accurate technique for the detection of inguinofemoral hernias in patients with clinically equivocal findings

Labral stitch for open repair of bankart lesion. Simple, safe and effective technique

In this study, 32 patients with recurrent traumatic anterior shoulder instability were treated prospectively by vertical apical labral stitch technique. All had many episodes of documented complete anterior dislocation. All were men with an average age of 23 years. The minimum follow up duration was 2 years [range 24-41 months]. The patients were evaluated according to the shoulder instability score of Rowe et al. Rowe score was excellent and good in 94% of the patients and fair in 6%. The limitation of movement did not exceed 5 degrees in forward flexion and 10 degrees for external rotation with the arm to the side. There was no postoperative re-dislocation or reoperation. Apprehension was persistent in two patients. All patients returned to preoperative work

new entry point for interlocking nail fixation of pathological fractures of distal third of humerus

The interlocked intramedullary nail fixation of pathological fractures of the humerus secondary to metastatic deposits, is simple and effective way to restore function and relief pain. Fractures outside the area of interlocking, specially at the lower end is amenable to reconstruction only by plating or replacement. Either involves quite big exposure and dissection with increased risk of complications. Hence, there was the idea of introducing the retrograde humeral nail from distalmost end of the bone aiming to stabilize those fractures by simple technique. A new entry point and technique of interlocking has been described. Eight pathological fractures at the lower third of the humerus in seven patients with metastatic disease have been treated. Results confirm the effectiveness of the procedure in restoration of stability and hence function, with remarkably low incidence of complications. The average time to return to function was 11 days, hospital stay was 4 days in average, improvement on pain scale was excellent and good in all patients. Five patients survived for more than three months postoperatively, union was confirmed in three. The simplicity of the new technique far outweighs other more complicated alternatives of management. The benefits justify using this procedure even in patients with short life expectancy