Modified Capsulorrhaphy Technique in Open Reduction of Developmental Dysplasia of the Hip.

BACKGROUND: Neglected patients with developmental dysplasia of the hip (DDH) are not uncommon. Various treatment modalities have been used. Capsulorrhaphy is one of the most critical steps during the process of open reduction of DDH. Inadequate capsulorrhaphy technique can increase the failure rate of open reduction procedures. This study presented the clinical and radiographic results of using a new capsulorrhaphy technique. METHODS: Between November 2005 and March 2018, 540 DDH in 462 patients were retrospectively reviewed. The mean age at surgery was 31 months. All patients underwent a modified capsulorrhaphy technique developed by the main author (with or without additional pelvic or femoral procedures). Postoperative patient assessment during the follow-up period was performed both clinically and radiologically. RESULTS: Follow-up period ranged between 36 months and 12 years. Based on the modified McKay score, good and excellent outcomes were obtained in 90.3%. Functional results were better in younger age (less than 39 mo). Both acetabular index and lateral center edge angle showed significant improvement at 3 years follow-ups. Proximal femoral growth disturbance (PFGD) was encountered in 92 hips. Classes 2 and 3 did not affect the functional results, whereas patients with PFGD classes 4 and 5 had fair to poor functional outcomes. There were 12 hips with redislocation. Revision was done using the same capsulorrhaphy technique. CONCLUSION: Using the index technique of capsulorrhaphy in DDH surgery is safe, reliable, and yields good functional and radiologic outcomes with a relatively low complication rate. LEVEL OF EVIDENCE: Level IV-therapeutic retrospective case series.

The impact of vitamin A supplementation on thyroid function and insulin sensitivity: implication of deiodinases and phosphoenolpyruvate carboxykinase in male Wistar rats.

PURPOSE: Vitamin A is an essential nutrient with vital biological functions. The present study investigated the effect of different doses of vitamin A palmitate at different time intervals on thyroid hormones and glycemic markers. METHODS: Male rats were administrated vitamin A palmitate at different doses (0, 0.7, 1.5, 3, 6, and 12 mg/kg, oral) and samples were collected at different time intervals of 2, 4, and 6 weeks. The levels of vitamin A, thyroid hormones (T3, T4, and TSH), deiodinases (Dio1 and Dio3), glycemic markers (blood insulin and fasting glucose levels, HOMA IR and HOMA ß), retinol-binding protein 4 (RBP4) and the gluconeogenic enzyme phosphoenolpyruvate carboxykinase (PEPCK) were measured. RESULTS: The findings demonstrated that long-term supplementation with high doses of vitamin A palmitate resulted in hypothyroidism (lower T3 and T4 levels and elevated TSH levels) as well as upregulation of Dio1 and Dio3 expression levels. This effect was associated with elevated glucose and insulin levels, enhanced HOMA IR, and decreased HOMA B index. In addition, prolonged vitamin A supplementation significantly increased RBP4 levels that upregulated the expression of PEPCK. CONCLUSION: High doses of vitamin A supplementation increased the risk of hypothyroidism, modulated insulin sensitivity, and over a long period, increased the incidence of type 2 diabetes mellitus associated with oxidative stress and hepatitis.

Potential therapeutic effects of Ulva lactuca water fraction on monosodium glutamate-induced testicular and prostatic tissue damage in rats.

Male infertility is considered one of the most critical health problems that are expected to expand worldwide. Ulva lactuca is a species of green seaweeds which is known to be a rich source of many important nutrients. Accordingly, this study is designated to investigate the therapeutic role of Ulva lactuca water fraction (UL) against monosodium glutamate (MSG)-induced male reproductive system disorders in male rats. Ulva lactuca methanolic crude extract was prepared firstly, and then water-dissolved compounds of this crude methanolic extract were separated. Ulva lactuca water fraction active phenolic compounds were determined using high-performance liquid chromatography (HPLC). Thirty-two male rats were divided equally into four groups; male infertility was induced in sixteen experimental animals by MSG at dose of 15 mg/Kg for 45 days. Eight infertile animals were treated with 100 mg/Kg of Ulva lactuca water fraction for 30 days. The rest of the animals were divided into two control groups; one control group (eight animals) was used to study the effect of UL on healthy rats at dose of 100 mg/Kg for 30 days and healthy control group (eight animals). Semen quality parameters (concentration and motility ratio), serum testosterone, prostate-specific antigen (PSA), and phosphatases were estimated by using standard protocols. Moreover, prooxidants and endogenous antioxidant enzymes were measured in prostate and testis homogenates. In addition, relative expression of pro-inflammatory genes (inducible nitric oxide synthase (i-NOS), cyclooxygenase-2 (COX-2), tumor necrosis factor-α alpha (TNF-α), and tumor protein (P53)) were assessed in testicular and prostatic tissues. Finally, histological alterations were measured by hematoxylin and eosin (H&E) stain. Results revealed that Ulva lactuca water fraction contains active phenolic constituents responsible for its antioxidant bioactivity. Oral administration of MSG significantly induced histological alterations. Oxidative stress was observed with elevated levels of nitric oxide (NO), thiobarbituric acid reactive substances (TBARS), and xanthine oxidase (XO) activity in both testis and prostate tissues. MSG adversely affected prostate function via elevation of PSA, prostatic acid phosphatases (PAPs), and total acid phosphatases (TAPs). In addition, it upregulated pro-inflammatory genes in testis and prostate tissues. Meanwhile, MSG reduced serum testosterone, semen quality, and antioxidant enzyme activities (glutathione peroxidase (GPx), glutathione-s-transferase (GST), and superoxide dismutase (SOD)). Treatment with UL notably ameliorated the state of oxidative stress and downregulated the expression of pro-inflammatory gene markers. This study highlighted the potential efficacy of Ulva lactuca water fraction on MSG-induced male infertility in rats. Therapeutic effect of UL on oxidative stress and inflammation induced by MSG in testicular and prostatic tissues.

Ipriflavone and Ipriflavone loaded albumin nanoparticles reverse lipopolysaccharide induced neuroinflammation in rats.

BACKGROUND: Neuroinflammation causes neurodegenerative conditions like Alzheimer's disease (AD). Ipriflavone (IP), therapeutic compound to postmenopausal osteoporosis, has limited estrogenic activity and is accounted as AChE inhibitor. The developing of drug delivery systems to enable drug targeting to specific sites increases the drug therapeutic effect. OBJECTIVE: The aim of the present study was to formulate and evaluate ipriflavone loaded albumin nanoparticles (IP-Np) along with free ipriflavone against lipopolysaccharide (LPS) induced neuroinflammation in rats. METHODS: Neuroinflammation was induced by intra-peritoneal (i.p) injection of LPS (250 µg/kg rat body weight) then treatments were conducted with (1) ipriflavone at two doses 50 mg/kg and 5 mg/kg, (2) IP-Np (5 mg ipriflavone/kg) or (3) IP-Np coated with polysorbate 80 (IP-Np-T80) (5 mg ipriflavone/kg). The alteration of the inflammatory response in male adult Wistar rats' brain hippocampus was investigated by examining associated indices using biochemical and molecular analyses. RESULTS: A significant upsurge in inflammatory mediators and decline in antioxidant status were observed in LPS-induced rats. In one hand, ipriflavone (50 mg/kg), IP-Np and IP-Np-T80 ameliorated LPS induced brain hippocampal inflammation where they depreciated the level of pro-inflammatory cytokines (TNF-α, IL-6, IL-1ß) and enhanced antioxidant status. In another hand, ipriflavone at dose (5 mg/kg) didn't show the same therapeutic effect. CONCLUSION: The current study provides evidence for the potential neuroprotective effect of ipriflavone (50 mg/kg) against LPS-induced neuroinflammation in rats through its anti-inflammatory and antioxidant activities. Moreover, nanoparticles significantly attenuated neuroinflammation in concentration lower than the effective therapeutic dose of free drug ten times.

Dega osteotomy for the management of developmental dysplasia of the hip in children aged 2-8 years: results of 58 consecutive osteotomies after 13-25 years of follow-up.

PURPOSE: Developmental dysplasia of the hip (DDH) is a term used to cover a broad spectrum of anomalies ranging from mild dysplasia to high-riding dislocations. We report the management of DDH in children using the Dega osteotomy and their long-term follow-up. METHODS: Fifty-eight hips from 48 children younger than 8 years treated using the Dega osteotomy between January 1988 and October 2000 were included in this multcenter study. Both prospective (41 hips) and retrospective (17 hips) cases were included, and follow-up was for a minimum of 13 years. Radiographs were made preoperatively, immediately postoperatively, after 6 weeks or at removal of the spica cast if any, at 6-month intervals and/or as indicated for 3 years postoperatively and then on annual basis until the last follow-up. A single-cut computed tomographic scan was performed for all prospective patients. Special attention was paid to the predictive measures of hip arthrosis and the survival of the hip after Dega osteotomy. RESULTS: The final clinical outcome was favorable in 44 hips (75.9 %). Eleven hips needed a second surgery (acetabuloplasty and/or arthroplasty) during the follow-up period. CONCLUSIONS: In our pediatric patient population the Dega osteotomy proved to be an adequate measure for the management of this complex condition. The worst complication was avascular necrosis, and all of the affected hips ended with failure (pain, another surgery, or both).

Efficacy of a compliant semicircular Ilizarov pin fixator module for treating infected nonunion of the femoral diaphysis.

Percutaneous transosseous Ilizarov wiring, whilst preferred in the tibia because of its unique properties, carries a high risk of complications in the femur. The aim of this work was to evaluate the efficacy of a more patient-friendly semicircular pin external fixator module built up from parts of the Ilizarov fixator components and its use in managing diaphyseal femoral nonunions. A group of 20 patients with infected diaphyseal nonunions of the femur after internal osteosynthesis were included in this study. The mean age of the patients at the time of surgery was 46 years (range 16-60, SD 15.6). The mean morbidity time since the original trauma was 10.2 months (range 6-15, SD 2.5). All the cases were fixed by the described external fixator module. Bony union with resolution of infection occurred in 18 (94.7 %) out of 19 cases after a mean period in the fixator of 11.2 months (range 8-18 SD 2.9). After a mean follow-up period of 3.5 years (range 2-9, SD 2.6), there were 14 excellent, 3 good, 1 fair and 1 poor results from radiological evaluation and 10 excellent, 7 good, 1 fair and 1 poor results from functional assessment. In conclusion, the described semi-circular pin fixator module is patient-friendly and effective in managing infected nonunions of the femoral diaphysis.

Pauwels' osteotomy for surgical correction of infantile coxa vara.

Infantile coxa vara can be corrected by valgus osteotomies, but recurrence is high. Achieving an Hilgenreiner epiphyseal angle (HEA) of 40° or less prevents recurrence. In this study, Pauwels' osteotomy is stabilized using a rigid method of fixation. The aim of the study is to confirm previous reports regarding the correction of the physeal inclination to 40° or less to prevent recurrence. Thirty-one hips with infantile coxa vara were subjected to an intertrochanteric Y-shaped valgus osteotomy. In 27 hips, the HEA was corrected to 40° or less and none had a recurrence. This study confirms previous recommendations regarding the correction of HEA to 40° or less to avoid recurrence.

Hind-foot correction and stabilization by pins in plaster after surgical release of talipes equino varus feet in older children.

Congenital talipes equino varus (CTEV) is a three dimensional deformity and is one of the most common congenital abnormalities affecting the lower limb and can be challenging to manage. Hind-foot deformity is considered the most difficult to treat. Unfortunately, the calcaneus is often small and thus difficult to control during casting after surgical release in severe or relapsed cases. We used three pins to control and maintain the hind foot correction, after surgical release, during casting in 47 cases (59 feet). We introduced a modified, coronal plane, transverse calcaneal pin. This pin is inserted from medial to lateral through the calcaneus to correct the varus mal-positioning of the calcaneus in the sagittal plane and to provide a better control on the small sized, hind-foot during casting. We paid special attention to the final hind-foot deformity after surgery, and the results were favorable after the application of this transverse pin.

Surgical management of complex humerus head fractures.

The locked plate systems provided adequate fixation of osteoporotic fractures of the proximal humerus in the elderly. But is the PHILOS plate adequate for stabilization of high-energy fractures, and fracture-dislocations of the proximal humerus in relatively younger age populations? In this retrospective study, performed at a referral, academic supervised, level III-trauma center, all high-energy trauma patients under the age of 55 years, with closed, 3 part, 4 part fractures, and/or fracture dislocations, were included in this study. Patients with open fractures, osteoporotic low-energy fractures, as well as patients older than 55 years were excluded. Fifty-nine patients entered and completed the study. They were all managed by open reduction and internal fixation using the PHILOS plate system. Patients' age ranged between 31-52 years, with a mean of 42 years. A minimal follow-up period of two years was a mandatory inclusion criterion in this study. All the patients who did not complete the follow-up period were excluded from the study. The results were evaluated using the Constant, Neer and DASH scoring systems, which revealed favorable results in 41 patients (69.5%). The results were comparable to the recent articles published in the literature in relatively older age groups. It was concluded that, despite the relatively high rate of complications encountered in the management of these complicated high-energy fractures, the PHILOS plating system could be considered an adequate management of polytrauma patients.

Limb sparing reconstructive surgery and Ilizarov lengthening in fibular hemimelia of Achterman-Kalamchi type II patients.

The aim of this study is to evaluate the long-term results of management of fibular hemimelia (Achterman-Kalamchi type-II) using the Ilizarov method. We reviewed 157 consecutive patients (180 limb segments) with a mean follow-up period of 10.7 years (1.2-21 years). The results were favorable. Although, this type of management is technically demanding and entails a lengthy procedure with many complications anticipated, the Ilizarov lengthening after limb reconstruction is still an option for management of this type of limb deficiency.

Single-stage open reduction, Salter innominate osteotomy, and proximal femoral osteotomy for the management of developmental dysplasia of the hip in children between the ages of 2 and 4 years.

The management of neglected developmental dysplasia of the hip in walking children has always been a challenge to orthopedic surgeons. The aim of this study was to access the early clinical and radiographic results of surgical treatment of such cases using one-stage open reduction, Salter innominate osteotomy, and proximal femoral osteotomy. Seventy-one surgeries were performed in 55 patients. Favorable clinical and radiographic outcomes were comparable to other studies. We concluded that this single-stage surgery is a technically demanding, but satisfactory procedure in the management of neglected developmental dysplasia of the hip patients, and when performed adequately in indicated patients in specialized centers, it is expected to give good short-term results.

Novel reaction products from thiobarbituric Acid of biological interest.

The reactions of 1, 2-dihydro-2-thioxo-4, 6(1H, 5H)pyrimidinedione (1) with some pi-deficients have led to the formation of unexpected heterocyclic products such as anilinomethylenethioxopyrimidinedione, 2, 2'-bis(pyrimidinecarbothioamide), allylthioxopyrimidinecarbothioamide, indenopyranopyrimidine and benzofuropyrimidine derivatives. A possible mechanism for the formation of these products is discussed, and the biological activity is determined.